From ijansen@cupe.ca Mon May 10 20:50:31 2010 Received: from CUPEHUB1.CUPE.CA (cupehub1.cupedom.local [10.1.0.81]) by lists.cupe.ca (8.12.11.20060308/8.12.11) with ESMTP id o4B0oVZi004142 for ; Mon, 10 May 2010 20:50:31 -0400 Received: from E2K7CLUSTER.cupedom.local ([10.1.0.76]) by cupehub1.cupedom.local ([10.1.0.81]) with mapi; Mon, 10 May 2010 20:50:32 -0400 From: Irene Jansen To: "healthcare@members.cupe.ca" Date: Mon, 10 May 2010 20:47:42 -0400 Thread-Topic: Destruction of aging hospitals premature; Lack of capacity after the fact forced Calgary to turn to private clinics - Edmonton Journal Thread-Index: AQHK8KP0pa0AHsJy4ku6WwiHjOa1Ag== Message-ID: <8F5713DF2D6DF14293423EF519BFB40D8C588514FB@E2K7CLUSTER.cupedom.local> Accept-Language: en-US Content-Language: en-CA X-MS-Has-Attach: X-MS-TNEF-Correlator: acceptlanguage: en-US Content-Type: text/plain; charset="Windows-1252" MIME-Version: 1.0 Content-Transfer-Encoding: 8bit X-MIME-Autoconverted: from quoted-printable to 8bit by lists.cupe.ca id o4B0oVZi004142 Subject: [CUPE healthcare list] Destruction of aging hospitals premature; Lack of capacity after the fact forced Calgary to turn to private clinics - Edmonton Journal X-BeenThere: healthcare@lists.cupe.ca X-Mailman-Version: 2.1.8 Precedence: list List-Id: "Share news, research and ideas to defend public health care." List-Unsubscribe: , List-Archive: List-Post: List-Help: List-Subscribe: , X-List-Received-Date: Tue, 11 May 2010 00:50:31 -0000 Destruction of aging hospitals premature; Lack of capacity after the fact forced Calgary to turn to private clinics Edmonton Journal Sun May 9 2010 Page: A4 Section: News Byline: Don Braid Dateline: CALGARY Source: Calgary Herald; Canwest News Service A mighty medical wind blew through Calgary 16 years ago, ripping apart the health system and seeding the thunderheads for today's storms in private surgery clinics. Last week's crisis over the Health Resources Centre, the privately owned hip and knee surgery clinic at the old Grace Hospital, emerged from the 1994 upheaval. So did the ongoing uproar among local ophthalmologists over the allocation of cataract surgery to only two private clinics in Calgary. After the wrenching changes of the 1990s, closed Calgary hospitals were sold to private groups, including doctors who created for-profit clinics. They, in turn, signed contracts with the health system to perform surgeries. Now the troubled Health Resources Centre -- a private surgery clinic owned by Networc Health Inc. -- is so essential it can't be allowed to close, the Alberta Health Services Board says in court documents. As a result, the public system is temporarily paying receivership fees to keep the private medical facility open. This is only the latest impact from decisions that go back to the early days of former Premier Ralph Klein's regime. After years of bed shortages, lengthening waiting lists and now even a bankruptcy, the 1994 decisions seem bizarre if not downright foolish. They also raise questions about how Edmonton emerged in better shape, with more hospitals and operating rooms, and little reliance on private clinics. Save health care; save money In March 1994, the debt-ridden province sent in the three-member Calgary Facilitation Group on Health Services, headed by Edmontonian and former Treasurer Lou Hyndman. The group's stated goal was not to save health care, but to save money. The members toured the Holy Cross, where the province had just spent $35 million on modern operating rooms and systems. They called for the Holy Cross to close. It was shut in 1996. The Salvation Army Grace, housing the Women's Health Centre, also closed that year. The province had also spent heavily on the Bow Valley Centre, known as the General. The study group called for its closing. On Oct. 4 1998, the huge complex was brought down with dynamite. "It may seem bizarre to close or move these (hospitals)," the group's report said, "but the fact is the middle-and long-term operating costs of keeping them open far exceed the costs of closing, moving and rationalizing." The 1994 committee relied on financial projections from consultant Price Waterhouse. Today, that firm's successor company, PricewaterhouseCoopers, is the court-appointed interim receiver charged with running the private surgery clinic in the old Grace. Population explosion hit The Calgary Facilitation Group first met here March 21, 1994. The report was completed in 21 days and went to the government April 11 -- warp speed by government standards. Of all the many reports on health care over the years, the one done in the most haste was taken most seriously. "It is really amazing how in health care it can take the province many years to build something, but they can change everything so quickly," said Dr. Tom Noseworthy, professor of health policy at the University of Calgary. The need for acute-care beds had fallen for more than a decade, said the report, "and all indications are that hospital-bed requirements will continue to fall for some time to come." But the committee didn't take into account the population explosion that was about to hit. Acute-care beds would be cut to 1,815 from nearly 3,000 just as thousands of newcomers began to arrive. The committee said only three of the city's seven hospitals should stay open -- the Peter Lougheed, Rockyview and Foothills. The Children's Hospital survived the cataclysm. As this was going on, the province split the province into 17 health regions with their own appointed authorities. Calgary's new board, headed by business icon Bud McCaig, zealously followed the government agenda. The population grew by 100,000 in his four years on the job. By the time he left in 1998 -- just as the General was about to be demolished -- McCaig was begging the province to restore funding. Closures fiercely rejected Edmonton faced the same pressures in 1994. The province wanted to shut aging hospitals such as the Misericordia and General. The city's bed count was to be drastically reduced. But the suggestions met fierce resistance. As many as 15,000 people swarmed to demonstrations. The local board rejected closures, opting instead to shut wings of hospitals. Edmonton's system suffered. It ended up with slightly more than 1,600 acute-care beds, even fewer than Calgary. More than 4,000 health-care jobs were lost. But the city kept its hospitals. By 1996, Edmonton got its own report from a committee headed by Tory MLA and medical doctor Lyle Oberg. It called for closure of only one facility, Alberta Hospital Edmonton, and partial closing of the General. "McCaig and the original Calgary board, they did what they were supposed to do," says one veteran health official, speaking on condition of anonymity. "But in Edmonton, politics intervened. Nothing closed and very little changed." 'It was our only choice' As the financial storm waned later in the decade, it was relatively easy to restore service on closed Edmonton wards. But Calgary no longer had extra space. That simple fact drove Calgary's search for private clinics to do public surgeries. "If we'd had the capacity, we wouldn't have put the work out," says the same official, who has first-hand knowledge of the major changes. "But we had a huge waiting list to deal with. There was no ideological reason. Contracting surgeries was just practical. It was our only choice." Today, the Edmonton health zone has 2,793 acute-care beds. Calgary has 2,297. Edmonton has 75 operating rooms; Calgary 57. Almost all the eye surgeries in Calgary are done in private clinics. In Edmonton, more than two-thirds are performed in a dedicated eye clinic at the Royal Alexandra Hospital. The same hospital also has a clinic for hip and knee surgeries. In Calgary, about one-third of those operations -- roughly 1,000 a year -- are performed under contract by the private clinic owned by Networc. "The Edmonton clinics within the hospital are extremely efficient and well organized," Alberta Liberal MLA and health critic Kevin Taft said. "We hear very few complaints from doctors, staff or patients." In Calgary, eye doctors are now squabbling over the awarding of extra cataract surgeries to two local clinics out of five. And an interim receiver has been appointed for Health Resources Centre, and it's case is back before the courts Tuesday. The public system won't be able to handle the work now done by the bankrupt clinic before the opening of new surgery suites at the Foothillsbased McCaig Tower. Lower cost not a benefit Defenders of private delivery say the clinics drive innovation, cost less and challenge the public system to do better. Experts like Noseworthy agree there can be some benefits, although lower cost isn't one of them. Often, the new private owners benefit from facilities already financed by the public. "And at some point, private facilities really reduce capacity, expertise and educational opportunity within the public system," Noseworthy said. Taft said Calgary's private clinics emerged from a peculiar moment in time when "Ralph Klein and Rod Love were at the height of their power, and there was a convergence of political, business and public interests in Calgary. "Now we're seeing some of the results of that. The Calgary experiment has been more tumultuous than anything in Edmonton." Illustration: • Colour Photo: David Mol, Calgary Herald, Canwest News Service, File / The General Hospital is demolished with dynamite in Calgary on Oct. 4, 1998. • Colour Photo: Canwest News Service, File / The provincial health board is trying to help keep the private clinic -- at the site of Calgary's old Grace Hospital -- functioning despite its financial troubles. Edition: Final Story Type: News Length: 1210 words Idnumber: 201005090009 From ijansen@cupe.ca Wed May 12 10:24:02 2010 Received: from CUPEHUB1.CUPE.CA (cupehub1.cupedom.local [10.1.0.81]) by lists.cupe.ca (8.12.11.20060308/8.12.11) with ESMTP id o4CEO2mF005885 for ; Wed, 12 May 2010 10:24:02 -0400 Received: from E2K7CLUSTER.cupedom.local ([10.1.0.76]) by cupehub1.cupedom.local ([10.1.0.81]) with mapi; Wed, 12 May 2010 10:23:49 -0400 From: Irene Jansen To: "healthcare@members.cupe.ca" Date: Wed, 12 May 2010 10:24:01 -0400 Thread-Topic: Commissioning in the English NHS: A failing system that needs to be abandoned - British Medical Journal Thread-Index: Acrx3sSbx+7wr2XcTxmBC7zzTH6zag== Message-ID: <8F5713DF2D6DF14293423EF519BFB40D8C58DF832E@E2K7CLUSTER.cupedom.local> Accept-Language: en-US Content-Language: en-US X-MS-Has-Attach: yes X-MS-TNEF-Correlator: acceptlanguage: en-US Content-Type: multipart/related; boundary="_004_8F5713DF2D6DF14293423EF519BFB40D8C58DF832EE2K7CLUSTERcu_"; type="multipart/alternative" MIME-Version: 1.0 Subject: [CUPE healthcare list] Commissioning in the English NHS: A failing system that needs to be abandoned - British Medical Journal X-BeenThere: healthcare@lists.cupe.ca X-Mailman-Version: 2.1.8 Precedence: list List-Id: "Share news, research and ideas to defend public health care." List-Unsubscribe: , List-Archive: List-Post: List-Help: List-Subscribe: , X-List-Received-Date: Wed, 12 May 2010 14:24:02 -0000 --_004_8F5713DF2D6DF14293423EF519BFB40D8C58DF832EE2K7CLUSTERcu_ Content-Type: multipart/alternative; boundary="_000_8F5713DF2D6DF14293423EF519BFB40D8C58DF832EE2K7CLUSTERcu_" --_000_8F5713DF2D6DF14293423EF519BFB40D8C58DF832EE2K7CLUSTERcu_ Content-Type: text/plain; charset="us-ascii" Content-Transfer-Encoding: quoted-printable Published 15 April 2010, doi:10.1136/bmj.c1979 Cite this as: BMJ 2010;340:c1979 Editorials Commissioning in the English NHS A failing system that needs to be abandoned Commissioning in the English NHS was born officially in 1997, when the new = Labour government dropped the previous Conservative government's term "purc= hasing." The aim was to signal that the culture of the competitive market w= as being replaced with collaboration between purchasers (health authorities= , from 1997 to 2001) and providers (hospitals, mental health services, and = community services), although the structure of the market-the split between= purchaser and provider-remained. From 2002 the market was revived and comm= issioning became part of the new market. Commissioning can be interpreted in two different ways. To some, it means c= ollaboration between commissioners (primary care trusts and their associate= d general practices) and providers to determine healthcare needs and how to= provide them in an affordable way. To others, commissioning is the means b= y which providers are disciplined-a view embraced by the Department of Heal= th's "world class commissioning" initiative, which is geared to making prim= ary care trusts a meaningful countervailing power to hospitals. Since the original "internal market" in the NHS, introduced in 1991, purcha= sing or commissioning has mutated through a series of confusing and frequen= t reorganisations, involving mutually incompatible policies and high costs.