The discussion surrounding SYSCO and their decision to locate in Woodstock raised a number of questions around industrial land development.  There were also a number of things that I learned, and a number of assumptions that were challenged.  To get an overview of industrial land in London, check out this report from 2011.  A couple of highlights:

• We do have industrial land available
• But it is moving, so we are going to keep requiring more
• Part of the reason it is moving is that it is at a discount
• But given the economic context and the policies and prices of our neighbours, we will need to continue to offer it at a discount for the foreseeable future

How much of a discount land is offered at is highlighted by Councillors Polhill and Hubert’s comments to the press that we couldn’t out-bid Woodstock without breaking the law, and costing taxpayers a huge amount of money.  That said, we lost the facility.  So, the tough question is, in the race to spend money to purchase jobs, should we ever pull out?

A part of this picture is our current policy on development charges, particularly that there is an exemption for industrial land (and residential development in certain areas).  Development charges cover the costs of both engineered services and soft services; for (much) more on these charges and how they are calculated see this background study.  Industrial land costs $108.64/sq m, which is currently carried through property taxes.  To be more clear, you and I pay the cost of bringing new businesses to London.  Industrial land pricing and policies seems very much a catch-22 in my mind, so I’m interested in hearing your perspectives.  Do you think that development charges on industrial land should continue to be exempted?

I work closely on a number of projects with Dr. Cheryl Forchuk, and much of her current work focuses on youth homelessness.  I was quoted in this news article talking about some of the root issues and key challenges of youth homelessness.  In the work that I do looking at policies and homelessness mostly with adults, the majority of them trace their life stories back to a tipping point, a time when things went downhill and since which they just haven’t been the same.  For many, this is the point at which they left school (willingly or not).

However, the end of school is often only one domino falling in a long line.  After the school domino falls, there are often others that come down, such as starting to use substances, which makes it harder for people to exit homelessness.  And, on the other side, the dominoes that knocked out school are often leaving home, precipitated by family conflict, precipitated by either poverty, abuse, mental illness, substance use of parents,  separation/divorce/marriage, or all of the above.  So, the lack of an education can doom a youth to poverty, but far before that was what is often a lifetime of family conflict in the (former) home.

This has significant implications for how we organize social services.  Getting into the home to help people, or surrounding people with supports through the school system, is very difficult.  It is actually far easier to create a drop-in for homeless youth than to try to prevent family conflict.  In terms of upstream versus downstream services, this appears to be one of the hardest.  However, if we could support children and youth we would be preventing substance use, mental illness, poverty and homelessness, and assisting with education and employment.  The big question is: How do we intervene?

For my third and final post on the Drummond Report, I will focus on the second area that I am most connected with, post-secondary education.  I will then move on to analyzing the provincial and federal budgets.

The same principle in my opening blog applies, that we need to look at education being scaled to people’s ability to pay, rather than giving rebates to everyone (I forgot to mention the tax-free savings account before, which is another good example of a regressive program).  The Ontario Tuition Grant is obviously the example of this most on people’s minds, and has a cut-off set so high that many people who could afford to pay, are getting a rebate.  We need to continue to move away from government as give of gifts to all, to the government targeting people in low-income to try to level the field.

Drummond points out an important reality in the university sector, that research is really the prime currency.  This is leading universities to create large internal research funds, rather than relying on faculty to be solely supported by external funds.  This is often done to support ‘weaker’ researchers, and is due to the fact that all faculty must be researchers as well as teachers.  Drummond suggests allowing flexible work-loads so that those who are good at teaching can just teach, and those who are good at research can just do research.  This way universities can save money from internal research funding and keep costs down.

The second important problem Drummond highlights is the proliferation and duplication of programs.  It is in the best interests of universities to offer every possible program for every possible student so that they can attract the most students, and the best students.  This is blurring out into colleges as well, who are increasing their degree granting programs or partnerships.  This leads to more levels of administration as each department and program has a director, or chair, or manager.  Instead, what we need to be open to is university specialization.  Having fewer departments or programs at each university site would mean that students might have to travel further abroad to find the program they want, but would save millions in terms of administrative costs.  Similarly, colleges should absolutely not take on granting of degrees that are offered in universities in the same city.

