Volume 4, No. 2February 2012

A recap /critical look at health care news and the reality behind the reporting from the viewpoint of front-line Ontario registered nurses

Behind the Front Lines

continued on page 3

1. Drummond Report:Coverage Unrelenting – goNumbers Don’t Add Up – goONA’s Analysis Shows Pitfalls Possible – goMore Private-Sector Health Care? – go

2. Record Hospital CEO Pay-Out Attracts New Outrage – go

ThingsYou’ll Learn in This

Issue: There was much coverage given to CIHI’s new report on nursing trends in Canada – some of it misleading.

The Globe and Mail (source) headline focused on the fact that Nurse Practitioner numbers have doubled in the past five years – a good-news story in Ontario where so many people have no access to primary care.

But the report gives a clear picture of the nursing shortage and Ontario’s funding of health care.

Kudos toKevin Donovan

Reporters today experience working conditions that are in some ways similar to those of RNs: too much to do, too little time to do it thoroughly. Both health care workers and media have seen massive cuts to staff and have coped with increased workloads as a result.

That is why it has been refreshing to see the in-depth investigative reporting done by the Toronto Star’s Kevin Donovan on the ORNGE air ambulance fiasco.

ONA members are among the health care workers who have encountered difficulties returning from trips in which they’ve had to accompany patients who were transferred by ORNGE. News of just how troubled the taxpayer-funded air ambulance service

• Registered Nurses: 2009 - 94,296 2010 - 95,185

While there has been an increase of RNs (889) from 2009 to 2010, because of higher population growth in Ontario, the number of RNs per 100,000 population declined slightly from 722 to 721 in 2010 (-0.1% decrease).

Note that the ratio of RNs to 100,000 population in Ontario remains the second lowest in Canada, with B.C. the only province lower at 682. The Canadian average is 787.

The report also has data (direct care counts and per 100,000 population ratio) for each of the Ontario public health unit geographic areas. Interestingly, the areas with the highest ratios of RNs (direct care) include: Hamilton (1006), Kingston and area (1,112), Middlesex-London (1,165), Thunder Bay district (1,061). Toronto’s ratio is 802.

• Registered Practical Nurses: 2009 - 28,804 2010 - 30,423

An increase of 1,619 and an increase in ratio per 100,000 from 220 to 230 in 2010 (4.5% increase).

• Nurse Practitioners: 2009 - 1,124 2010 - 1,482

An increase of 358 (31.9% increase). Not all provinces submit data on NPs and the numbers are relatively small in other provinces; caution is warranted when interpreting the overall average percentage increase for Canada.

The number of registered nurses (RNs) employed in Ontario has slightly increased, but due to the province’s increase in population,the per-capita rate has actually declined.

Nursing Number Headlines Misleading

NPs provide primary health care.

(Numbers employed as nurses in Ontario)

Behind the Front Lines page 2

What is ONA?The Ontario Nurses’ Association (ONA) is the union representing 58,000 registered nurses and allied health professionals and more than 13,000 nursing student affiliates providing care in Ontario hospitals, long-term care facilities, public health, the community, clinics and industry.

Visit us at:www.ona.orgwww.youtube.com/OntarioNurseswww.Facebook.com/OntarioNurseswww.Twitter.com/OntarioNurses

Who is Linda Haslam-Stroud, RN?

ONA President Linda Haslam-Stroud, RN (pictured), is a veteran renal transplant nurse who is an expert spokesperson on a range of issues. Linda is available to com-ment on everything from workplace violence, patient care, health care policy in Ontario, the flu pandemic, nursing cuts, public health and much more. Simply contact ONA’s media relations officer, Sheree Bond, at (416) 964-8833, ext. 2430 if you would like to interview Linda on a health-related issue.

How to reach us:Ontario Nurses’ Association85 Grenville Street, Suite 400Toronto, ON M5S 3A2(416) 964-8833www.ona.org

continued on page 3

Drummond Commission Report:Media Coverage Unrelenting

The report of the Drummond Commission is not due to be released until mid-February. But from the constant stream of leaks, interviews with Don Drummond and opinion columns, there may be little left to report on.

One of the more fascinating evolutions in coverage has been how the Drummond report will impact health care. As the Toronto Star reported, the Liberal’s cabinet ministers have been prepared for a “grim new era of cutbacks” (source). The report says that the Premier believes government can “spend the dollars more efficiently,” and Finance Minister Dwight Duncan warned that some ministries may see a 30-per-cent budget reduction over the next few years – but that the budgets of health and education will likely be spared.

Just a week later, Health Minister Deb Matthews was speculating about procedures that would be delisted by OHIP (source) – though she backtracked on the possibility of delisting caesarean sections.

Numbers Don’t Add UpOne very refreshing opinion column, also from the Toronto Star, took a hard look at the math behind Ontario’s health budget – and found that it doesn’t add up.

Carol Goar (source) writes that every recent finance minister has warned “in ominous tones” that health spending is growing so fast that it will soon overwhelm the provincial budget.

Goar looked at the health expenditures for the past decade and found that health accounts for 42 per cent of spending today – a decade ago, that amount was 46 per cent.