= 1 According to one= recently published report from the House of Commons' Health Select Committ= ee,2 the costs of = commissioning are 14% of the NHS budget. The idea of general practitioners holding money to buy secondary services h= as come and gone repeatedly. Two other recent reports, produced jointly by = the King's Fund and Nuffield Trust,3 4 seek to revive that idea, despite the recent failure of "practice base= d commissioning"-a recent abortive attempt to replicate the incentives crea= ted by giving real budgets to general practitioners (as with the Conservati= ve government's general practitioner fund holding policy of 1991-7). The Nuffield Trust and King's Fund advocate "integrated care," whereby prim= ary and secondary clinicians work together, perhaps holding real budgets, b= ut with the primary care trust as a separate higher level commissioning org= anisation. This would be complex and incur high costs. What is more, the ma= in reason for such complexity would be to retain the purchaser-provider spl= it, which many policy analysts see as necessary for the English NHS. Yet th= is is yesterday's dogma rather than a necessity. The Nuffield report argues= that primary care trusts will have to be larger.3 This is sensible, but hardly news (the 200= 5-6 merging of primary care trusts only three years after they had been cre= ated kept them still too small to plan complex services serving large popul= ations). Yet it does not sit well with earlier research by some of the auth= ors of the report, who argued that the benefits of purchasing or commission= ing in primary care derive from the enthusiasm engendered by locally "owned= " schemes.5 6 So why is commissioning so weak? Firstly, most of conventional wisdom is wr= ong. It is argued that primary care trusts cannot control powerful hospital= s, referrals, and admissions; and that commissioning attracts a lower calib= re of manager than hospitals. Yet hospitals are desperate to avoid admissio= ns for which they are not properly paid, which is the norm, as the idea tha= t hospitals are "paid by results" (or rather, activity) falls down when con= fronted with cash limits. Separate commissioners have failed to work with providers to achieve the ou= t of hours care that would avoid repeat admissions to hospital. And the mai= n reason why commissioning attracts lower calibre people (which it generall= y does) is that it is divorced from provision. This is a structural problem= , and not one that can be solved by sending managers on expensive leadershi= p courses. The major challenge for the NHS now is to combine financial savings with qu= ality. This means the trade-off that Kaiser Permanente in the United States= allegedly achieved-shorter lengths of stay but with many more senior docto= rs per capita.7 Bu= t this cannot be achieved with commissioners who are distinct from the doct= ors and hospitals that provide care. In many areas of England, primary care= trusts and hospitals seek to make financial savings at the expense of othe= rs. It is ironic that many of the policy analysts who advocated the purchaser-p= rovider split are now supporting integrated care. The latest trend is "comp= eting integrated organisations." This idea is one in which care is delivere= d by collaborating primary and secondary doctors, but people choose which p= rimary care trust (which buys that care) to belong to. Commissioners are no= longer geographically based but compete for annual enrolments by the publi= c. This idea was considered and rightly rejected by the government as long ago= as 1993 and is a variant of the "managed competition" proposal developed i= n the US,8 which i= s relevant, if at all, only in those European countries with social insuran= ce rather than an NHS. It would involve yet higher costs for dubious benefi= t and new capacity (enough hospitals and clinics with "excess capacity" to = allow competition) just when we are being told that we cannot afford what w= e already have. So where now for commissioning? Instead of using yesterday's solutions, whi= ch are tortuously constructed so that the NHS market is retained as in the = options advocated by the Nuffield Trust and King's Fund, it would be better= to be bolder and to drop the industry of commissioning and its ever worsen= ing jargon, along with the purchaser-provider split-an option that is canva= ssed by the Health Select Committee. Integrated health authorities (what we= now call local health economies) and patient choice are perfectly compatib= le, as long as such authorities are funded in line with their workload. Ind= eed, this removes the bureaucracy from the current choice policy in England= , sometimes known as "managed choice" (with more management than choice). T= here is little practical difference between the types of choice patients re= ally have in the different systems of the UK, and it is only in England tha= t the market is seen as such a high priority. Cite this as: BMJ 2010;340:c1979 Calum Paton, professor of public policy 1 Keele University, Keele, Staffordshire ST5 5BG c.paton@hpm.keele.ac.uk ________________________________ Competing interests: The author has completed the Unified Competing Interes= t form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declares = (1) No financial support for the submitted work from anyone other than his = employer; (2) No financial relationships with commercial entities that migh= t have an interest in the submitted work; (3) No spouse, partner, or childr= en with relationships with commercial entities that might have an interest = in the submitted work; (4) No non-financial interests that may be relevant = to the submitted work. Provenance and peer review: Commissioned; not externally peer reviewed. References 1. Paton C. New Labour's state of health: political economy, public polic= y and the NHS. Ashgate, 2006. 1. House of Commons Select Committee on Health. Commissioning. 4th report= . Session 2009-10. 2010. www.parliament.uk/parliamentary_committees/health_= committee/health_committee_reports_and_publications.cfm. 1. Smith J, Curry N, Mays N, Dixon J. Where next for commissioning in the= English NHS? Nuffield Trust, 2010. www.nuffieldtrust.org.uk/publications/d= etail.aspx?id=3D145&prID=3D694. 1. Lewis R, Rosen R, Goodwin N, Dixon J. Where next for integrated care o= rganizations in the English NHS? Nuffield Trust, 2010. www.nuffieldtrust.or= g.uk/members/download.aspx?f=3D%2Fecomm%2Ffiles%2FWhere_next_ICO_KF_NT_2303= 10.pdf&a=3Dskip. 1. Walshe K, Smith J, Dixon J, Edwards N, Hunter DJ, Mays N, et al. Prima= ry care trusts. BMJ 2004;329:871-2.[Free Full Text] 1. Smith J, Mays N, Dixon J, Goodwin N, Lewis R, McClelland S, et al. The= purchasing of health care by primary care organizations. Open University P= ress, 2001. 1. Feachem RGA, Sekhri NK, White KL, Dixon J, Berwick DM, Enthoven AC. Ge= tting more for their dollar: a comparison of the NHS with California's Kais= er Permanente. BMJ 2002;324:135-43.[Abstract/Free Full Text] 1. Enthoven A. The theory and practice of managed competition. North-Holl= and, 1988. [cid:image003.png@01CAF1BD.3D804590] Published 11 May 2010, doi:10.1136/bmj.c2521 Cite this as: BMJ 2010;340:c2521 Letters Commissioning in English NHS Time to debate neoliberalism Paton highlights the inadequacies of commissioning in the English NHS.1 One of the recent = reports from the King's Fund and Nuffield Trust he cites illustrates the co= mplexities of the system, including the many models available (box).2 Current commissioning models2 National commissioning groups Supra-regional specialised groups Regional specialised groups Joint commissioning with local authority Primary care trust (PCT) Whole PCT practice based commissioning (PBC) Locality PBC consortium Personal medical services (PMS) provider organisation Single practice Personal health budgets The system is designed to increase market forces in the NHS. However, the e= xpense and the information asymmetry between primary and secondary care are= more examples of how markets fail in healthcare policy. For the past 30 years world governments have expected markets to solve all = their problems, including in the public services. Market forces and private= sector management practices (New Public Management) penetrate the whole pu= blic sector: All public services have to be based on a diversity of independent provider= s who compete for business in a market governed by consumer choice. All acr= oss Whitehall, any policy option now has to be dressed up as "choice," "div= ersity," and "contestability". These are the hallmarks of the "new model pu= blic service".3 But the evidence base for market based policies in many public services is = weak, so why has this approach become embedded across the public sector? On= e explanation from two Labour MPs in the last government: After years in opposition and with the political and economic dominance of = neoliberalism, New Labour essentially raised the white flag and inverted th= e principle of social democracy. Society was no longer to be master of the = market, but its servant. Labour was to offer a more humane version of Thatc= herism, in that the state would be actively used to help people survive as = individuals in the global economy-but economic interests would always call = all the shots.4 It is now time for the medical profession to question the underlying politi= cal and economic philosophy of neoliberalism that has dominated the politic= al landscape for the past 30 years. The charge has been led by the Australi= an prime minister, Kevin Rudd, in an 8000 word polemic.5 We should at least start some deb= ate. Cite this as: BMJ 2010;340:c2521 Clive Peedell, consultant clinical oncologist1 1 Middlesbrough TS4 3BW clivep-1._@tiscali.co.uk ________________________________ Competing interests: CP is a member of BMA Council BMA Political Board. References 1. Paton C. Commissioning in the English NHS. BMJ 2010;340:c1979. (15 Apr= il.)[Free Full Text] 1. Smith J, Curry N, Mays N, Dixon J. Where next for commissioning in the= English NHS? Nuffield Trust, 2010. www.nuffieldtrust.org.uk/publications/d= etail.aspx?id=3D145&prID=3D694. 1. Denham J. How not to make policy. Available at: www.chartist.org.uk/ar= ticles/labourmove/march06denham.htm 1. Cruddas J, Tricket J. How New Labour turned toxic. New Statesman 2007 = Dec 6. 1. Rudd K. The global financial crisis. The Monthly. Available at: www.th= emonthly.com.au/monthly-essays-kevin-rudd-global-financial-crisis--1421 Published 11 May 2010, doi:10.1136/bmj.c2522 Cite this as: BMJ 2010;340:c2522 Letters Commissioning in English NHS The market delusion Paton is right that the idea of general practice commissioning is recurring= .1 Politicians = realise that people trust their general practitioners more than politicians= or faceless commissioners in the health authority, primary care trust, or = whatever the organisation is called at the time; a few enthusiastic GPs wit= h an eye to improving services for their patients-and, possibly, their inco= me-actively campaigning to do it better than the existing commissioning bod= y; changes are made so that all GPs have to commission; and the enterprise = fails because, once everybody has to do it, the incentives to a few pilot p= ractices disappear, and, anyway, most GPs are more interested in being GPs = than commissioners. The idea of using a market to provide people with what they want is an illu= sion. Basic economic theory dictates that markets work in favour of consume= rs only when there is an oversupply. The health service is designed to be a= s "efficient" as possible, with oversupply seen as inefficiency to be ruthl= essly eliminated (even when it is needed to cope with outbreaks or the stoc= hastic nature of demand). In these circumstances, playing up the importance= of providing choice is dishonest rhetoric. Cite this as: BMJ 2010;340:c2522 Peter M B English, consultant in public health1 1 Surrey KT19 9XF petermbenglish@gmail.com ________________________________ Competing interests: None declared. References 1. Paton C. Commissioning in the English NHS. BMJ 2010;340:c1979. (15 Apr= il.) --_000_8F5713DF2D6DF14293423EF519BFB40D8C58DF832EE2K7CLUSTERcu_ Content-Type: text/html; charset="us-ascii" Content-Transfer-Encoding: quoted-printable

