CUPE Health Care

Ontario is among Canada's lowest provincial funders for hospital care. Based on the latest figures from the Canadian Institute for Health Information (CIHI), Ontario government funding for hospitals is $1,395.73 per capita. The rest of Canada, excluding Ontario, spends $1,749.69 per capita. In other words, provincial and territorial governments outside of Ontario spend $353.96 more per person on hospitals than Ontario does. That is a whopping 25.3 per cent more than Ontario. "BGH is not alone in racking up a deficit. Every hospital in Ontario is struggling because hospital funding is far too low," says Hurley. Research done by CUPE has found that average Ontario hospital funding for the population the size of Brockville in 2005/6 would have been about $1.04 million less than average funding for the same population outside of Ontario. But by 2015/16 the funding shortfall for a population the size of the City of Brockville would have exploded to $7.74 million.

"$7.74 million a year for the Brockville hospital would have them operating solidly in the black. This hospital is struggling valiantly to provide services through eight consecutive years of provincial funding cutbacks. The solution here isn't a supervisor and more cuts to care, staff and programs but to increase this hospital's funding," says Hurley.The views expressed in any and all content distributed by Newstex and its re-distributors (collectively, the "Newstex Authoritative Content") are solely those of the respective author(s) and not necessarily the views of Newstex or its re-distributors. Stories from such authors are provided "AS IS," with no warranties, and confer no rights. The material and information provided in Newstex Authoritative Content are for general information only and should not, in any respect, be relied on as professional

es," said Dr. Liz Tayler, senior technical adviser on antimicrobial resistance with WHO. There are many reasons why antibiotic resistance has struggled to gain traction as global priority, however. For one, it's a complex issue that can prove difficult to explain - a headache-inducing combination of molecular chemistry, evolutionary concepts, and bacteria with unpronounceable names. WHO has compared the problem to a "silent tsunami." Unlike

a high-profile killer like cancer, deaths caused by antibiotic resistance tend to be less obvious or visible. "It never goes on anyone's death certificate ... when someone has died of a nasty infection, the fact that it's resistant either wasn't known or hasn't been talked about," Tayler said. "And while it's a really big problem in developing countries, the labs there aren't very good and they don't have the resources to do the testing to find out (why someone died)." Antibiotic resistance is also considered a "tragedy of the commons," where the effectiveness of antibiotics has been depleted by people who prioritize their own interests over the public good. And everyone is culpable: patients who demand antibiotics unnecessarily and doctors who cave to their demands; farmers who feed their livestock antibiotics and consumers who demand cheap

meat; low-income countries that allow antibiotics to be widely sold without prescription, and wealthy nations that need to do more to help those countries improve the sanitary conditions that lead to high infection rates. All of this human activity is pouring unprecedented volumes of antibiotics into the environment - and placing evolutionary pressure on microbes to evolve new strategies for defeating them. "I think of this problem as a planetary change at a microscopic level - one that we don't even notice. We're changing microbial ecology in a very significant way," Laxminarayan said. "We need to protect antibiotics with the same seriousness as we protected the ozone layer through the Montreal protocol." Wednesday's UN meeting will likely see countries agreeing to a declaration on combating antimicrobial resistance. This step - while largely symbolic - will draw global attention to the issue, sketch out solutions, and place pressure on countries to address the problem within their own boundaries.

"It requires all of these folks to be paying attention that they are now on notice," Laxminarayan said. But the declaration won't be binding, nor will it contain specific targets. For Dr. Brad Spellberg, an antibiotic resistance expert with the University of Southern California, the UN meeting is just one step and "there's still a lot of heavy lifting that has to be done." Tackling antibiotic resistance will require work on multiple fronts, he said - everything from improving prevention efforts to reducing antibiotic use in livestock and fish farms. The world also needs to recognize that antibiotic resistance is a threat we will have to face for not just years, but centuries or millennia, he added.

Reportedly, Dr. Philpott wrote to her counterpart earlier this month, intimating Ottawa would start withholding transfer payments if extra-billing is not addressed. Now Dr. Barrette is making the typical spluttering noises about Ottawa invading provincial jurisdiction and claiming credit. In recent years, the provinces have tended to treat the federal Health Department as a cash machine; the extra-billing skirmish may end up being part of a broader negotiation over a likely reduction in federal transfers.

Let's hope Quebec's decision, and Dr. Philpott's role in it, signal a new era of robust federal defence of publicly funded medicare. With the British Columbia Supreme Court hearing arguments this week in a case that challenges some key pillars of the Canada Health Act, such robustness is needed.

