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UPDATE: Mounting Health Care Cuts

Posted: November 20, 2019

(November 20, 2019)

List of the Ford government health care cuts to date:

  • Cut OHIP+ so families with sick children will have to seek private coverage first and pay deductibles and co-payments (June 2018).
  • Cut planned mental health funding by more than $330 million per year (July 2018).
  • Cancelled all new planned overdose prevention sites. (Autumn 2018). Cut funding for six overdose prevention sites (April 2019).
  • Cut funding to the College of Midwives of Ontario. (December 2018).
  • Cut funding for the dementia strategy.
  • Cut and restructured autism funding, in addition closed waitlists (Winter 2018/19). There were major problems rolling out the current autism plan with the capped funding levels per family. The newest plan, an expected return to a needs-based program, will not be rolled out until April 2020. In October, an expert panel recommended extensive changes to the government’s autism strategy. Families are reporting they are still waiting for funding to flow (October 2019).
  • Set overall health funding at less than the rate of inflation and population growth, let alone aging. This means service levels cannot keep up with population need (2019 Budget).
  • Set public hospital funding at less than the rate of inflation. This means real dollar (inflation adjusted dollar) funding cuts and serious service cuts (2019 Budget).
  • Cut funding from long-term care. Funding for long-term care daily care set at 1% which is approximately half the rate of inflation and equals real dollar cuts (2019 Budget).
  • Introduced Bill 74, which gives sweeping new powers to the minster and Super Agency to force restructuring of virtually the entire health system (February/March 2019).
  • Municipalities revealed Ford government plan to cut and restructure paramedic ambulance services, down from 59 to 10 (April 2019). Set 2019 land ambulance grant funding at less than the rate of inflation. This means real dollar cuts to paramedic ambulance services. The City of Toronto has calculated the value of these cuts to amount to $4 million for Toronto alone (April 2019). Under pressure, changed course. Proposed to increase paramedic service funding by 4% but still move forward with closures of local paramedic ambulance services from 59 down to 10 (August 2019).
  • Cut OHIP funding for residents travelling out of Canada (May 2019).
  • Leaked document revealed plans to cut half a billion dollars in OHIP services. On the chopping block: sedation for colonoscopies, chronic pain management services and others. Plans were supposed to be made public this  services from OHIP including physical assessments for surgery, ear wax removals, and physician referrals (August 2019).
  • Cut 44 positions at the Ontario Telemedicine Network (OTN) –provider of video medical services — which previously employed 265 people. In other words, 1 in every 6 telemedicine staff positions are slated to be cut. The official dollar figure has not yet been released, but, OTN received $42 million in provincial funding 2017-18, nearly all came from the Ministry of Health (May 2019).
  • Plans to reduce the number of Public Health Units from 35 to 10. Cut 27%, or $200 million per year, of provincial funding for public health. Toronto Public Health has been particularly hard-hit. The city of Toronto has calculated the cuts will amount to $1 billion over a 5-year period. The Ford government disputes these figures (April 2019). Under pressure from municipalities, the Ford government backtracked and reduced the amount of their cuts but still plan significant cuts (August 2019). In late May the government announced it will delay these cuts by one year but still plans to move forward with them next year.
  • Cut more than $70 million from eHealth’s budget (May 2019).
  • Cut almost $53 million from the Health System Research Fund, a fund dedicated to research relevant to provincial policy and health-care system restructuring (May 2019).
  • Cut $5 million in annual funding for stem-cell research at the Ontario Institute for Regenerative Medicine (May 2019).
  • Cut $22 million from cancer screening programs (May 2019).
  • Cut $24 million in funding for artificial intelligence research from the Vector Institute for Artificial Intelligence as well as the Canadian Institute for Advanced Research (May 2019).
  • Cut $1 million in funding to Leave the Pack Behind, a free program designed to help young adults quit smoking (May 2019).
  • Eliminated more than 800 full-time equivalent positions in the LHINs (Local Health Integration Networks) and in the six health care agencies (including Cancer Care Ontario, Health Quality Ontario, Trillium Gift of Life, Health ForceOntario and others) that were closed and merged into the new “Super Agency” (June 2019).
  • Cut 291 staff at autism centre for children, ErinoakKids Centre for Treatment and Development (June 2019).
  • Cut all Nurse Practitioner services and 15% of nursing positions at Haldimand-Norfolk Health Unit resulting in cuts to nurses providing school health programs, community health, infectious diseases, sexual health and vaccine-preventable diseases (June 2019).
  • Eliminated 170 Cancer Care Ontario FTE positions. Many of the positions eliminated were directly responsible for measuring and comparing quality in cancer care (June 2019).
  • Cancelled the Quality Management Partnership (QMP) that ensured quality and consistency in cancer care. The QMP program was started in response to women undergoing unnecessary mastectomies for mistaken diagnoses of breast cancer. QMP developed quality standards for cancer screening and quality improvement for pathologists (June 2019).
  • Cut and cancelled two long-term care home funds that amount to a $34 million dollar cut to long-term care home programs, services, equipment and facility maintenance (June 2019). Postponed these cuts until October 1st to offer facilities time for adjustment (August 2019). Postponed these cuts until 2020 (September 2019).
  • Raised long-term care resident co-payment fees by 2.3%, meaning older adults would have to pay $500 more per year (August 2019).
  • Eliminated forensic pathology services in Hamilton (July 2019).
  • Cut $634,689 used to run the Mobile Cancer Screening Coach that screened for breast cervical and colorectal cancers in Hamilton, Burlington and Niagara. The bus will go off the road in April 2020 (July 2019).
  • Cut 9 child development staff at KidsAbility Child Development Centre locations in Fergus, Guelph, Cambridge, Kitchener and Waterloo (March 2019). Will eliminate another 20 – 25 FTE staff in January 2020 due to cuts to autism services.
  • As a result of provincial funding cuts to Public Health, the Windsor-Essex County Public Health Unit issued layoff notices to nine registered nurses (RNs) from the Healthy Families and school programs (November 2019).