Lastly, is the sticky issue of salaries and benefits.  Everyone wants their salary to increase at least at the rate of inflation.  However, like the physicians who have asked to be taxed more, professors have been doing well and could survive a freeze or a decrease in pension contributions.  The university essentially pays 3-1 for my pension contributions, which is great, but honestly, isn’t entirely necessary as we also earn above average.  If there is anyone who should take a hit in the budget, it is high-income earners, so that more can be done for those in poverty.

For the second in my series on the Drummond Report, I get into the part the hits closest to home for me as a nurse, health care.  The report mostly covers issues that many of us within the system have been talking about for years, so hopefully this part will get the full attention of decision-makers.  However, before highlighting the key points that I agree with, I wanted to speak briefly to the LHINs.

LHINs came under fire during the last provincial election due to the costs of paying management level positions.  However, it is important that we remember the history and the purpose of regionalizing health care.  For years, if not decades, in London we have been complaining about a health system centralized in Toronto and not terribly responsive to our particular needs.  The district health authorities seemed tokenistic and toothless.  We wanted local decision-making for local health care.  So, the LHINs are an answer to this, truly being able to manage our health care dollars locally.  However, the biggest problem we have had since their inception is that LHINs have not had enough power to really work.  Primary health care, public health, home health all fall outside their authority, and hospitals operate with independent boards.  The Drummond Report gets to the heart of this matter, and says that a truly integrated, truly efficient system means that all pieces have to be folded into local decision-making.  This is a positive direction.

Other than that, there are many recommendations that we have been saying for years:

• We must move away from an acute care heavy system and do as much as possible through primary care, home care, and outpatients.
• We must protect our drug costs from the impact of free trade agreements.
• We have to stop having the most expensive care providers doing care that others could do.  This means more nurse practitioners, and many more nurses working at full scope of practice.
• We cost the most to the health care system in the last year of life.  We need to ensure everyone has pre-planned for end-of-life care to avoid extremely expensive procedures and treatments that might not be wanted.
• Let’s hold off greatly increasing long-term care beds before we can better figure out our home care system.
• Physicians should be paid primarily through salary/capitation versus fee-for-service, and compensation could be frozen and still have Ontario physicians as the best paid in the country.
• Primary care physicians should all work within teams that are interdisciplinary.
• Health benefits should be linked to income, not age (ie. progressive not regressive).
• Electronic records…need I say more?

There are lots of suggestions here.  However, I wouldn’t even describe this as ‘tough medicine’, I would describe it as good system management, that has strong fiscal benefits.

This is the first in what will be a series looking at the recommendations and the implications of the Drummond Report, looking at Ontario’s public services.  So, my apologies to out-of-province or out-of-country readers, but it’s going to be Ontario for the next number of posts.

As you are all aware, the Drummond Report is really about fiscal responsibility, and eliminating the provincial deficit.  So, the first key point is that we’re talking deficit, not debt, the goal is simply to get to the point of spending no more than we earn each year, so that debt will hold steady rather than grow.  This is an important endeavour, one that those of any political stripe can get behind, because the more money that we spend servicing debt each year, the less we can spend on other programs.

The second key point is that the Drummond Report focuses mostly on expenditure reduction versus revenue generation.  While a number of recommendations are made related to the taxation system, the focus is not on analysing the optimum corporate or income tax rates.  This is important, because if new revenue is not forthcoming, then we must cut in order to balance the books.  We can argue another day about revenues and taxation.

Much of the Report focuses on increased efficiency, such as consolidating back office services.  This makes plenty of sense, but the third key point is that much of this will cost us jobs.  Approximately 50% of spending is labour costs, so decreasing spending will relate to decreased jobs.  For example, if we consolidate all purchasing departments, that means someone who works in purchasing somewhere will be laid off.  The same, of course, with detention centres.  So this will hurt, but not as much as continuing to have to cut programs to service debt.

