A new approach to managing health care in Ontario
Good evening and let me take this opportunity to thank the OHC and the panel for allowing me to speak on some very important issues related to not only small, rural and northern hospitals but all hospitals in Ontario.
As a back grounder, I am the Hospital Sector Lead for SEIU Local 1 Canada. We represent 1,800 service and clerical workers with in the Niagara Health Service (NHS) in addition to approximately 3,200 members in Niagara Region in LTC/Retirement Homes, Home Care and Community Services. Nationally SEIU has over 100,000 members in Canada and 2.2 million members in North America.
SEIU has been the Union of Choice for hospital workers in Niagara for over 60 years.
When it comes to health care, SEIU knows what we are talking about!
My experience in health care spans over 28 years. 16 years as a front line health care worker at the GNGH in Niagara Falls, Ontario. Working in various positions such as Certified Orderly, Dietary Stores and Environmental Services and 12 years as a Union Rep for SEIU Local 1 Canada.
My presentation today is not about tooting SEIU’s horn or my own, it’s about addressing the concern’s that is facing Niagara in health care restructuring as it relates to hospitals. Let me reassure this panel and your audience that Niagara is not alone! The crisis that is facing Ontario hospitals is at a critical stage! With the release of the provincial throne speech and the Ontario budget, it’s only going to get worse!
We have identified all kinds of problems with our public health care system in Ontario, over the years such as, under funding, duplication of services, and the list goes on. In identifying these problems, a very useful tool was used and it’s called, “consultation”. Consultation with service providers, the community, labour, and many, many other groups. Through that consultation process, solutions were also identified by those same groups. Good solutions & some were tough solutions that had both positive and negative impacts on the services and programs. But those decisions were made by local communities not by bureaucrats that have no vested interest in our communities as is now the case with the introduction of the LHIN’s.
Our first recommendation to the panel is:
1. Reinstatement by the provincial government of a consultation process before any changes to health care Services/hospital’s funding/restructuring is implemented.
Next let’s turn our minds back to the early 1990’s when there were no LHIN’s. Instead there were District Health Councils (DHC) that over saw the service and programs with in each Regional Municipality of Ontario. Those District Health Councils were required by the Ministry Health/LTC to set up Hospital Operating Plan Review Committee’s (HOPRC) which was a subcommittee of the DHC. The HOPRC were made up of citizens from the community, business, health experts, Labour representatives etc. The HOPRC would meet annually with each hospital in the regional municipality to review the operating plans of the hospitals which were required to be submitted to MOH/LTC annually. Through that operating plan review process, the HOPRC would review the detailed break down of the operating costs/plans and identify cost savings. We would also start the consultation process amongst service provided if the reduction of a service had a potential impact on other services or service providers in the community. In other words, if there where bed closures or reduction of beds at any given hospital, the HOPRC would arrange for consultation of the service provider and home care agencies as the bed closures could have an impact on the level of service for the home care service provider. However, the most important mandate of the HOPRC was to make recommendations to the MOH/LTC based on the operating plan review and consultation process.
And make recommendations we did. They weren’t easy ones, however they were made through consultation with stakeholders in our community and that included labour. Which is far different from today’s process as the Ontario government takes the position that the current changes to funding of hospitals is a change in policy and requires no consultation process. This couldn’t be further from the truth! Consultation with community stake holders is a progressive and a proactive approach to find local solutions to local problems and even provincial ones in some circumstances, unlike today’s approach of the LHIN’s who consults with very few if any one other then the service providers. The public has limited access to financial information of there local hospitals as compared to when the DHC and HORPC were in place in the 1990’s.
Our 2nd recommendation to the panel is;
2. Dismantle the LHIN’s and reinstate the District Health Councils in all municipalities of Ontario so that local consultation/decisions can be made by local communities.
Lastly let’s look at the true drivers of increased cost in the hospital sector. Those being, 1, Pharmaceuticals have increased by staggering amounts in recent years, however, very little attention has been given this issue. One must ask the question of why. Why would we not have public debate and disclosure on a profit making entity that is taking money at staggering increases to our health system?
Other drivers in increased costs in hospitals could be that patients are being admitted to hospitals sicker and leaving quicker. This data is supported by a decrease in inpatient day stays provided by the Hospitals to the MOH/LTC based on actual patient admissions and discharge information. The problem is that the MOH/LTC requires no data to be kept on re-admissions of patients as a result of poor patient outcomes due to a lack of services in the community. District Health Councils have been requesting this requirement for years prior to the dismantling. Let me clarify. Patient A is discharged home with an incision after major surgery with instructions for home care on wound care. And dressing changes. However the service can not be provided with in a proper or certain time frame due to whatever reasons, maybe a back log of clients to be serviced at home and therefore a delay in the CCAC assessment by a case manager to a service provider. That process alone could take up to a 3-5 days and some times even longer. All the time the patient is with out wound care. So now we have a patient who has developed an infection as a result. If that patient is readmitted to hospital it shows as a new admission as the patient is not readmitted within 24 hours of there discharge. Therefore this is not a new case for treatment as would be indicated under the current measuring tools of decreases in over night stay, (in patient day stays.) thus driving the cost of treating that patient increases due to the fact that they were not cared for properly in the first place. If we are going to continue to move services and programs from hospitals to communities, we must have those service in place in the community so that we don’t have re-admissions to hospitals driving up the costs even further. Therefore we must monitor this to ensure that we are making necessary changes with in our hospitals that truly are cost effective and sustainable long term goals of cost effectiveness and not short term fix of balancing a hospital budget when in reality we are actual causing the costs of health care to increase due to poor patient outcomes which are a direct result of gaps in services.
Therefore our 3rd recommendation to the panel is;
3. The development of a tool that captures readmissions of patients to hospitals as a direct result of lack of services and improper services in the community.
Thank you for you time and dedication to looking at these important, complex issues which will result in recommendation based on data and consultation with stake holders in the respective communities which is absolutely necessary in a democratic society.
More importantly, thank you to the thousands of workers in our hospitals, nursing homes, home care agencies from RPN’s, clerical workers, health records techs, ward clerks, maintenance staff, dietary and environmental services, home care workers, paramedical staff, central supply and stores staff, thank you for being a part of the health care team. Thank you for your hard work and dedication which results in good quality health care that you deliver each and every day, 24/7, 365 days a year. Thank you.