She notes that Don Drummond – a former civil servant and TD Bank economist – in a speech to the C.D. Howe Institute last November, joined the list of finance ministers making dire predictions.

Drummond warned that health care spending would gobble up to 80 per cent of the provincial budget by 2030 if left unchecked.

Goar writes that Ontarians need to know if things are as bad as we’re being told they are, and need to see the evidence to back up the statements being made by Drummond and others.

Percentages, she writes, are easy to manipulate. If a government caps all other expenditures but allows health care and education to grow, their share of the budget will grow. She concludes that the trends in health care spending warrant prudence, but not panic.

ONA’s Analysis Shows Pitfalls PossibleGoar’s column echoes much of what the Ontario Nurses’ Association’s research has shown.

Behind the Front Lines page 3

continued on page 4

Kudos to Kevin Donovan,cont’d from page 1

ONA’s Analysis, cont’d from page 2

is has been primarily due to the series of exposés written by Donovan.

One fascinating tidbit in one of the ORNGE reports was the experi-ence of the union representing EMS workers who reported prob-lems at ORNGE (source).

Paramedics complained to ORNGE and the Health Ministry “numerous times” last year that air ambulance services were being “downstaffed” – putting paramedics with less training on aircraft, providing just one paramedic on board flights (ministry rules say that two paramedics with a high level of training are needed on an air ambulance to transport critical patients) and not calling in a replacement paramedic when someone called in sick.

Documents reveal that despite repeated complaints, nothing was done – was this because it was unionized paramedics alerting the company and the ministry of the problem?

ORNGE failed to address the problems because it was experi-encing financial pressures in the wake of purchasing a fleet of AW 139 helicopters – each installed with a $600,000 medical interior – that paramedics repeatedly told officials were unsafe.

The company’s executives were also travelling worldwide to pro-mote a new for-profit service – the ORNGE Global Memberships Program for the wealthy – that would have provided a travel medi-cal program. The service never took off, but nonetheless, directed funds and attention away from the service in Ontario.

ONA policy analyst Salimah Valiani’s analysis (source) makes calculations based on government data, demonstrating that Ontario’s finances are not as tight as is currently being touted. Compared to several countries, Ontario has relatively small deficit-to-GDP and debt-to-GDP ratios – true markers of economic health.

“Our findings are quite striking and call into question exactly what actions should be taken to eliminate the province’s deficit,” says ONA President Linda Haslam-Stroud, RN. “The research paper also examines how the drastic measures taken in Greece have further worsened that country’s economy while devastating public services.”

The paper, entitled Fixing the Fiscal House: Alternative macroeconomic solutions for Ontario, shows that Ontario is suffering from a structural deficit largely due to low taxation of corporations and high-income individuals. Government data on production and profit rates in Ontario since the late-1990s show that the link between low corporate tax rates and increased job creation is simplistic and effectively inaccurate.

During a period of reduced taxation, our economy has experienced falling or stagnant production levels, falling employment and healthy profits for corporations. Tax cuts have created more wealth for the wealthy and intensified work for the majority of Ontarians – and registered nurses are a prime example of work intensification and its effects. Further reducing public-sector spending will simply add public-sector workers to the growing numbers of unemployed private-sector workers. This in turn will reduce domestic consumption and delay economic recovery.

ONA will provide the paper and its economic analysis to the provincial government and is also presenting its findings at the Commission on Quality Public Services and Tax Fairness town hall meetings across the province. The paper is available on ONA’s website.

Will Drummond Recommend More Private-Sector Health Care?The Ontario Health Coalition, reporters, health care advocates and ordinary Ontarians have all expressed their opinions on whether the Drummond Commission report will recommend bringing more private, for-profit health care providers into the mix.

Another Toronto Star columnist, Thomas Walkom, noted that health care unions and critics suspect that Drummond will propose measures that force Ontario’s non-profit hospitals to operate more like profit-maximizing corporations (source).

ONA President Linda Haslam-Stroud questions the actions

needed to balance theprovincial budget.

Behind the Front Lines page 4

UNDER THE RADARNews the Media is Missing

A Few Ontario Health Care Statistics

Economist Don Drummond, the provincial government and opposition parties have continued to speak about their position that Ontario has “hit a wall” and the spending levels for health care are unsustainable.

In advance of the release of the Drummond Commission report, a few statistics about health care spending are interesting to ponder:

Total spending per capita:

Ontario spends an average of $9,853 per person on all government programs and services (source: CIHI 2011). This is $1,358 per person less than the rest of Canada’s provinces.

Total spending as a percentage of provincial GDP:

Ontario is eighth out of the 10 provinces – PEI: 33.55%; Quebec: 30%; Newfoundland: 27.86%; New Brunswick: 24.08%; Nova Scotia: 24.08%; Saskatchewan: 21.29%; Ontario: 21.26%; British Columbia: 19.70%; Alberta: 15.41% (source: CIHI 2011).