A fourth key point highlighted in the Report is that the government should not play Santa Claus.  That is, there should be nothing in the system by which the government subsidizes costs for everyone ,such as water, or gives away money to everyone such as the Ontario Clean Energy Benefit.  This is regressive, and means that our tax dollars are going to the rich as much as the poor.  Eliminating these give-aways and creating real world costing means that the cost of living will go up, necessitating an increase in social assistance as recommended in the report.  This is the most important point, because we can use these recommendations to actually decrease income inequality, rather than increasing poverty.

And, as opposed to government give-aways, on the flip side the Report makes a fifth key point that we should hang onto revenue generating assets.  Whether the government should be in casinos, or alcohol, or driver licensing, lets hang onto these items and keep taxes down if they are generating revenues.  This is a message that municipal governments need to hear as well, because Drummond makes it clear that selling revenue-generators to meet short-term fiscal goals (such as development or just balancing the books) is poor long-term fiscal planning.

The methadone clinic issue discussed yesterday is one piece in a much larger picture of challenges that are facing us with addictions.  We currently have a perfect storm of legislation changes and system issues at the federal, provincial, LHIN, and municipal level that are going to work together to create a substance use crisis.

At the federal level, you have Bill C-10, which legislates mandatory minimum sentences.  At the provincial level, we have the introduction of Bill 101 last year that I discussed in this post.  This Bill limits the prescription of narcotics.  More recently, we had the delisting of OxyNEO (new form of Oxycontin) from the Ontario Drug Benefit, meaning that it will not be paid for unless one qualifies under the Exceptional Access Program.  And of course, there is the creation of OxyNEO itself, which will be much harder to abuse.  Within the LHIN, we have a crisis around access to residential treatment, with wait-lists for subsidized beds extending beyond six months.  And municipally, we have the still on-going moratorium on the creation of new methadone maintenance treatment clinics and pharmacies.

Put this all together, and you have a situation whereby people with narcotic addictions will be unable to obtain prescription narcotics, and have difficulty accessing treatment.  These changes will mean that other substances, such as Fentanyl and heroin, will be ‘priced’ into the market.  With heroin you have the re-introduction of organized crime as the primary source for narcotics, at the same time as Bill C-10 will mean that those committing such crimes will face much longer sentences.  This will increase significantly our costs in the justice system, while facing increased costs of substance use related property crime and prostitution (ie. policing).

So, who owns this problem?  Which level of government is going to step up and prevent this crisis?  Who will hold them accountable?

The Methadone clinic and pharmacy issue in London Ontario has been long-standing, as evidenced in my first post on this issue almost a year ago, that was a reflection looking a year back.  In a nutshell, a new Methadone clinic was proposed, a community association opposed it, and Council delayed the establishment of any new clinics until it could have full public consultation, and create by-laws to address public concerns.

The upside of the whole discussion and consultation is that absolutely everyone has agreed on the importance of Methadone Maintenance Therapy (MMT) as part of the spectrum of recovery and reducing the harm of substance use in our community.  So, there will be more clinics, but the real concern is the public perception of what happens in the area of a clinic when a large number of people in recovery and the drug dealers who prey on them are around.  And, although I feel that some of these concerns are based in undue prejudices, if the public wants set-backs from schools, we can have set-backs from schools.

And, set-backs from schools, community centres, and parks are largely what is proposed in the new by-laws.  There is also considerations of at what point a physician’s practice becomes a Methadone clinic, and what point a pharmacy becomes a Methadone pharmacy (over 30 patients/day in both cases).  If you have a look at page 27 of the staff recommendations, you will see that this still allows for plenty of new clinics to open.  Although initially concerned about the process, only one point remains that worries me in terms of limiting access to treatment: the requirement for public site plan consultation.  Now, you might say that this flies in the face of yesterday’s concern about the lack of listening to the public.  However, in this case there are explicit directions in terms of the siting of clinics, the size, access to transit, and access to indoor waiting space.  My concern is that public consultation will simply create a context where NIMBYism will run rampant with no value-add in terms of developing the sites.