List of Hospital Cuts, Privatization, Mergers & Closures to Date

 

  • Cut more than 120 full-time equivalent staff including nurses, health professionals and patient support staff from Sudbury’s Health Sciences North. After protests by the public and the Health Coalition some of the cuts were rolled back but significant cuts continued nonetheless (November 2018). Plan to cut 22 hospital beds and 176 positions from Sudbury Health Sciences North over a five-year span (July 2019).
  • Privatized lab service, transcription, and patient transportation; outsourced microbiology testing at South Bruce Grey Health Centre. Cut acute care hospital beds up to 40% across all sites. Downgraded acute beds to reactivation beds at a lower staffing level, centralized them to Chesley Site and renamed them “Seniors Centre of Care” (January 2019).
  • Cut 46 RN positions from Grand River Hospital in Kitchener – Waterloo (July 2019). This amounts to more than 80,000 hours of registered nursing care hours cut this year.
  • Cut 80 staff from Windsor Regional Hospital (WRH) mostly in housekeeping and food services departments (April 2019).
  • Privatized outpatient lab services to private for-profit LifeLabs laboratories at two North Wellington Health Care hospitals – Louise Marshall Hospital and Palmerston and District Hospitals (April 2019).
  • Privatized routine outpatient blood tests and lab tests at St. Michael’s hospital to for-profit laboratories (April 2019).
  • Cut the pediatric ABC Clinic at Michael Garron Hospital (May 2019).
  • Cut 14 full-time registered nurses, which equals a cut of over 25,000 hours of patient care, at Orillia Soldiers’ Memorial Hospital (May 2019).
  • Cut at least 50 clerical staff at St. Michael’s Hospital, St. Joseph’s and Providence Health Centre in Toronto (May 2019).
  • Cut 165 full-time equivalent staff positions from London Health Sciences Centre (June 2019).
  • Cut 60 positions from Addiction and Mental Health Services – Kingston, Frontenac, Lennox and Addington (AMHS-KLFS) (June 2019).
  • Closed the Maternal Fetal Medicine Clinic at Windsor Regional Hospital (June 2019).
  • Privatized outpatient lab services at Clinton Public Hospital, Seaforth Community Hospital St. Marys Memorial Hospital (June 2019).

Service closures that may be cuts

  • Cut obstetrical care on weekends at West Lincoln Memorial. Women are forced to travel to Hamilton or St. Catharines if they go into labour on weekends (February 2019).
  • Board passed a motion to close inpatient pediatrics and obstetrics-gynecology from the Birchmount Campus of Scarborough Health Network, formerly the Scarborough Grace General Hospital which serves 200,000 residents (January 2019). Working group is figuring out the process of restructuring and they are open while they plan logistics.