Published 15 April 2010, doi:10.1136/bmj.c1979
Cite this as: BMJ 2010;340:c1979

Editorials

Commission= ing in the English NHS

A failing system that needs to be abandoned =

Commissioning in the Englis= h NHS was born officially in 1997, when the new Labour government dropped the previous Conservative government’s term "purchasing." The aim was to signal that the culture o= f the competitive market was being replaced with collaboration bet= ween purchasers (health authorities, from 1997 to 2001) and providers (hospitals, mental health services, and community services), although the structure of the market—the split between purchaser and provider—remained. From 2002 the market was revived and commissioning became part of the new market.

Commissioning can be interpreted in two different ways. To some, it means collaborati= on between commissioners (primary care trusts and their associated general practices) and providers to determine healthcare needs a= nd how to provide them in an affordable way. To others, commissioni= ng is the means by which providers are disciplined—a view embraced by the Department of Health’s "world class commissioning" initiative, which is geared to making primar= y care trusts a meaningful countervailing power to hospitals.

Since the original "internal market" in the NHS, introduced in 1991, purchasing or commissioning has mutated through a series of confusing and frequent reorganisations, involving mutually incom= patible policies and high costs.1<= /sup> According to one recently published report from the House of Commons’ Health Select Committee,2<= /sup> the costs of commissioning are 14% of the NHS budget.

