On Friday, January 20, OPSEU's Health Care Divisional Council (HCDC) presented its pre-budget submission to the Standing Committee on Finance and Economic Affairs.
Out of Patience: it's time to save public health care
A pre-budget submission of the Health Care Divisional Council, Ontario Public Service Employees Union, to the Standing Committee on Finance & Economic Affairs
January 20, 2017
About the Ontario Public Service Employees Union
The Ontario Public Service Employees Union (OPSEU) is a trade union representing 130,000 Ontarians working in every corner of Ontario and most areas of the provincial public sector, including the municipal sector. In health care, OPSEU represents approximately 45,000 frontline workers in these areas: ambulance services; long-term care; mental health care; hospital professional services; hospital support services; community health care; and Canadian Blood Services and diagnostics.
Introduction
Ask Ontarians, and the vast majority will agree: public health care is not only part of the Canadian identity, it is a top priority for voters, regardless of their party affiliation. Public medicare is based on the principle that as citizens, we ought to receive health care based on our need, not our ability to pay. The principles of equity, compassion and fairness are what make us proud of our health care system.
But for the better part of the last decade, the services and infrastructure that make up the foundation of this system have been chipped away at during an Age of Austerity in Ontario. During this period, funding for public services has been cut back sharply while regular Ontarians suffer and profiteers line their pockets. Needless to say, inequality is growing and the working conditions of health care workers are deteriorating.
This is of particular concern to OPSEU and its members. OPSEU members not only use the public services that are funded and delivered by the province; we also deliver the services and are the public face of the system. At the bedside and behind the scenes, we are on the frontlines of health care.
Create a crisis, then privatize
Ontario’s hospitals are in a crisis, one that has been systematically created through relentless cuts that have lasted nearly a decade. Since 2008, the province has set hospital global funding increases below the rate of inflation. This means real-dollar cuts. From year to year, Ontarians have seen services and staff cuts deepen. Entire community hospitals have been put on the chopping block. This is the longest period of sustained hospital cuts in Ontario’s history.
While Ontarians continue to hear the rhetoric about “transforming” our health care system, and that transition can be painful, they’ve come to see this as code for the cuts to and privatization of our health care system. By a host of key measures, Ontario now ranks at the bottom of comparable jurisdictions on hospital care levels: Ontario has the fewest hospital beds per capita of any Canadian province; Ontario has the fewest nurses per patient in Canada (RNs and RPNs); and Ontario ranks near the bottom for funding of our public hospitals (both by population and as a percentage of GDP).
After nearly a decade of cuts, patients are suffering.
The government’s formula has been to create a crisis through cuts, then offer privatization as a solution. But in reality, privatization creates investment opportunities for private companies at the expense of the public medicare system and those who depend upon it. When we consider that the main bidders on home care contracts, or on the contracts for cleaning, food services and portering in hospitals, are often multinational consortia, one must question the argument that there is no money for health care. Millions of dollars are being siphoned from the public purse into private hands annually.
In their recent analysis, Ontario’s Financial Accountability Office (FAO) stated that, “If the current level of health care quality and service are to be maintained, health expenditures will require 5.3 per cent annual increases from this year to 2020.” According to the FAO however, the government plans to limit growth this year through to 2018-19 to 1.7 per cent. This plan will not even cover the basic rate of inflation, let alone population growth, the demands of an aging population, and the higher rates of inflation typically seen in health care, e.g., for pharmaceutical drugs. It will invariably result in deeper and deeper cuts.At the hospitals we visited, we saw patients placed on uncomfortable stretchers or gurneys in hallways and other high-traffic areas that were never designed for patient care [and] these waits can last as long as 28 hours for a minority of patients. Overcrowded emergency rooms also make it difficult to control infections. The first Canadian to die in the 2003 SARS outbreak, for example, was infected after spending one night in a hospital emergency room.— Warren (Smokey) Thomas, President, OPSEU
Privatization has become embedded in our health care system. It is being used as a method to download costs onto individual patients, often the frail, sick and elderly who can least afford to pay. This is true in Ontario’s home care system, which is rife with privatization, where the majority of provider agencies are private, for-profit entities competing for bids to provide services and seek profits. OPSEU is calling for an end to contracting-out and the delivery of home care by private operators, which sees public money siphoned into the hands of private profiteers.
While OPSEU is very concerned about Bill 41, the Patients First Act, and has pointed out that the Government of Ontario is taking no action to end the contracting out of home care services, we remain hopeful that the legislation, which does remove the structural barriers to allow the Local Health Integration Networks (LHINs) to assume responsibility for the management and direct delivery of home and community care, will be used to do so. The ministry ought to explore its options for termination or non-renewal of all contracts with current provider agencies. Patients must have enshrined rights to access the care they need along the entire continuum of care. This legislation could be an important step toward a fully public, non-profit home care system in Ontario and we encourage the provincial government to initiate that transition.
According to the Auditor General’s 2015 report, there are 160 third-party providers currently contracted by the province’s Community Care Access Centres (CCACs) to provide home and community health care services. Many of these are for-profit. The Auditor General found that for every dollar spent by a CCAC, only 61 per cent is spent on the actual face-to-face treatment of patients.Currently, based on the Ministry of Health and Long-Term Care’s data and its formula to calculate hours of direct care, long term care residents are receiving an average of 3.4 hours a day. The Association calculated that the gap of just over half an hour per resident per day could be closed with an investment of $385 million and recommended that this be phased in over three years in recognition of the fiscal situation.