Scroll down for:

  • Public Health cuts/restructuring
  • Serious Threat of Health Privatization
  • Ambulance cuts/restructuring
  • Overall cuts/restructuring
  • Bill 74 – Most Radical Restructuring in our Province’s History
  • Who’s Who: A primer on Ford’s insiders and the pro-privatization forces in government
  • Printable versions

Public Health cuts/restructuring

Doug Ford announced that he will delay public health cuts by one year, but severe cuts amounting to almost one-third of provincial funding for public health are still planned to go forward next year if we don’t stop them. These cuts threaten vital local services including food and water safety, infectious disease tracking and prevention, immunizations, prenatal training and safety, overdose prevention, safe needle and biohazard programs and many others.

In the 2019 Provincial Budget it was revealed that the Ford government plans to cut provincial funding for Public Health by 27 per cent and cut the number of local Public Health Units from 35 to 10. In early May, the government made public their plans for the closures/takeovers/mergers of local public health units. In the summer, the government rolled back some of the cuts and cancelled the retroactive cut. But still significant provincial government funding cuts for Public Health are slated to go forward unless they are stopped. There has been no public consultation on this major change even though municipalities match provincial funding for public health, thereby providing half of public health funding. Municipalities were not consulted, public health experts including nurses and doctors who specialize in public health were not consulted, nor were affected communities or Ontarians who fund and rely on Public Health services. The plans that have been revealed to date follow here. In response to pressure, the Ford government has appointed a “facilitator” to consult, not on whether to cut funding and eliminate 25 of 35 local Public Health Units, but on how to go about cutting and restructuring public health. The cuts and restructuring are supposed to start in January. As of mid October, the facilitator has not begun his consultation. However, there is no public process, no written plan that measures or mitigates the impact on the people of Ontario, no plan for consultation, no clear timeline. In fact, no normal processes for public health care planning are being followed whatsoever.

 

 The following will be the results of the planned takeover/mergers/closures of Public Health Units if they are forced through by the Ford government: 

  • Middlesex London Health Unit, Southwestern Public Health Unit, Windsor-Essex County Health Unit, Chatham-Kent Public Health Unit and Lambton Public Health Unit will be forced into a single regional Public Health Unit covering 1.3 million people.
  • Bruce Grey Health Unit, Huron County Health Unit and Perth District Health Unit will be forced into a single regional Public Health Unit covering 300,000 people.
  • Public Health Sudbury and Districts, Algoma Public Health, North Bay-Parry Sound District Health Unit, Timiskaming Health Unit, Porcupine Health Unit, and Simcoe Muskoka District Health Unit will be forced into a single regional Public Health Unit covering 625,000 people.
  • Thunder Bay District Health Unit and Northwestern Health Unit will be forced into a single regional Public Health Unit covering 228,000 people.
  • Waterloo Public Health Unit, Halton Public Health Unit, Peel Public Health Unit, and Wellington-Dufferin-Guelph Public Health Units will be forced into a single regional Public Health Unit covering 2.94 million people.
  • Hamilton Public Health Services, Niagara Region Public Health Unit, Brant County Health Unit, and Haldimand-Norfolk Health Unit will be forced into a single regional Public Health Unit covering1.4 million people.
  • Ottawa Public Health Unit, Eastern Ontario Health Unit (Prescott-Russel, Cornwall), Smith Falls Health Unit, and Kingston, Frontenac, Lennox and Addington (KFL&A) Public Health will be forced into a single regional Public Health Unit covering 1.6 million people.
  • Peterborough Public Health, Haliburton, Kawartha, Pine Ridge (HKPR) District Health Unit, Hastings Prince Edward Health Unit, and Durham Region Health Unit will be forced into a single regional Public Health Unit covering 1.2 million people.
  • York Region Public Health and Simcoe County District Health Unit will be forced into a single regional Public Health Unit covering 1.7 million people.
  • Toronto Public Health will serve 2.9 million people.

Serious Threat of Health Privatization

In Bill 74, passed last spring by the Ford government, the Minister of Health has given herself and the Super Agency vast new powers to order and otherwise force the privatization of most of our health care services. Opposition parties have asked direct questions about private surgery clinics bidding to close down and take over our local hospital services and neither the Premier nor Health Minister will say that they will not privatize. In documents being circulated from municipalities, Ford’s plans may include privatization of parts of ambulance services. In the leaked documents from the Ontario civil service in February, plans were revealed to privatize eHealth, laboratories, air ambulance, long-term care inspections and other services. At no time, under questioning by media and opposition parties, will this government clearly promise not to hand over ownership of our public health care services to private for-profit corporations. The signs of impending privatization are serious.