The idea of general practitioners holding money to buy secondary services has come a= nd gone repeatedly. Two other recent reports, produced jointly by t= he King’s Fund and Nuffield Trust,3<= /sup> 4<= /sup> seek to revive that idea, despite the recent failure of "pr= actice based commissioning"—a recent abortive attempt to replicate the incentives created by giving real budgets to gener= al practitioners (as with the Conservative government’s gener= al practitioner fund holding policy of 1991-7). <= /p>

The Nuffield Trust and King’s Fund advocate "integrated care," whereby primary and secondary clinicians work together, perhaps holding = real budgets, but with the primary care trust as a separate higher le= vel commissioning organisation. This would be complex and incur high costs. What is more, the main reason for such complexity would b= e to retain the purchaser-provider split, which many policy analysts = see as necessary for the English NHS. Yet this is yesterday’s dogma rather than a necessi= ty. The Nuffield report argues that primary care trusts will have to be larger.3<= /sup> This is sensible, but hardly news (the 2005-6 merging of primary= care trusts only three years after they had been created kept them st= ill too small to plan complex services serving large populations). Y= et it does not sit well with earlier research by some of the author= s of the report, who argued that the benefits of purchasing or commissioning in primary care derive from the enthusiasm engende= red by locally "owned" schemes.5<= /sup> 6

So why is commissioning so weak? Firstly, most of conventional wisdom is wrong. It is argue= d that primary care trusts cannot control powerful hospitals, referrals, and admissions; and that commissioning attracts a low= er calibre of manager than hospitals. Yet hospitals are desperate t= o avoid admissions for which they are not properly paid, which is = the norm, as the idea th= at hospitals are "paid by results" (or rather, activity) falls down when confronted with cash limits. <= o:p>

Separate commissioners have failed to work with providers to achieve the out of hours care t= hat would avoid repeat admissions to hospital. And the main reason w= hy commissioning attracts lower calibre people (which it generally does) is that it is divorced from provision. This is a structura= l problem, and not one that can be solved by sending managers on expensive leadership courses.

The major challenge for the= NHS now is to combine financial savings with quality. This means the trade-off that Kaiser Permanente in the United States allegedly achieved—shorter lengths of stay but with many more senior doctors per capita.7<= /sup> But this = cannot be achieved with commissioners who are distinct from the doctors= and hospitals that provide care. In many areas of England, primary c= are trusts and hospitals seek to make financial savings at the expen= se of others.

It is ironic that many of t= he policy analysts who advocated the purchaser-provider split are n= ow supporting integrated care. The latest trend is "competing integrated organisations." This idea is one in which care i= s delivered by collaborating primary and secondary doctors, but pe= ople choose which primary care trust (which buys that care) to belong= to. Commissioners are no longer geographically based but compete for annual enrolments by the public.

This idea was considered and rightly rejected by the government as long ago as 1993 and is a variant of the "managed competition" proposal developed in the US,8<= /sup> which is relevant, if at all, only in those European countries w= ith social insurance rather than an NHS. It would involve yet higher= costs for dubious benefit and new capacity (enough hospitals and clini= cs with "excess capacity" to allow competition) j= ust when we are being told that we cannot afford what we already hav= e.

So where now for commission= ing? Instead of using yesterday’s solutions, which are tortuous= ly constructed so that the NHS market is retained as in the options advocated by the Nuffield Trust and King’s Fund, it would be better to be b= older and to drop the industry of commissioning and its ever worsening= jargon, along with the purchaser-provider split—an option t= hat is canvassed by the Health Select Committee. Integrated health authorities (what we now call local health economies) and patien= t choice are perfectly compatible, as long as such authorities are funded in line with their workload. Indeed, this removes the bureaucracy from the current choice policy in England, sometimes known as "managed choice" (with more management than choice). There is little practical difference between the types = of choice patients really have in the different systems of the UK, = and it is only in England that the market is seen as such a high priority.

Cite this as: <= i>BMJ 2010;340:c1979

Calum Paton= , = professor of public policy

1 K= eele University, Keele, Staffordshire ST5 5BG

c.paton@hpm.keele.ac.uk

Competing interests: The au= thor has completed the Unified Competing Interest form at www.icmje.org/coi_disclosu= re.pdf (available on request from the corresponding author) and declare= s (1) No financial support for the submitted work from anyone othe= r than his employer; (2) No financial relationships with commercia= l entities that might have an interest in the submitted work; (3) No spouse, partner, or children with relationships with commerci= al entities that might have an interest in the submitted work; (4) = No non-financial interests that may be relevant to the submitted wo= rk.

Pr= ovenance and peer review: Commissioned; not externally peer reviewed.

References

  1. Paton C. New Labour’s= state of health: political economy, public policy and the NHS. Ashgate, 2006= .
  1. House of Commons Select Committee on Health. Commissioning. 4th report. Session 2009-10. 2010. www.parliament.uk/parli= amentary_committees/health_committee/health_committee_reports_and_publicati= ons.cfm.
  1. Smith J, Curry N, Mays N, Dixon J. Where next fo= r commissioning in the English NHS? Nuffield Trust, 2010. www.nuffieldtrust.org.uk/publications/detail.aspx?id=3D= 145&prID=3D694.
  1. Lewis R, Rosen R, Goodwin N, Dixon J. Where next= for integrated care organizations in the English NHS? Nuffield Trust, 2010= . www.nuffieldtr= ust.org.uk/members/download.aspx?f=3D%2Fecomm%2Ffiles%2FWhere_next_ICO_KF_N= T_230310.pdf&a=3Dskip.
  1. Walshe K, Smith J, Dixon J, Edwards N, Hunter DJ= , Mays N, et al. Primary care trusts. BMJ 2004;329:871-2.[Free Full Text]
  1. Smith J, Mays N, Dixon J, Goodwin N, Lewis R, McClelland S, et al. The purchasing of health care by primary care organizations. Open University Press, 2001. =
  1. Feachem RGA, Sekhri NK, White KL, Dixon J, Berwi= ck DM, Enthoven AC. Getting more for their dollar: a comparison of the NH= S with California’s Kaiser Permanente. BMJ 2002;324:135-43.= [Abstract/Free Full Text]
  1. Enthoven A. The theory and practice of managed competition. North-Holland, 1988.

3D"

Published 11 May 2010, doi:10.1136/bmj.c2521
Cite this as: BMJ 2010;340:c2521

Letters

Commissioning in English NHS<= o:p>

Time to de= bate neoliberalism

Paton highlights the inadequacies of commissioning in the English NHS.1 One of the recent reports from the King’s Fund and Nuffiel= d Trust he cites illustrates the complexities of the system, inclu= ding the many models available (box).2 <= /sup>


Current commissioning models2

National commissioning groups

Supra-regional specialised groups<= /span>

Regional specialised groups

Joint commissioning with local authority=

Primary care trust (PCT)

Whole PCT practice based commissioning (PBC)<= o:p>

Locality PBC consortium

Personal medical services (PMS) provider organisation

Single practice

Personal health budgets


The system is designed to increase market forces in the NHS. However, the expense and the information asymmetry between primary and secondary care are mor= e examples of how markets fail in healthcare policy.

For the past 30 years world governments have expected markets to solve all their problems, including in the public services. Market forces and private sect= or management practices (New Public Management) penetrate the whole public sector:

All public services have to be based on a diversity of independent providers who compete for business in a market governed by consumer choi= ce. All across Whitehall, any policy option now has to be dressed = up as "choice," "diversity," and "contestability&qu= ot;. These are the hallmarks of the "new model public service".3 <= /p>

But the evidence base for market based policies in many public services is weak, so why ha= s this approach become embedded across the public sector? One explanation from two Labour MPs in the last government:

After years in opposition and with the political and economic domina= nce of neoliberalism, New Labour essentially raised the white flag= and inverted the principle of social democracy. Society was no lon= ger to be master of the market, but its servant. Labour was to off= er a more humane version of Thatcherism, in that the state would be actively used to help people survive as individuals in the glo= bal economy—but economic interests would always call all the shots.4 <= /p>

It is now time for the medi= cal profession to question the underlying political and economic philosophy of neoliberalism that has dominated the political landscape for the past 30 years. The charge has been led by the Australian prime minister, Kevin Rudd, in an 8000 word polemic.<= sup>5 We should at least start some debate.

Cite this as: <= i>BMJ 2010;340:c2521

Clive Peedell, = consultant clinical oncologist1

1 Middlesbrough TS4 3BW

clivep-1._@tiscali.co.uk =

Competing interests: CP is = a member of BMA Council BMA Political Board.