Kat Lanteigne, executive director for BloodWatch.org and writer of the play Tainted based on three-years of research about the tainted blood scandal, travelled to Alberta to help spread the message about concerns about private, donor-paid plasma collection. Lanteigne said these types of clinics had started to show up in Ontario in the last few years. "This is a big-pharma push," she said. "If they can build a clinic and get a licence from Health Canada then they can open without the province's permission." She said that the private sale and collection of blood and plasma introduces risk into the system. She also dispelled another myth that plasma is being imported into the country. She said that is not the case, as about 70 per cent of the drugs produced from plasma is what is being imported. When successful in the fight to get Ontario to legislate against private, donor-paid plasma collection at the end of 2014, and because Quebec has a similar law, Lanteigne said they made the mistake of thinking that because the largest provinces in Canada had done this, the rest of the provinces would follow suit.

Instead, as part of one of her first decisions, the new federal Liberal Health Minister approved CPR opening a clinic in Saskatchewan. Lanteigne says the Saskatchewan government, led by Premier Brad Wall, then approved the private, donor-paid plasma collection business to open in Saskatoon, "in between a pawn shop and a pay-day loan company." "This collection facility is a blood broker. They are literally a middle man Ñ a source to get profits. "We're asking the provinces and territories to pass voluntary blood donation acts which adds blood and plasma to their existing human tissue acts ..." Lanteigne explained. There is a lot of information on the BloodWatch.org website about the issue, including an informative timeline. The organization also has a Heart Watch rating system. Alberta currently has three hearts and Lanteigne would like to see that increase to five. "Saskatchewan has broken our hearts," she adds.

Kim Storebo, CUPE Local 46 president who works with Canadian Blood Services (CBS), also spoke at the event. She said CUPE supports a public, voluntary-based blood system in Canada, adding CBS needs to increase the number of its own plasma collection sites. The organization has been slowly closing locations since 2012. "There is no evidence the collection of plasma from paid donors will create self-sufficiency," she said. "Under no circumstances should there be payment of blood plasma donors with cash or cash-in-kind equivalents." The union wants to see blood and plasma collection remain the sole responsibility of Canadian Blood Services and for the organization to expand its plasma collection and its work hours and ensure stable and consistent hours for its employees. As part of the wrap-up of the Alberta tour officials with FOM, BloodWatch.org and CUPE presented an online SumOfUs petition with more than 15,000 signatures to provincial health minister Sarah Hoffman asking for all provincial governments to "implement legislation that ensures no for-profit, donor-paid blood plasma collection clinics are allowed to operate in Canada." Azocar assured those at the meetings that Friends of Medicare would continue to lobby the Alberta government this fall and next spring during the Legislature sittings.

Dewar couldn't estimate how much money will be saved by the layoffs because staff numbers change constantly. Three full-time and two part-time management positions will not be filled and savings will be re-directed to front-line services in long-term care. For some time, the Saskatchewan Union of Nurses (SUN) has raised concerns that registered nurses (RNs) are being replaced by licensed practical nurses (LPNs). When asked if this could happen, Dewar replied: "For RNs or LPNs, what's really important is how you organize that care team to deliver quality care and there is a substantive overlap between the two professional groups."

He emphasized it's important to assess what care is required by patients and who can best deliver that care. CUPE Local 3967 president Scott McDonald said Friday's announcement was news to him. The local represents most RQHR workers who aren't RNs, including those in housekeeping and maintenance, dietary professionals, technicians and LPNs. CUPE has had brief conversations with the health region, but McDonald didn't think the layoffs were a firm thing until he heard Friday's announcement.

He said CUPE's 5,500 members are already overloaded. "These layoffs are going to affect patient care. I don't see any way of getting around that," said McDonald. SUN president Tracy Zambory agreed. There are already "huge challenges" when it comes to staffing, said Zambory. She pointed to the 28 per cent increase in critical incidents as reported in the Health Ministry's annual report released in July. That includes errors in medication and diagnosis. "Regional health authorities have been told they have to come up with efficiencies; that translates down always to the front-line staff," Zambory said. Realigning staff won't impact services, bed numbers or programs, Dewar said. On Thursday, the Saskatoon Health Region issued 70 layoff notices.

Numerous factors could explain the difference in the number of layoffnotices the province's two largest health regions are handing out - including the SHR's larger deficit, Dewar said.