Drummond Report – Post-Secondary Education

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.

Fleming Drive: Be Careful What You Wish For

When a riot in your hometown hits BBC news, it’s probably time to blog about it.  For my international friends who haven’t heard, there was a St Patrick’s Day riot in London, Ontario in a neighbourhood made up predominantly of student housing.

I wanted to comment briefly on potential police response and preventing further occurrences.  From the G20 protests, the Vancouver hockey riots, and this weekend’s St Patrick’s Day riot, it is clear that once these kind of events are in motion, police are ill-equipped, and likely ill-advised, to intervene.  However, after the events are over, public ire often turns towards police forces with demands that they should have stopped it.

Well, we tried that during the G20, don’t you remember?  You likely remember smashed windows and burning cop cars, but remember how at the end of the first day they went into the park and did mass arrests of peaceful protesters?  Do you remember the kettles on the second day that caught up people out for dinner, and the TVO journalist Steve Paikin?  This is what a heavy police presence and preventative arrests looks like, and it sure looks ugly.  This was the largest mass arrest in Canadian history, the vast majority of whom were released without charges.  Do you remember the cages?  The cold?  The indignity?

And then of course there is the cost.  Yes, we could use a massive police presence, go heavy on the arrests, and kettle people in, as ugly as it is; but freedom and human rights issues aside, do we really want to pay for this?  Each major potential party we’re going to pay overtime for 100’s of SWAT officers?  This would quickly make $100,000 of property damage look like peanuts.  And, with police budgets taking an ever increasing portion of the City budget, what services will we cut to make this happen?

So, I conclude that the heavy police response is not the route any of us really want to go.  In the search for quick and easy solutions it is tempting, but hopefully we can be more thoughtful than the easy and expensive.  Other bloggers have begun to offer insight into possible solutions that focus instead on community-building; this is where we need to go.

Drummond Report – Health Care

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.

Drummond Report – The Key Principles

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.

Housing and Homelessness – London

A friend recently asked for some of the basics on housing and homelessness in London, here’s what I sent him:

Our best estimate is that on any given night in London, 2000 are homeless.  This represents 600 in shelter and transitional housing, about 20 sleeping rough, many women trading sex for a place to stay, those in hospital and jail with no-fixed-address, and the hidden 1000 or so who are couch surfing.  This, of course, depends on the definition of homelessness used.  An important point is that although 2000 are homeless on any night, for most it is a transitional experience, and a recent project in London identified just over 10,000 Londoners who were homeless at least 1 night of the year.

In terms of housing, there are just over 3000 families on the wait-list, representing approximately 4300 individuals.  The wait-list is 1-2 years for those who are high need (example: children, and women fleeing abuse), and 8.3 years for the general wait-list.  The current Housing Strategy is to create 1000 new units over the next 5 years, although the fiscal plan only predicts 450 over the next 3 years, and the new plan that takes into consideration the cut predicts just 115 new units over the next 2 years.  The thing about housing is that the City doesn’t actually build, but provides funds to private or non-profit entities that approach the City to build.  With the money currently in the reserve fund the City will match provincial and federal dollars granted to builders over the next 2 years, but will be unable to do so in years 3-5 of the plan.  It’s currently looking unlikely that we will achieve even half the goal of 1000 units.  This means that with the continued increase of those on OW and ODSP, the wait-list is likely to grow, creating a bubble of homeless people who are homeless simply because they cannot afford housing.  Over the past five years we added 873 units, bringing the total units (representing various delivery models from rent-subsidy to public housing) to 8,060.  As the new units are built by independent developers and organizations, they can target particular groups, such as recent buildings for seniors, First Nations people, and adults with disabilities.  The City does not mandate this, only that they units be at a maximum of 80% of market rent, and preferably 70%.

In terms of causes of homelessness, other than the obvious lack of housing, complicating factors are that about 2/3rds are experiencing a mental illness, and 1/3 are experiencing an addiction.  These individuals often require not just affordable housing, but affordable housing with supports.  This is challenging, as no level of government or government department is currently focusing on supporting people in their home, outside of the Ministry of Health program for seniors, Aging at Home.

A Perfect Storm

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?

Methadone Clinic/Pharmacy By-Laws

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.