References

  1. Paton C. Commissioning in the English NHS. BM= J 2010;340:c1979. (15 April.)[Free Full Text]
  1. Smith J, Curry N, Mays N, Dixon J. Where next fo= r commissioning in the English NHS? Nuffield Trust, 2010. www.nuffieldtrust.org.uk/publications/detail.aspx?id=3D= 145&prID=3D694.
  1. Denham J. How not to make policy. Available at: = www.chartist.org.uk/articles/labourmove/march06denham.htm
  1. Cruddas J, Tricket J. How New Labour turned toxi= c. New Statesman 2007 Dec 6.
  1. Rudd K. The global financial crisis. The Monthly= . Available at: www.themonthly.com.au/monthly-essays-kevin-rudd-glo= bal-financial-crisis--1421

 

Published 11 May 2010, doi:10.1136/bmj.c2522
Cite this as: BMJ 2010;340:c2522

Letters

Commissioning in English NHS<= o:p>

The market delusion

Paton is right that the ide= a of general practice commissioning is recurring.1 Politicians realise that people trust their general practitioner= s more than politicians or faceless commissioners in the health authori= ty, primary care trust, or whatever the organisation is called at th= e time; a few enthusiastic GPs with an eye to improving services f= or their patients—and, possibly, their income—actively campaigning to do it better than the existing commissioning body= ; changes are made so that all GPs have to commission; and the enterprise fails because, once everybody has to do it, the incentives to a few pilot practices disappear, and, anyway, most= GPs are more interested in being GPs than commissioners. =

The idea of using a market = to provide people with what they want is an illusion. Basic economi= c theory dictates that markets work in favour of consumers only wh= en there is an oversupply. The health service is designed to be as "efficient" as possible, with oversupply seen as inefficiency to be ruthlessly eliminated (even when it is needed= to cope with outbreaks or the stochastic nature of demand). In thes= e circumstances, playing up the importance of providing choice is dishonest rhetoric.

Cite this as: <= i>BMJ 2010;340:c2522

Peter M B English, = consultant in public health1

1 S= urrey KT19 9XF

petermbenglish@gmail.com =

Competing interests: None declared.

References

  1. Paton C. Commissioning in the English NHS. BM= J 2010;340:c1979. (15 April.)

 

--_000_8F5713DF2D6DF14293423EF519BFB40D8C58DF832EE2K7CLUSTERcu_-- --_004_8F5713DF2D6DF14293423EF519BFB40D8C58DF832EE2K7CLUSTERcu_ Content-Type: image/png; name="image003.png" Content-Description: image003.png Content-Disposition: inline; filename="image003.png"; size=173; creation-date="Wed, 12 May 2010 10:24:02 GMT"; modification-date="Wed, 12 May 2010 10:24:02 GMT" Content-ID: Content-Transfer-Encoding: base64 iVBORw0KGgoAAAANSUhEUgAAAB4AAAAeCAMAAAAM7l6QAAAAAXNSR0ICQMB9xQAAAANQTFRFAAAA p3o92gAAAAF0Uk5TAEDm2GYAAAAJcEhZcwAADsQAAA7EAZUrDhsAAAAZdEVYdFNvZnR3YXJlAE1p Y3Jvc29mdCBPZmZpY2V/7TVxAAAAEUlEQVQ4y2NgGAWjYBQMXgAAA6IAAfxo8voAAAAASUVORK5C YII= --_004_8F5713DF2D6DF14293423EF519BFB40D8C58DF832EE2K7CLUSTERcu_-- From ijansen@cupe.ca Wed May 12 10:37:32 2010 Received: from CUPEHUB1.CUPE.CA (cupehub1.cupedom.local [10.1.0.81]) by lists.cupe.ca (8.12.11.20060308/8.12.11) with ESMTP id o4CEbWHI006660 for ; Wed, 12 May 2010 10:37:32 -0400 Received: from E2K7CLUSTER.cupedom.local ([10.1.0.76]) by cupehub1.cupedom.local ([10.1.0.81]) with mapi; Wed, 12 May 2010 10:37:19 -0400 From: Irene Jansen To: "healthcare@members.cupe.ca" Date: Wed, 12 May 2010 10:37:32 -0400 Thread-Topic: Canada-EU trade accord could erode health care, say unions - British Medical Journal Thread-Index: AcrxOBCCpLNaUSUMRJiNANgNMCrgPAAAS4aAAClit9A= Message-ID: <8F5713DF2D6DF14293423EF519BFB40D8C58DF8344@E2K7CLUSTER.cupedom.local> Accept-Language: en-US Content-Language: en-US X-MS-Has-Attach: X-MS-TNEF-Correlator: acceptlanguage: en-US Content-Type: multipart/alternative; boundary="_000_8F5713DF2D6DF14293423EF519BFB40D8C58DF8344E2K7CLUSTERcu_" MIME-Version: 1.0 Subject: [CUPE healthcare list] Canada-EU trade accord could erode health care, say unions - British Medical Journal X-BeenThere: healthcare@lists.cupe.ca X-Mailman-Version: 2.1.8 Precedence: list List-Id: "Share news, research and ideas to defend public health care." List-Unsubscribe: , List-Archive: List-Post: List-Help: List-Subscribe: , X-List-Received-Date: Wed, 12 May 2010 14:37:32 -0000 --_000_8F5713DF2D6DF14293423EF519BFB40D8C58DF8344E2K7CLUSTERcu_ Content-Type: text/plain; charset="us-ascii" Content-Transfer-Encoding: quoted-printable See also: Scott Sinclair. April 2010. Negotiating from Weakness: Canada-EU trade trea= ty threatens Canadian purchasing policies and public services. Ottawa: Cana= dian Centre for Policy Alternatives. http://www.policyalternatives.ca/publications/reports/negotiating-%E2%80%89= weakness CUPE, NUPGE, PSAC and EPSU. January 2010. Critical Assessment of the Propos= ed European Union/ Canada Comprehensive Economic and Trade Agreement. http://cupe.ca/privatization-watch-january-2010/study-exposes-flaws-canada-= eu-trade __________________________________________ Published 10 May 2010, doi:10.1136/bmj.c249 Cite this as: BMJ 2010;340:c2490 News Canada-EU trade accord could erode health care, say unions John Zarocostas 1 Geneva Free trade talks currently under way between Canada and the European Union = risk eroding the role of the public sector in the provision of health care = on both sides of the Atlantic, say public service unions. The unions aired their concerns after they reviewed a leaked "secret" draft= text of a proposed comprehensive economic and trade agreement between the = EU and Canada, which has since been posted on the internet. "Although free trade may sound promising, such deals largely benefit huge m= ultinational corporations which have identified public services such as hea= lth care, education, and public security as the next frontier for making pr= ofit," said Peter Waldorff, general secretary of Public Services Internatio= nal, an umbrella group representing more than 20 million civil servants bel= onging to 693 unions in 156 countries. "This agreement's draft text outlines an agenda focused on privatisation, d= eregulation, and domestic restructuring. Public procurement policies and th= e right to regulate in the public interest are under threat," he said. Carola Fischbach-Pyttel, general secretary of the European Federation of Pu= blic Service Unions, said, "We believe there is no need for a deal that all= ows corporations to challenge local government policies on purchasing or re= gulation." The unions note that provisions of the draft would prevent municipal govern= ments from applying local or ethical procurement strategies. They also point out that a controversial dispute resolution mechanism is pr= oposed, similar to the one used under the North American Free Trade Agreeme= nt between Canada, Mexico, and the United States that has permitted corpora= tions to sue governments for compensation over public health and environmen= tal policies that limit the role of corporations. A spokesman for the EU's trade commissioner declined to comment on the crit= icisms, saying that as a rule the commission does not comment on leaked doc= uments. Canada's minister of international trade, Peter Van Loan, said in a keynote= speech on 30 April: "We also need to remind Canadians that, like all our t= rade agreements, an agreement with the European Union would exclude public = services such as health, education, and social services." He added, "It would also have no effect on the ability of governments at al= l levels to regulate in the public interest." However, public service unions want to see such agreements including airtig= ht guarantees that public services in health and education will not be chal= lenged. "Provisions for health and education should be exempted from clauses on pub= lic procurement or fair competition," said Jorge Mancillas, health services= officer for Public Services International. He said that such an exemption clause was needed to prevent private compani= es using fair competition clauses to challenge the right of public entities= to provide healthcare services or to challenge the procurement of public s= ervices. Dr Mancillas said that provisions in the proposed agreement concerning inte= llectual property were also of concern and that moves by corporations to ex= tend patent rights could limit the availability of cheaper generic drugs. So far negotiators at the talks, launched in 2009, have held three rounds o= f discussions, and new rounds are due to take place in July and October, wi= th a goal to reach a final agreement in 2011, senior transatlantic diplomat= s said. Spokesmen for the Canadian government and the EU say that an economic and t= rade agreement would seek to maximise new opportunities for economic growth= . Both Brussels and Ottawa have debriefed interested groups after each round,= but public service representatives say they have not been fully engaged or= consulted. "Ottawa is very vague about the negotiations," said Blair Redlin, a researc= her with the Canadian Union of Public Employees. "In the debriefings they d= on't tell us much. The whole process is not very transparent. There should = be public debate-they are not really dealing with us." Cite this as: BMJ 2010;340:c2490 ________________________________ The leaked draft text of the comprehensive economic and trade agreement is = available at www.tradejustice.ca. --_000_8F5713DF2D6DF14293423EF519BFB40D8C58DF8344E2K7CLUSTERcu_ Content-Type: text/html; charset="us-ascii" Content-Transfer-Encoding: quoted-printable