Ambulance cuts/restructuring

Ford’s plans, revealed by municipalities, include cutting the number of local paramedic ambulance services from 59 to 10 as well as the number of local dispatch services. These cuts will be particularly devastating to rural and smaller communities which are already suffering from a shortage of services. The Ford government’s restructuring plan does not address any of the causes of too-long ambulance response times; it does not ameliorate services even where there is evidence of significant need. The current paramedic services system in Ontario was created by Mike Harris’ restructuring in the 1990s. The evidence from that round of restructuring is that costs grew dramatically post-restructuring. Ford’s plans for further centralization of paramedic ambulance services and cuts also threaten to deepen inequalities between rural and urban communities: “Cutting and centralizing the ambulance services down to ten giant regions means that smaller rural and northern communities will be lesser priorities and risks their service levels,” warned OHC executive director Natalie Mehra.

An EMS vision-Ontario 2050 Report came out after the 2018 provincial election, penned by owners of a private, for-profit, ambulance company. The report set out a map towards privatization of land ambulance services. It suggested Ontario could “save” $200 million by consolidating over 50 provincial paramedic services into only 10, run by a single Commission. The fact that the government announced that 59 provincial paramedic services will indeed be consolidated into 10 as the report suggested has led to concerns that the privatization of ambulance services is part of Ford’s agenda. The report has also mentioned a plan to reduce the number of Public Health Units from 35 to 10 – a plan that is being implemented by the Ford government.

Overall cuts/restructuring

The Ford government is now clearly embarking on the most aggressive and radical health care restructuring that Ontario has ever seen. Previous large-scale restructuring in Ontario undertaken by the Mike Harris government involved province-wide hospital restructuring, including mergers and closures of dozens of local hospitals. It ultimately did not reduce administrative costs as was promised. In fact, it cost $3.9 billion. That is $3.9 billion,  according to the Provincial Auditor General, to cut $800 million from public hospitals. The restructuring costs were made up of laying off staff, moving buildings, renovating and rebuilding, re-hiring staff, renaming services, re-doing letterheads and communications systems and so on. The evidence is indisputable that those cost were lost to health care and were never recouped. Moreover, restructuring led to for-profit privatization and new user fees for an array of services. The costs were never recovered and many of the current problems that we face in health care can be traced back to the last two rounds of restructuring.

Bill 74 – Most Radical Restructuring in our Province’s History

The Ford government is now clearly embarking on the most aggressive and radical health care restructuring that Ontario has ever seen. Previous large-scale restructuring in Ontario undertaken by the Mike Harris government involved province-wide hospital restructuring, including hospital mergers and closures of dozens of local hospitals. It ultimately did not reduce administrative costs as was promised. In fact, it cost $3.9 billion. That is $3.9 billion, according to the Provincial Auditor General, to cut $800 million from public hospitals. The restructuring costs were made up of laying off staff, moving buildings, renovating and rebuilding, re-hiring staff, renaming services, re-doing letterheads and communications systems and so on. The evidence is indisputable that those costs were lost to health care and were never recouped. Moreover, restructuring led to for-profit privatization and new user fees for an array of services. The costs were never recovered and many of the current problems that we face in health care can be traced back to the last two rounds of restructuring.

In the last few months plans have been revealed that expose the Ford government’s intent to undertake the most radical health care restructuring in our history. Bill 74, the so-called “People’s Health Care Act” has been passed through the Legislature by the majority Ford MPPs against strong opposition. It does not improve a single health care service. What it does is create one mega-merger of 20 agencies into a Super Agency and give extraordinary restructuring powers to the government. This new law launches restructuring for hospitals, long-term care, home care, community mental health and addictions, community care, cancer care, palliative care, labs, eHealth, air ambulance, community health centres, home care, non-profit primary care and more. The Health Minister has revealed her plan is to restructure 1,800 health service providers down to 30 – 50 conglomerates. That’s not all though. In the Provincial Budget, plans to cut Public Health by almost 1/3 of provincial funding (27%) and reduce Health Units from 35 to 10 were revealed. Then, municipalities revealed the Ford government’s plans to restructure paramedic ambulance services from 59 down to 10.

Sweeping new powers to force through mega-mergers, transfer services from one community to another, close services, privatize services

The new law gives sweeping powers to the Minister and the government appointees in their new Super Agency to force through mergers, mega-mergers, amalgamations, transfers of services, closures of local services, and entire closures of service providers. In five separate areas in the legislation these restructuring powers enable the government, its appointees, and health service providers to transfer our public and non-profit health care services to for-profit companies.  Already for-profit hospital companies are making bids to take over surgeries in London Ontario.