Public health care spending by province per capita:

Ontario spends an average of $440 per capita less than the rest of Canada and the third-lowest amount on public health care per capita. CIHI (2011) statistics list the following: Newfoundland $4,982.9; Alberta: $4,762.9; Manitoba: $4,611.5; Saskatchewan: $4,602.1; PEI: $4,389.6; New Brunswick: $4,210.5; Nova Scotia: $4,192.9; Ontario: $3,911.7; BC: $3,801.8; Quebec: $3,603.3.

Other key spending trends:

• Hospital spending in Ontario has been shrinking as a percentage of health care spending – from 57 per cent of provincial spending in 1981 to 37 per cent today.

• Home care funding has been shrinking as a percentage of health care spending – from 5.47 per cent in 1999 to 4.13 per cent in 2009.

• On a per-client basis, home care spending has been reduced from $3,486 per client in 2002/03 to $3,003 per client in 2008/09.

• Corporate tax cuts have reduced the provincial budget by $18 billion per year as of 2007-08.continued on page 5

More Private-SectorHealth Care?cont’d from page 3

Saying that the unions have a monetary interest in this, Walkom instead interviewed physician and public health professor Steffie Woolhandler. Woolhandler, a former Harvard professor who now teaches at the City University of New York, has done extensive research into the U.S. Medicare system. Medicare is publicly funded, but hundreds of for-profit corporations play a far bigger role in delivering services than they do in Canada.

Woolhandler’s insight into the role of for-profit providers in U.S. health care revealed some interesting facts:

• For-profit hospitals do not provide higher-quality care – in fact, patients do “marginally worse” in private hospitals.

• In for-profit dialysis clinics, one investigation found that patients were 21-per-cent MORE likely to die.

• Market reforms in U.S. Medicare have not saved money – in fact, they’ve cost taxpayers more.

• For-profit institutions have an overwhelming incentive to ‘game the system,’ in order to squeeze out as much as possible.

• Some for-profit providers order unnecessary tests or services operated by their own subsidi-aries. Others “upcode” patients – present them as being sicker than they are in order to reap higher payments.

Behind the Front Lines page 5

London Health Sciences Centre was the focus of community outrage when it announced it was cutting breast cancer screening RNs in 2010. Here, a breast

cancer patient speaks out against the cuts at an open forum.

More Private-SectorHealth Care?cont’d from page 4

Hospital CEO Salaries:Record Pay-Out Attracts New Outrage

Readers’ Commentis Music

to Nurses’ EarsA letter to the editor from a Brantford Expositor reader (source) no doubt expressed the thoughts of many nurses regarding the unending vilification of public-sector workers.

Anita Burns writes that while she understands that Ontarians are having a hard time economically, Ontarians are turning on public-sector employees who are also struggling to survive.

Burns fears we are “experiencing a lynch mob mentality” and those who are more privileged are not who we are pursuing. The true hefty pay increases, perks and waste exists at the upper-tier level of workers.

Burns encourages people to really ask themselves if they’ll be better off if public-sector workers arelaid off.

News that former London Health Sciences Centre CEO Cliff Nordal received a $1.17-million retention bonus has sparked more than average outrage and media attention in London.

Details of the CEO’s contract were posted on the hospital’s website and show that in addition to a yearly salary of $732,615 and taxable benefits of $100,934, Nordal received a membership for himself at London’s Hunt and Country Club, a family membership to a health/fitness club, two home office systems (one for London, one for Toronto) a leased Lexus ES/330 or comparable vehicle and all vehicle expenses and a financial planner for his personal finances and tax returns. Nordal received a $1.17-million bonus when he stayed on the job for four years, though he announced – three weeks after qualifying for the bonus – that he would be leaving his position.

While the hospital board defended the payouts – Nordal’s and another $2.9 million in severance packages it paid to other executives – Health Minister Deb Matthews asked how much health care could have been paid for with those funds.

Nurses and other public-sector workers also read – the same day – that Premier Dalton McGuinty expects them to “hold their salary demands in check” while the province eliminates a $16-billion debt (source).

Speaking at the Canadian Club, McGuinty said he has built up good will with unions and will continue to show them respect at the bargaining table. He added that “most taxpayer dollars should go into paying the people who deliver the services, like our nurses, our doctors…”

The vast majority of registered nurses (working in hospitals, long-term care, public health and Community Care Access Centres) are already under a two-year wage freeze, something the Premier has yet to mention publicly.

• For-profit hospitals engage in “cherry picking” – they prefer to avoid the most seriously ill patients as they cost more to treat.

• Even hospices for the terminally ill try to fill their beds with dying heart patients to avoid end-of-life cancer patients – they cost more to treat.

Walkom says the lesson for the Premier is that reducing health care costs shouldn’t rely on free-market reforms.

Behind the Front Lines page 6

www.ona.orgSheree Bond, Media Relations Officer,

(416) 964-8833, ext. 2430 or cell (416) 986-8240shereeb@ona.org

The Ontario Nurses’ Association has a whole host of experts in health care.ONA members work in hospitals, long-term care, public health, the community and industry

and can answer your questions as health continues to evolve in this province.

Looking for the real story? Contact ONA.

Speak to front-line nurses!

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