See also:<= /span>

Scott Sinclair. April 2010. Negotiating from Weakness: Canada-EU trade treaty threatens Canadian purchasing policies and public services. Ottawa: Canadian Centre for Policy Alternatives.

http://www.policyalternatives.ca/publications/reports/neg= otiating-%E2%80%89weakness

 

CUPE, NUPGE, PSAC and= EPSU. January 2010. Critical Assessment of the Proposed European Union/ Canada Comprehensive Economic and Trade Agreement.

http://cupe.ca/privatization-watch-january-2010/study-exp= oses-flaws-canada-eu-trade

_____________________= _____________________

Published 10 May 2010= , doi:10.1136/bmj.c249
Cite this as: BMJ 2010;340:c2490 <= /p>

News

Canada-EU trade accord could erode health care, say unions

John Zarocostas

1 Geneva

Free trade talks currently under way between Canada and the European Union risk eroding the role of the public sector in the provisio= n of health care on both sides of the Atlantic, say public service unions.

The unions aired their concerns after they reviewed a leaked "s= ecret" draft text of a proposed comprehensive economic and trade agreem= ent between the EU and Canada, which has since been posted on the internet.

"Although free trade may sound promising, such deals largely benefit huge multinational corporations which have identified public services such as health care, education, and public security as the next frontier for making profit," said Peter Waldorff, general secretary of Public Services International, an umbrella group representing more than 20 million civil servants belonging to 69= 3 unions in 156 countries.

"This agreement’s draft text outlines an agenda focused on privatisation, deregulation, and domestic restructuring. Public procurement policies and the right to regulate in the public interest are under threat," he said.

Carola Fischbach-Pyttel, general secretary of the European Federation o= f Public Service Unions, said, "We believe there is no need f= or a deal that allows corporations to challenge local government poli= cies on purchasing or regulation."

The unions note that provisions of the draft would prevent municipal governments from applying local or ethical procurement strategies.

They also point out that a controversial dispute resolution mechanism= is proposed, similar to the one used under the North American Free Trade Agreement between Canada, Mexico, and the United States that has permitted corporations to sue governments for compensation over public health and environmental policies that limit the role of corporations.

A spokesman for the EU’s trade commissioner declined to comm= ent on the criticisms, saying that as a rule the commission does not comment on leaked documents.

Canada’s minister of international trade, Peter Van Loan, said in a keyno= te speech on 30 April: "We also need to remind Canadians that, like all our trade agreements, an agreement with the European Un= ion would exclude public services such as health, education, and soc= ial services."

He added, "It would also have no effect on the ability of governments at all levels to regulate in the public interest."

However, public service unions want to see such agreements including airt= ight guarantees that public services in health and education will not= be challenged.

"Provisions for health and education should be exempted from clauses on publ= ic procurement or fair competition," said Jorge Mancillas, hea= lth services officer for Public Services International.

He said that such an exemption clause was needed to prevent private companies using fair competition clauses to challenge the right = of public entities to provide healthcare services or to challenge t= he procurement of public services. <= /o:p>

Dr Mancillas said that provisions in the proposed agreement concern= ing intellectual property were also of concern and that moves by corporations to extend patent rights could limit the availabilit= y of cheaper generic drugs.

So far negotiators at the talks, launched in 2009, have held three rounds of discussions, and new rounds are due to take place in J= uly and October, with a goal to reach a final agreement in 2011, senior transatlantic diplomats said.

Spokesmen for the Canadian government and the EU say that an economic and trade agreement would seek to maximise new opportunities for economic growth.

Both Brussels and Ottawa have debriefed interested groups after each round, but public service representatives say they have not been fully engaged or consulted.

"Ottawa is very vague about the negotiations," said Blair Redlin, a= researcher with the Canadian Union of Public Employees. "In the debriefings they don’t tell us much. The whole process is = not very transparent. There should be public debate—they are n= ot really dealing with us."

Cite this as: BMJ 2010;340:c2490

The leaked draft text of the comprehensive economic and trad= e agreement is available at www.tradejustice.ca.

 

 