Now, however, the plot has thickened with a simple letter sent to Council from Barbara Hall, the Chief Commissioner of the Ontario Human Rights Commission.  In the letter, Commissioner Hall points out that Kitchener tried a similar approach and was required to re-write due to “people zoning”, a process of discrimination against people experiencing a mental illness, including an addiction.  Methadone clinics and pharmacies are medical centres, existing to treat people with medical conditions.  Zoning these out of certain areas might simply be turned down at the Ontario Municipal Board.

This is a letter I have sent to the editor of London Community News, as well as City Council:

To the Editor/Mayor and City Councillors,

Affordable housing is a good investment.  Although considered a part of the social services basket, affordable housing carries a number of positive economic implications.  Historically, every $1 of municipal funding has leveraged $3 from other orders of government and almost $4 from the private sector.  This means that the $1M cut to the Housing Reserve Fund represents a potential $8M loss, or at $140,000 per unit, 57 units of affordable housing not built.  Each new unit also represents 2 person years of full-time employment.

Secondly, affordable housing represents a much cheaper way to house people who are experiencing homelessness.  Housing an individual in shelter costs $1,450 per month, jail costs $140 per day, psychiatric acute care costs $650 per day, and acute care inpatient over $1,000 daily.  These statistics are clearly outlined in your Council-approved London Community Housing Strategy.  Therefore, putting money into housing up-front saves us much greater costs down the line.

Finally, building affordable housing is part of the intensification process that saves our communities.  London has a 40% intensification target, of which affordable housing is a key component.  A quick walk through the Old East Village will show you the CentreTown Mall site now being developed, along with the Medallion development on King, which will bring much needed life to a high vacancy strip of Dundas Street between Adelaide and Lyle.

I understand the desire to limit property taxes, but let’s do so in a manner that is best for our community.  I urge you to vote against the recommendation to cut the payment to the Housing Reserve Fund.

Respectfully,

Abe Oudshoorn, RN, PhD

Those who provide services to people experiencing homelessness know that the Safe Haven drop-in centres have closed this year (although the Men’s Mission maintains a parallel drop-in service at their same site).  This, as with any service change, has not been very well received in the community.  At a time when resources were stretched, the loss of any service (particularly one that was accessed 113,700 times per this report, pg 331) hits hard.

So, why were they closed?  Well, there were a number of reasons that they might not have been optimal, but the primary reason would be that the funding is being reallocated.  This funding is now being utilized for re-housing services provided by street level workers.  The concept is spending less money on managing homelessness, and more on ending it.  This is a large part of what the current community plan is looking at, and is an intelligent direction.  However, the change is still uncomfortable.

The other important piece to note is that there are indeed places for people to go during the times that the Safe Havens operated.  Now, that they were so well utilized means that they fit a purpose, but there are still other places to go.  That said, it is still worthwhile for London to consider low-barrier, after hours drop in spaces for people, particularly those using substances.

‘Twas a week of letter writing apparently, below is my submission to City Council on the issue of the installation of more needle collection bins in London. You can see the London Free Press article on the issue here.

To the Community Services Committee and London City Council,

I would like to make comment on the issue of recently installed additional needle collection bins. As a professor whose research covers homelessness and health, I have followed with great interest the activities around London CAReS since the original report in December of 2007. I believe that it reflects very well on Council to have been proactive in addressing issues around addictions and homelessness in our community, rather than putting off the concerns to other orders of government. Needle bins are indeed an important component of a comprehensive response to addiction, while also having the added benefit of community safety. Although ‘harm reduction’ is not popular terminology in some circles, it does not take complex science to understand that in order to treat addictions, step one is keeping the addict alive.

I trust that the memory of Council is longer than that of the general public, and you will recall the concerns of needles found in public spaces and spaces utilized by children. Needle bins, although described by a few as ‘unsightly’, are both part of best practices in responding to addictions, and are a significantly better alternative to our former state of haphazard disposal. If you find yourselves requiring further research to assist you with decision-making, I would be happy to serve as a resource to your staff.

Thank you for your time,

Abe Oudshoorn, RN, PhD