Unfettered powers to force health care providers to restructure, close, privatize

The legislation allows the Minister and the government appointees that run their new Super Agency the power to order, direct and coerce (using their funding power) local providers of service to comply with these restructuring edicts and pressures. It does this in multiple sections of the legislation. In most of these sections there is no fetter on these extraordinary powers and no public process. It takes away any last vestiges of local control over health care. They can close a hospital with the stroke of a pen, move a service to another town or close it entirely, order the privatization of all labs or all surgeries, for example. It is truly shocking.

No public interest protections, no appeals, no access to information, no clear rulings: worst ever

There are no public interest protections in the legislation. There is no public notice at all for most of the sections that give new restructuring powers. There is minimal public notice in one section. There is no right to appeal anywhere in the legislation. There is no public access to documents anywhere in the legislation. The new Super Agency is not subject even to the conflict of interest rules of the Ontario Public Service. There are no principles to guide restructuring. There is no requirement that any one, not the Minister, not the Super Agency, no one, actually measure and plan to meet population need for health care, protect any local health services at all, ensure that patients have access to care, worry about the workforce that will be subject to massive upheaval. There are no procedural protections whatsoever.

Who’s Who: A primer on Ford’s insiders and the pro-privatization forces in government

Charles Lammam, formerly of the extreme right-wing Fraser Institute, is now the Director of Policy (2nd highest staff position) in the Health Minister’s office. The Fraser Institute has spent years trying to dismantle Canada’s social programs and one of their prime targets is health care. The Fraser Institute has been funded by the American Koch brothers (funders of the Tea Party) among others.

Shelly Jamieson, one of Ford’s appointed board members of the new Super Agency, is the former president of Extendicare, a for-profit long-term care home giant. She was on the Mike Harris government’s Restructuring Commission that ordered the closure of >40 hospitals and thousands of hospital beds. After this she moved to Extendicare which gained from the subsequent expansion of long-term care. Now she is on the new Super Agency, this government’s health restructuring board.

Elyse Allan is on the board of Brookfield Assets Management and the right-wing pro-privatization C.D. Howe Institute and was recently on the pro-corporate Board of the Conference Board of Canada, the Chamber of Commerce and more.

Other board members include people from banks and private corporations including Real Estate Investment Trusts and others with direct interest in health care privatization.

In July, Doug Ford appointed Rueben Devlin, former president of the Ontario Conservative Party to be the Chair of a new Premier’s Council on Improving Health Care & Ending Hallway Medicine and Special Advisor on Ending Hallway Medicine. The positions come with a $348,000 per year salary for the Conservative stalwart who was president of the party during the Mike Harris era during which the government spent $3.9 billion closing and merging hospitals in an attempt to cut $800 million from their budgets. This was the most radical restructuring of public hospitals in the country’s history at the time. Rueben Devlin is also the former CEO of Humber River Hospital where he presided over the closure of three hospitals. The three were replaced with one privatized P3 hospital at an eye-popping $1.76 billion due to the exorbitantly expensive P3 financing and privatization model. In so doing, Devlin closed down a hospital in one of the poorest neighbourhoods of the city. The new P3 hospital did not have enough capacity to serve its population and last fall the former Liberal government reopened one of the closed-down sites in order to deal with patients waiting on stretchers in hallways for care.

Gordon Campbell: Not only does he have an abysmal record on financial matters, but the former B.C. Premier, whom Doug Ford appointed to lead Ford’s fiscal inquiry in Ontario, is perhaps the biggest enemy of public health care in Canada. It is now apparent that Campbell’s model of health cuts and privatization may be the model that Ford is copying here. Campbell set the stage for the biggest growth in for-profit privatization of hospital care in Canada, private clinics in BC openly charge patients thousands of dollars in violation of the Canada Health Act as a direct result of his policies, he cut and closed local hospitals, systematically appointed pro-privatization health board people, fired thousands of hospital support staff, and privatized their services. He routinely supported private for-profit interests in pharmaceutical policy and health care against the public interest. The extreme right-wing Fraser Institute loves him, but his record on finances is terrible. Not only did he do all these terrible things in health care, he wiped out a $1.5 billion surplus he inherited when he took government, then went on to post the largest deficits in the B.C.’s history up to that time, and added $20 billion to the province’s debt.

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