Friday, December 17, 2010

Crisis in Healthcare: Alberta's Five Year Plan

From: The Marxist-Leninist Daily, Daily Newspaper of the Communist Party of Canada (Marxist-Leninist)

- Peggy Morton -

Everyone agrees that the crisis in health care is deepening. Many of the symptoms are clear: overcrowded emergency rooms, long waits to access care at many levels and failure to provide care for frail seniors. The burn-out and exhaustion of health care workers is being recognized. But whenever discussion goes beyond symptoms to the cause of the malady and the treatment required, it becomes clear that the rich and their governments are living in a different world. Health care workers and their collectives, seniors organizations and citizens groups are identifying immediate problems which require solutions and making proposals on that basis. Governments, the monopoly media, the think tanks of the rich and the monopolies who want to expand their "market" are working overtime to overwhelm people and convince them that health care is not a right and this right cannot be provided with a guarantee. The rich and their governments are the block which people face in providing solutions on the basis that Health Care is a Right!

For example, the Globe and Mail says that the problem is that Canadians are just plain stubborn and cling to the "lofty principle" that everyone should receive care regardless of ability to pay. Hard choices have to be made, the rich say. Health care is eating up too much of provincial budgets, and the only source of additional funding for health care is to take it from other social programs such as education, they claim. The assault on the rights which people have as humans seems endless.

The Alberta government has responded to the tsunami from Albertans demanding the government provide the necessary resources to ensure people receive the highest quality care when needed by producing a "five-year health action plan." The plan sets out targets for everything under the sun, from emergency room wait times, wait times for primary care, surgery, consultation with a specialist and so on. When it comes to how it is going to deliver on these targets, there is nothing in the document which even remotely resembles a concrete plan.

Why is this the case? Is the government just stupid? Or does it recognize a different problem than the problem the people of Alberta have identified? According to the government, people are the problem. What to do about all these people who have health problems? What to do about all these angry Albertans who are speaking out. What to do about doctors, nurses, and support staff who refuse to be silenced? What about the physician in their own caucus who refused to abandon his responsibilities as a physician and persisted in speaking out on behalf of health care workers and the health care needs of Albertans? What to do about the seniors who refuse to be marginalized? The short-term fix is a PR job to convince people that the government is doing something. Fire the CEO of the health superboard. Empty the overflowing emergency unit by sending patients to other units which are already full and where patients will end up in hallways or as the third patient in a two-bed room. Produce a glossy plan full of targets and empty promises.

The targets are a way of claiming that something is being done. But they are also a means to force hospitals to meet the targets at the expense of patient care. If a patient is waiting longer than the "target" in emergency, skip the test and send the patient home. Discharge patients early from in-patient wards. Do whatever is "necessary." In the absence of additional resources and staff, wait time targets become a means to force compromised care. Together with "benchmarking," activity-based funding and other such measures, the health superboard becomes a giant U.S.-style health management organization.

As for the long-term solutions, here too the government says that people are the problem. Canadians consider it an achievement of the society that people are living longer and healthier lives. But the rich and their governments speak in apocalyptic terms of the spectre of all these aging baby boomers overwhelming the system, making it "unsustainable." They repeat endlessly that the publicly funded and delivered system is inefficient. It has to be made more efficient, more "business-like" -- in other words, less health care and more profits. The same mantra about making the monopolies competitive so that they can be global champions is to be applied to the health care "market."

Expanding the Public Health Care Workforce

Health care workers and their collectives point out that the first priority is to increase the training and hiring of health care staff. This is necessary to address the burn-out and stress staff experience trying to provide care with inadequate staff. Then additional staff are needed to add more services.

In response to Alberta Health's "solution" to emergency overcrowding, the United Nurses of Alberta (UNA) has pointed out that moving patients out of emergency to other nursing units, to hallways or putting three people in a two-person room cannot be called a solution.

"Unless appropriate staffing and support is provided in each and every environment, we are simply shoving the problem out of the emergency departments and hiding it across the continuum," UNA President Heather Smith said.

"We don't agree with 'pushing' more patients in to overcrowded or inappropriate beds or conditions. This is like the Tokyo subway system where they hire big men with white gloves to push more people into train cars. It is just that wrong," says Heather Smith. "Real expansion of capacity, opening significant numbers of beds and ending the constant squeeze and reduction of our public health system, is the only real solution to the problems.

"We've got to expand the health workforce, you can build buildings and buy beds, but if you can't staff them, you're never going to deal with the real emergency issue."

This is not what the government is doing. According to government calculations, more than 3,000 nurses currently working in Alberta will be over the age of 65 by 2015. It projects that Alberta will be short 6,500 nurses by 2016. Despite this it has committed only to hiring 70 per cent of nursing graduates in Alberta, even though hiring all nursing graduates would not fill the gap. Today's hospitals have shortages of housekeepers, clerical staff, support staff who maintain the buildings, sterilize surgical instruments and perform many other important services in hospitals. Yet there is no plan to hire more staff.

In 1995, after the Alberta government had closed half the beds in the province, there were 6,500 acute care beds (not including mental health beds in stand-alone psychiatric hospitals) for a population of 2.6 million people. Fifteen years later, there are 7,800 acute care beds for a population which has grown to 3.7 million. This means there is now one acute care bed for every 460 people, while in 1995, after half the beds were closed, there was one bed for every 400 people.

The five-year plan states that 360 new acute care beds will be opened in the first two years of the plan; no new beds are planned for the last three years. This means that the government plans to open fewer new beds over the next five years than were opened on average over the past 15 years. To put it another way, one new bed will be opened for each 10,000 people in Alberta. This is not even taking into account population increase, making it likely that bed/population ratios will fall ever further.
Dignity for Seniors

As for the government's "commitment" to open 5,300 continuing care spaces over the next five years, its announcement should get an award for the most brazen attempt at deception in the whole "plan." "New" terminology for "continuing care" includes expressions like the home stream, the supportive living stream and the facility living stream. This means if a senior is receiving some home care services, their bedroom can be counted as a "continuing care space." So too a room in a lodge where room and board are provided but there are no health care staff on site. A continuing care space can mean almost anything, as long as the senior is not in an acute care hospital.

It appears that most of the "spaces" referred to will be in private, for-profit assisted living facilities being built with government handouts. There is no change to the plan to cap the number of publicly-funded long-term care beds at the current 14,500. Seniors will be forced to pay for more and more of their care. Funding will be diverted from care for seniors and decent wages and living conditions for health care workers into the hands of the private health care monopolies.

When delivery of home care services is contracted out to private companies, the home care workers are paid less than half the hourly rate the private companies charge. The private operators profit from each and every service provided. Eliminating for-profit care would immediately improve living and working conditions for health care workers and provide more funding for patient care.

Funding must be directed to providing care and services so as to provide the right to health care with a guarantee. Out-of-hospital care must not be turned over to private, for-profit health care corporations, and monopolies. This must be reversed and the monopolies restricted. Organizations like the Public Interest Alberta Seniors' Task Force have put forward a concrete plan for action. The government must provide expanded publicly delivered home care services. The conversion of long-term care facilities to for-profit assisted living facilities must stop. High quality, affordable long term care facilities must be built as required to eliminate waiting lists and plan for the future. Every seniors care facility should have an advisory council to ensure that residents and their families have a democratic say in how these facilities are run.

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