World Health News
Ontario Health Coalition – defying the neoliberal offensiveJune 2015
It's a tough fight defending health services in Ontario, Canada's most populous province, in which the universal health care system Medicare is now in its ninth year of below inflation funding increases under successive provincial governments, and its fourth year of frozen funding.
The financial squeeze is exacerbated by Canada's federal government, headed by neoliberal Stephen Harper, which last year refused to renew the accord between the provinces that underpins Medicare, and announced further regressive cuts in federal funding that will make it impossible for many of the provinces to maintain their level of health care provision. If Harper wins re-election later this year, it will increase the chances that Canada's 30-year progressive break from the costly, wasteful and privately-led US insurance-based health care system could be brought to an end, at least in a number of provinces.
Medicare was first established with the federal government contributing 50% provincial budgets: that has been steadily eroded over the years, but Harper's decisive and deliberate further cut will reduce the federal contribution from 20.4 per cent in 2010-11 to less than 12% over the next 25 years.
Back in December 2011, Harper also insisted that that there would be no negotiations to renew the expiring health accord with the provinces, due last year: he stuck to this commitment.
His neoliberal objective: to strip away the funding that secured Medicare and open up each province to pressures from the private sector as failing publicly-funded services run into disrepute.
An aggressive private sector has indeed also begun relentlessly exploiting the key weakness of Medicare. Reflecting the health care thinking of its time, the Canada Health Act which established Medicare in 1984 only covers hospital care, leaving scope in recent years in some provinces for a vast potential hinterland of private clinics delivering diagnostics and outpatient services, and - like many countries - leaving a huge gap where there should be continuity of care when patients are discharged from hospital.
Despite incessant rhetoric, similar to that in most countries, about the need to deliver more services out of hospital and support patients where possible to live at home, funding for home care in Ontario is below 2002 levels, and a recent Expert Review highlighted the inequalities and gaps, noting the "struggle to manage rapidly growing volumes within the allocated funds".
Ontario is at or near the bottom of the league in Canada for its spending on public services in general, and health in particular - coming equal bottom with Quebec on public hospital spending per person, eighth out of ten provinces for funding of hospitals, and with health receiving a steadily declining share of the provincial budget since 2008.
The limited resources have been reflected in extremely limited provision - notably of hospital beds, with Ontario coming well below the Canadian average and bottom of all ten provinces with just 2.5 beds per 1,000 people: even moving to the Canadian average would require an extra 14,300 beds. Indeed if Ontario is compared with developed countries, its bed provision comes out near the bottom of the OECD rankings, with only Turkey, Chile and Mexico having fewer beds per head.
Inadequate bed numbers lead to extremely high levels of bed occupancy and frequent delays in treatment when beds are not available when required. Ontario's larger hospital beds are almost all averagely running near or above 100% capacity, leaving little scope for winter pressures or increases in demand.
The provincial target time for 90% of patients to be treated and admitted or discharged from Emergency Rooms within 8 hours (a target time double the equivalent target in England) is widely flouted, again by the larger hospitals, with delays impacting most on the most serious cases. Breaches of the target are so common as to attract little if any media comment.
But the delays in treatment of the more serious cases are significant. In the south west of Ontario the time to get 90% of more complex cases through the ER ranges from 14 to 19 hours in the main teaching hospitals in London; around Ottawa in the east, the range again is from 13 to 19 hours in the larger hospitals. West of Toronto, ER waits are also consistently much higher than the target, with 14 hours in St Catharine's, near Niagara Falls, 15 hours in Brantford, 16 hours in West Lincoln, 20 hours in the Juravinski Hospital and a massive 24.5 hours at Joseph Brant Hospital in Hamilton.
The delays in St Catharine's are especially galling for local campaigners, since one reason for the poor performance is that the hospital is recently constructed, financed through a highly controversial 'Public Private Partnership' (P3) deal similar to the Private Finance Initiative in Britain. This has created a problem grimly familiar to us in England: the inflated costs for building, leasing and maintaining the hospital have left insufficient cash in the pot to staff all of the shiny new wards, resulting in just 300 of the 400 beds being operational.
Far from addressing these problems, Kevin Smith, the "supervisor" sent in by Ontario's health minister to take charge of the surrounding Niagara Health System, as a part time addition to his $750,000 a year role as chief executive at St Joseph's in Hamilton, has focused instead on closing five local community hospitals, several of them providing vital care for older patients with complex needs.
The complex needs beds in the Niagara area are already running at 93% capacity: Kevin Smith thinks that's not good enough: so the closures he wants would push this up to 97% -- guaranteeing repeated crises for lack of beds and an increased flow of patients to an under-resourced St Catharine's.
Despite the local outcry, Smith's plan for Niagara, backed by successive health ministers, is being driven through with no public consultation, and no serious scrutiny of his deeply flawed strategy document, which ignores population changes, demographic pressures, population changes and serious problems of access to health care if local services are closed, especially for frail older patients, across long distances - with no public transport network.
Like so many English cash-driven plans for "reconfiguration" the Smith plan made no detailed proposals for alternative services to be provided - although there is the suggestion of a new major hospital (for which no funds have been identified) which he claims might be built in "six years" - long after the five existing hospitals have been closed down and sold off.
Cash-driven threats to smaller local hospitals are a constant theme across much of the vast area of Ontario - with the added threat that once hospital services have been withdrawn any other services are likely to be outside the coverage of services free at point of use given by Medicare and the Ontario Health Insurance Plan.
So the fight is threefold:
" against cuts in services, and for adequate funding to expand services to meet growing levels of need
" against the piecemeal privatisation of services previously provided in hospital
" and for the extension of Medicare to cover all health-related services including care in step-down beds after discharge from acute hospitals, nursing homes and home care.
Courageously battling on, and winning some important victories has been the Ontario Health Coalition, based in Toronto. Its two organisers, backed up by an office team including volunteers, energetically tour up and down the vast province, organising the fight by local health coalitions in the towns and cities from the north (there was a recent day of action in Thunder Bay, and in the small town of Kenora they recently attracted 150 people to a vigorous meeting) to the south, east and west.
The OHC is funded through individual membership, the continued affiliation of a variety of trade unions, including some health unions - and by fundraising including a roaring trade each summer in the sale of organic garlic.
Having helped the OHC develop a detailed critique of the plans to cut services in the Niagara Health System, I spent two weeks in May touring with OHC organisers, speaking at meetings and briefing reporters, and joining noisy protest rallies outside the offices of provincial parliament MPs in Hamilton and St Catharines who have failed to speak up or fight for proper funding of their local hospital services.
By the end of the two weeks of traversing up and down a small part of the vast province I was pretty exhausted: but even as I left the OHC campaigning was continuing at full throttle, and going beyond defending hospitals to organise another round of their "Rocking Chair Tour", with a giant stage-prop rocking chair as the centrepiece for local rallies highlighting the fight for proper, funded care for older people.
The geography is clearly very different from England, and so is the political context, in which trade unions of different viewpoints have continued over the years to support the OHC's work, while only Unite of the British unions has shown any consistent support for similar campaigning work to defend our NHS by the nearest equivalent organisation, Keep Our NHS Public.
But both in Ontario and in England one thing above all is clear: to campaign cannot guarantee a victory … but to mount no campaign guarantees the loss of services through cuts and privatisation as ruthless neoliberals like Harper and Cameron's Tories press their offensive.
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