--_000_8F5713DF2D6DF14293423EF519BFB40D8C58DF8344E2K7CLUSTERcu_-- From ijansen@cupe.ca Sun May 16 08:53:25 2010 Received: from CUPEHUB1.CUPE.CA (cupehub1.cupedom.local [10.1.0.81]) by lists.cupe.ca (8.12.11.20060308/8.12.11) with ESMTP id o4GCrPsB010268 for ; Sun, 16 May 2010 08:53:25 -0400 Received: from E2K7CLUSTER.cupedom.local ([10.1.0.76]) by cupehub1.cupedom.local ([10.1.0.81]) with mapi; Sun, 16 May 2010 08:53:25 -0400 From: Irene Jansen To: "healthcare@members.cupe.ca" Date: Sun, 16 May 2010 08:53:24 -0400 Thread-Topic: Health care back on front burner in poll - Globe and Mail Thread-Index: AQHK9PRyHIqTPPW8SUeV9KhcWiOQVA== Message-ID: <8F5713DF2D6DF14293423EF519BFB40D8C58851528@E2K7CLUSTER.cupedom.local> Accept-Language: en-US Content-Language: en-CA X-MS-Has-Attach: X-MS-TNEF-Correlator: acceptlanguage: en-US Content-Type: text/plain; charset="Windows-1252" MIME-Version: 1.0 Content-Transfer-Encoding: 8bit X-MIME-Autoconverted: from quoted-printable to 8bit by lists.cupe.ca id o4GCrPsB010268 Subject: [CUPE healthcare list] Health care back on front burner in poll - Globe and Mail X-BeenThere: healthcare@lists.cupe.ca X-Mailman-Version: 2.1.8 Precedence: list List-Id: "Share news, research and ideas to defend public health care." List-Unsubscribe: , List-Archive: List-Post: List-Help: List-Subscribe: , X-List-Received-Date: Sun, 16 May 2010 12:53:25 -0000 http://www.scribd.com/doc/31363480/Nanos-poll-May-13-2010 Globe and Mail Friday, May 14, 2010 Health care back on front burner in poll Jane Taber Canadians are feeling comfortable with the state of the economy, so much so that for the first time since 2009 health care trumps it as the No. 1 issue of concern in a new poll. This could even provide some opportunities for the opposition, provided that one of the parties puts a policy piece in the window. The Nanos Research survey shows that 22.8 per cent of Canadians are concerned with health care – an issue that used to be so front and centre for Canadians – compared to 18.6 per cent who are concerned about the economy. Nearly 11 per cent of respondents are concerned about the environment compared to 5.4 per cent who fret about education. What should be noted, too, is that respondents provided their answers unprompted. Pollster Nik Nanos attributes the results to a “diminished concern about the state and stability in the economy.” He notes that there is a gender split with women more likely to be concerned about health care by about a margin of two to one, while men are worried about the economy. “There are strategic implications for the federal parties with a potential change in voter focus,” Mr. Nanos says. “Traditionally, times of focus on economy tend to favour the Conservatives while a focus on social issues, such as health care, tend to favour the Liberals and NDP.” So there are opportunities here for the Liberals, who have not seen their fortunes rise in the opinion polls of late despite their hammering of the governing Tories over the Guergis/Jaffer affair and the tussle over release of the secret Afghan documents. Mr. Nanos warns, however, that a party must put forward some ideas and policy in order to capitalize on the mood of the electorate. His poll of 1,003 Canadians was conducted between April 30 and May 3. It has a margin of error of plus or minus 3.1 percentage points, 19 times out of 20. From hfarrow@cupe.ca Tue May 18 14:29:14 2010 Received: from CUPEHUB1.CUPE.CA (cupehub1.cupedom.local [10.1.0.81]) by lists.cupe.ca (8.12.11.20060308/8.12.11) with ESMTP id o4IITEWM005205 for ; Tue, 18 May 2010 14:29:14 -0400 Received: from E2K7CLUSTER.cupedom.local ([10.1.0.76]) by cupehub1.cupedom.local ([10.1.0.81]) with mapi; Tue, 18 May 2010 14:29:14 -0400 From: Heather Farrow To: "healthcare@members.cupe.ca" Date: Tue, 18 May 2010 14:29:12 -0400 Thread-Topic: Ontario public health care and public services article Thread-Index: Acr2uAOepUkYTa1PT9uKJPzaVDZ22w== Message-ID: <8F5713DF2D6DF14293423EF519BFB40D8C58E3B6B9@E2K7CLUSTER.cupedom.local> Accept-Language: en-US Content-Language: en-US X-MS-Has-Attach: X-MS-TNEF-Correlator: acceptlanguage: en-US Content-Type: multipart/alternative; boundary="_000_8F5713DF2D6DF14293423EF519BFB40D8C58E3B6B9E2K7CLUSTERcu_" MIME-Version: 1.0 Subject: [CUPE healthcare list] Ontario public health care and public services article X-BeenThere: healthcare@lists.cupe.ca X-Mailman-Version: 2.1.8 Precedence: list List-Id: "Share news, research and ideas to defend public health care." List-Unsubscribe: , List-Archive: List-Post: List-Help: List-Subscribe: , X-List-Received-Date: Tue, 18 May 2010 18:29:14 -0000 --_000_8F5713DF2D6DF14293423EF519BFB40D8C58E3B6B9E2K7CLUSTERcu_ Content-Type: text/plain; charset="us-ascii" Content-Transfer-Encoding: quoted-printable The Public Sector: Searching for a Focus Sam Gindin and Michael Hurley As capitalism begins to emerge from the Great Financial Crisis, there is go= od reason for working people to refrain from celebration. Though the roots = of the crisis were in the private sector, it's clear that the bill will be = primarily paid via the public sector - which is to say that the costs will = be placed on the working class as both providers and recipients of social s= ervices. ...read more > Heather Farrow Health Care Research Assistant Canadian Union of Public Employees (CUPE) National Office 1375 St. Laurent Blvd., Ottawa, ON K1G 0Z7 hfarrow@cupe.ca www.cupe.ca Fax: 613-237-5508 Tel: 613-237-1590, ext. 320 --_000_8F5713DF2D6DF14293423EF519BFB40D8C58E3B6B9E2K7CLUSTERcu_ Content-Type: text/html; charset="us-ascii" Content-Transfer-Encoding: quoted-printable

 

The Public Sector: Searching for a Focus=

 

Sam Gindin and Michael Hurley

 

As capitalism begins to emerge from the Great Finan= cial Crisis, there is good reason for working people to refrain from celebration= . Though the roots of the crisis were in the private sector, it's clear that = the bill will be primarily paid via the public sector - which is to say that th= e costs will be placed on the working class as both providers and recipients = of social services.  ...read more <http://www.och= u.on.ca//Healthcare_news_releases.html>

=  

=  

=  

Heath= er Farrow
Health Care Research Assistant
Canadian Union of Public Employees (CUPE)
National Office
1375 St. Laurent Blvd., Ottawa, ON K1G 0Z7  
hfarrow@cupe.= ca
www.cupe.ca
Fax: 613-237-5508
Tel: 613-237-1590, ext. 320

 

--_000_8F5713DF2D6DF14293423EF519BFB40D8C58E3B6B9E2K7CLUSTERcu_-- From hfarrow@cupe.ca Fri May 21 11:48:58 2010 Received: from CUPEHUB1.CUPE.CA (cupehub1.cupedom.local [10.1.0.81]) by lists.cupe.ca (8.12.11.20060308/8.12.11) with ESMTP id o4LFmwAw002872 for ; Fri, 21 May 2010 11:48:58 -0400 Received: from E2K7CLUSTER.cupedom.local ([10.1.0.76]) by cupehub1.cupedom.local ([10.1.0.81]) with mapi; Fri, 21 May 2010 11:48:58 -0400 From: Heather Farrow To: "healthcare@members.cupe.ca" Date: Fri, 21 May 2010 11:48:52 -0400 Thread-Topic: OCHU Funding Campaign and Clerical Conference Thread-Index: Acr4/RzewC+2niasTOKV84Cebd99bg== Message-ID: <8F5713DF2D6DF14293423EF519BFB40D8C58E9018A@E2K7CLUSTER.cupedom.local> Accept-Language: en-US Content-Language: en-US X-MS-Has-Attach: X-MS-TNEF-Correlator: acceptlanguage: en-US Content-Type: multipart/alternative; boundary="_000_8F5713DF2D6DF14293423EF519BFB40D8C58E9018AE2K7CLUSTERcu_" MIME-Version: 1.0 Subject: [CUPE healthcare list] OCHU Funding Campaign and Clerical Conference X-BeenThere: healthcare@lists.cupe.ca X-Mailman-Version: 2.1.8 Precedence: list List-Id: "Share news, research and ideas to defend public health care." List-Unsubscribe: , List-Archive: List-Post: List-Help: List-Subscribe: , X-List-Received-Date: Fri, 21 May 2010 15:48:58 -0000 --_000_8F5713DF2D6DF14293423EF519BFB40D8C58E9018AE2K7CLUSTERcu_ Content-Type: text/plain; charset="us-ascii" Content-Transfer-Encoding: quoted-printable 1) Staff at Peterborough Regional Health Centre plan a major campaign to pr= otect services from Liberal budget cuts Peterborough Ontario; Union members attended an emergency meeting last nigh= t to discuss how to respond to the Peer Review which has called for 71 bed = cuts, 151 full-time equivalent staff cuts and the closure of many clinics a= nd other services at Peterborough Regional Health Centre.. ...read more > 2) OCHU Clerical Conference 2010 Information _____________________________ = > Heather Heather Farrow Health Care Research Assistant Canadian Union of Public Employees (CUPE) National Office 1375 St. Laurent Blvd., Ottawa, ON K1G 0Z7 hfarrow@cupe.ca www.cupe.ca Fax: 613-237-5508 Tel: 613-237-1590, ext. 320 --_000_8F5713DF2D6DF14293423EF519BFB40D8C58E9018AE2K7CLUSTERcu_ Content-Type: text/html; charset="us-ascii" Content-Transfer-Encoding: quoted-printable

 

 

1) Staff at Peterborough Regional Health Centre pla= n a major campaign to protect services from Liberal budget cuts

 <= /span>

Peterborough Ontar= io; Union members attended an emergency meeting last night to discuss how to respond = to the Peer Review which has called for 71 bed cuts, 151 full-time equivalent staff cuts and the closure of many clinics and other services at Peterborou= gh Regional Health Centre..

...read more<= /o:p>

<http:/= /www.ochu.on.ca//community_campaigns_peterborough.html>

 <= /span>

 <= /span>

 <= /span>

2) OCHU Clerical Conference 2010 Information _____________________________ <http://www.= ochu.on.ca//conferences_and_conventions.html>

 

=  

=  

=  

=  

H= eather

=  

Heath= er Farrow
Health Care Research Assistant
Canadian Union of Public Employees (CUPE)
National Office
1375 St. Laurent Blvd., Ottawa, ON K1G 0Z7  
hfarrow@cupe.= ca
www.cupe.ca
Fax: 613-237-5508
Tel: 613-237-1590, ext. 320

 

--_000_8F5713DF2D6DF14293423EF519BFB40D8C58E9018AE2K7CLUSTERcu_-- From hfarrow@cupe.ca Tue May 25 15:14:51 2010 Received: from CUPEHUB1.CUPE.CA (cupehub1.cupedom.local [10.1.0.81]) by lists.cupe.ca (8.12.11.20060308/8.12.11) with ESMTP id o4PJEp51019249 for ; Tue, 25 May 2010 15:14:51 -0400 Received: from E2K7CLUSTER.cupedom.local ([10.1.0.76]) by cupehub1.cupedom.local ([10.1.0.81]) with mapi; Tue, 25 May 2010 15:14:51 -0400 From: Heather Farrow To: "healthcare@members.cupe.ca" Date: Tue, 25 May 2010 15:14:44 -0400 Thread-Topic: Pickets against Peterborough hospital cuts - CUPE members in Ontario Thread-Index: Acr8Pog/1e4WC7dyQzSwADwazz7kKg== Message-ID: <8F5713DF2D6DF14293423EF519BFB40D8C58E90512@E2K7CLUSTER.cupedom.local> Accept-Language: en-US Content-Language: en-US X-MS-Has-Attach: X-MS-TNEF-Correlator: acceptlanguage: en-US Content-Type: multipart/alternative; boundary="_000_8F5713DF2D6DF14293423EF519BFB40D8C58E90512E2K7CLUSTERcu_" MIME-Version: 1.0 Subject: [CUPE healthcare list] Pickets against Peterborough hospital cuts - CUPE members in Ontario X-BeenThere: healthcare@lists.cupe.ca X-Mailman-Version: 2.1.8 Precedence: list List-Id: "Share news, research and ideas to defend public health care." List-Unsubscribe: , List-Archive: List-Post: List-Help: List-Subscribe: , X-List-Received-Date: Tue, 25 May 2010 19:14:51 -0000 --_000_8F5713DF2D6DF14293423EF519BFB40D8C58E90512E2K7CLUSTERcu_ Content-Type: text/plain; charset="us-ascii" Content-Transfer-Encoding: quoted-printable Workers picket Leal's office in protest of hospital cuts; The Peterborough Examiner Wed May 12 2010 Page: A3 Section: News Byline: BRENDAN WEDLEY EXAMINER STAFF WRITER; Nurses and other health-care workers protested Tuesday in front of Peterbor= ough MPP Jeff Leal's office to draw attention to the looming layoffs at Pet= erborough Regional Health Centre. About 40 people carried picket signs and chanted songs as part of a demonst= ration organized by Canadian Union of Public Employees (CUPE) Local 1943. Karen Ward, president of CUPE Local 1943, said she had a positive conversat= ion with Leal on Tuesday and he's willing to work with the union. "We do have concerns about the recommendation to close 71 beds at our hospi= tal and also the fact that we'll lose services, perhaps, within our communi= ty and the impact that it will have to the quality of care to our patients,= " she said. A peer-review team has recommended that Peterborough Regional Health Centre= (PRHC) cut 151 full-time equivalent positions and 71 beds as a way to help= address the hospital's chronic deficit situation. The team recommended that 121 of the staff reductions be nursing positions. Protesters marched on King St. between Aylmer and Bethune streets chanting = "save our health care." Picket signs carried messages such as "protect the health services in our c= ommunity," "bad boardroom decisions don't look after patients," "Jeff Leal = -- don't turn your back on our community" and "Jeff Leal, your hospital cut= s threaten our health." Leal wasn't at his constituency office to hear the protesters but he spoke = with Ward earlier in the day. He was at Queen's Park in the legislature. It's important that the hospital have financial stability to provide qualit= y and safe medical care and to provide a wide range of community health car= e services, Leal said in a phone interview. "The 60 recommendations from the peer review are not carved in stone," he s= aid. There are currently more than 140 vacant positions at the hospital because = PRHC president and CEO Ken Tremblay decided to not fill vacant positions, L= eal said. "We need to look at those vacant positions," he said, adding that the vacan= t positions could help minimize any job losses. "Any job loss has an import= ant impact on one's family and one's community." Wendy Miles has worked as a registered practical nurse at PRHC, the former = Civic Hospital and the former St. Joseph's hospital for a combined 18 years= . "We're very concerned about the proposed cuts affecting health care in Pete= rborough," she said as she took part in the protest. "I don't see how they = think people can be looked after with reduced staff and funding. "We want to preserve health care in Ontario. We want to keep service local = and have people looked after well." bwedley@peterboroughexaminer.com (c) 2010 Osprey Media Group Inc. All rights reserved. Heather Heather Farrow Health Care Research Assistant Canadian Union of Public Employees (CUPE) National Office 1375 St. Laurent Blvd., Ottawa, ON K1G 0Z7 hfarrow@cupe.ca www.cupe.ca Fax: 613-237-5508 Tel: 613-237-1590, ext. 320 --_000_8F5713DF2D6DF14293423EF519BFB40D8C58E90512E2K7CLUSTERcu_ Content-Type: text/html; charset="us-ascii" Content-Transfer-Encoding: quoted-printable

 

 

Workers picket Leal's office in protest of hospital cuts;=

The Peterborough Examiner
Wed May 12 2010
Page: A3
Section: News
Byline: BRENDAN WEDLEY EXAMINER STAFF WRITER;

Nurses and other health-care wor= kers protested Tuesday in front of Peterborough MPP Jeff Leal's office to draw attention to the looming layoffs at Peterborough Regional Health Centr= e.

About 40 people carried picket s= igns and chanted songs as part of a demonstration organized by Canadian Union= of Public Employees (CUPE) Local 1943.

Karen Ward, president of CUPE Lo= cal 1943, said she had a positive conversation with Leal on Tuesday and he's willing to work with the union.

"We do have concerns about = the recommendation to close 71 beds at our hospital and also the fact that we'l= l lose services, perhaps, within our community and the impact that it will ha= ve to the quality of care to our patients," she said. <= /p>

A peer-review team has recommend= ed that Peterborough Regional Health Centre (PRHC) cut 151 full-time equivalen= t positions and 71 beds as a way to help address the hospital's chronic defic= it situation.

The team recommended that 121 of= the staff reductions be nursing positions.

Protesters marched on King St. b= etween Aylmer and Bethune streets chanting "save our health care." =

Picket signs carried messages su= ch as "protect the health services in our community," "bad boardro= om decisions don't look after patients," "Jeff Leal -- don't turn yo= ur back on our community" and "Jeff Leal, your hospital cuts threate= n our health."

Leal wasn't at his constituency = office to hear the protesters but he spoke with Ward earlier in the day. He was at Queen's Park in the legislature.

It's important that the hospital= have financial stability to provide quality and safe medical care and to provide= a wide range of community health care services, Leal said in a phone intervie= w.

"The 60 recommendations fro= m the peer review are not carved in stone," he said.

There are currently more than 14= 0 vacant positions at the hospital because PRHC president and CEO Ken Trembla= y decided to not fill vacant positions, Leal said.

"We need to look at those v= acant positions," he said, adding that the vacant positions could help minim= ize any job losses. "Any job loss has an important impact on one's family = and one's community."

Wendy Miles has worked as a <= span style=3D'background:#FFFF99'>registered practical nurse at PRHC,= the former Civic Hospital and the former St. Joseph's hospital for a combined 1= 8 years.

"We're very concerned about= the proposed cuts affecting health care in Peterborough," she said as she = took part in the protest. "I don't see how they think people can be looked after with reduced staff and funding.

"We want to preserve health= care in Ontario. We want to keep service local and have people looked after well."

bwedley@peterboroughexaminer.com=

© 2010 Osp= rey Media Group Inc. All rights reserved.

 

=  

=  

=  

=  

H= eather

=  

Heath= er Farrow
Health Care Research Assistant
Canadian Union of Public Employees (CUPE)
National Office
1375 St. Laurent Blvd., Ottawa, ON K1G 0Z7  
hfarrow@cupe.= ca
www.cupe.ca
Fax: 613-237-5508
Tel: 613-237-1590, ext. 320

 

--_000_8F5713DF2D6DF14293423EF519BFB40D8C58E90512E2K7CLUSTERcu_--