Friday, June 16, 2017

Manitoba Conservative government may privatize home care services

The Manitoba Progressive Conservative (PC) government of premier Brian Pallister is looking to save money on provincial home care service programs and may even privatize the service.

However, Pallister won't say yet whether he plans to privatize the service saying: "I'll continue to say that we are looking for results and improving results. We shouldn't be close-minded about it. All across the country other provinces have faced up to these challenges — some private improvements, lots of changes within the public sector delivery model. We are pursuing these things. We are looking for options." A private company will operate the service only if it makes a profit so unlike a public service it needs to aim for more than just covering its costs. It would not want to incur a deficit to handle expanding needs. either.
In spite of Pallister's remarks, the Manitoba Government and General Employees'' Union (MGEU) revealed that the Winnipeg Regional Health Authority(WRHA) intends to contract out services provided by home care nurses for a newly announced "enhanced home care service". The government is great at rhetorical puffery when they want to promote what will probably be reduced services. MGEU president Michelle Gawronsky believes that the contracting out is a first step towards privatizing Manitoba's home care services resulting in public sector job losses. Gawronsky said: "[Home care workers] are very, very concerned. They're angry, they're upset. We are looking for major change to happen within our system and we are being attacked for trying to improve a system that is the worst in Canada."
The WRHA announced the plans for contracting out in April after the province cancelled the Hospital Home Team a unit of about 10 nurses who were in charge of caring for about 550 chronically ill patients in Winnipeg in their homes. The province had previously given $1.7 million to pay for the program but ended funding on March 31st this year. The appended video appears to be made by nurses in the program. On May 8 in a meeting with WRHA president Milton Sussman , Gawronsky learned about the contracting out scheme. Union members were shocked at the news.
The province has already cut health services in Winnipeg closing half of the emergency facilities, forcing many to make longer trips to emergency rooms. Present legislation in Manitoba requires all regional health authorities to provide home care services free to all who meet the program's requirements. The program is actually quite cost efficient in that it delays sending patients to a long-term care facility where costs are much higher. Under the current contract, 80 percent of the workers in the program must belong to the MGEU. However, contracting out could possibly lead to a breach in the contract according to Gawronsky who wrote to health minister Kevin Goertzen outlining her concern.
As the population of the province ages, a recent report claims that the program that costs now over $300 million annually could end up costing $874 annually by 2037. That is close to three times the present cost but that is over twenty years, a long period. Doing away with the program would cost even more. However much of that cost could be placed on the people now being served by the program rather than the government. In 1996 the then Progressive Conservative premier Gary Filmon also tried to move towards for-profit home care but had such negative reactions that he dropped his plans after a short pilot project.
The WRHA is being forced to find $83 million in savings for the coming year. Miton Sussman chair of the WRHA said that all options were on the table including privatization. He also said that he could not guarantee that jobs would not be lost. Not only will jobs be lost but they will be relatively well paying union jobs to be replaced by non-union jobs with lower pay in order to make room for private operators to make a profit should services be privatized. Sussman said that their had to be changes to achieve the savings required by the government. All five Manitoba health regions have been told by the government to balance their books and find savings for 2017-18. The budget for 2016-17 was $2.6 billion and was projected to wind up $30 million in the red. This is not that large a percentage in terms of the total budget.
Other services considered for privatization are MRI scans and cataract surgeries. However Sussman claimed that the WRHA was had made no decisions yet and was still considering options.,saying:"I don't want to speculate that it is something that is going to happen. What I am saying is we are looking at a whole range of options and if someone can provide a high quality at a lower cost, we have to consider those kinds of things.Where is makes sense, it might be something we look at." From the provincial government point of view it makes sense. It can provide new areas of investment for businesses many of whom support the Conservative government. It can also result in more donations as a token of appreciation.
The Pallister government has hired the consultant group KPMG to find savings and efficiencies in Manitoba health care systems KPMG is one of the big four global auditors with offices in many countries but main headquarters in the Netherlands. It employs about 189,000 people globally. It offers three basic lines of service, financial audits, tax, and advisory services. While the company has won many awards it has had clashes with the Canadian Revenue AgencyCRA) but for some reason the KPMG clients were given an amnesty :In 2015, KPMG was accused by the Canada Revenue Agency of Tax evasion schemes: "The CRA alleges that the KPMG tax structure was in reality a "sham" that intended to deceive the taxman.".[56] In 2016, the Canada Revenue Agency was found to have offered an amnesty to KPMG clients caught using an offshore tax-avoidance scheme on the Isle of Man.[57]
The KPMG report is completed but will not be released since much of the information is said to be proprietary. The Pallister government actually received an extensive report recommending reforms ordered by the previous New Democratic Party and co-authored by Dr. David Peachey of consulting firm of Health Intelligence Inc. in Nova Scotia. The report was received in February this year. However, the Pallister government decided to contract with KPMG for its own report.
These consulting firms that tell you how to save money actually cost a lot of money but they can provide expert opinion that you can use to support your favorite policies usually. This is worth a lot and avoids criticism which can be dismissed as political or ideological. Ontario spent nearly $7 million on consultants who helped a government-appointed panel recommend that the province sell a majority stake in Hydro One and liberalize the sale of beer. KPMG was one of several consultants involved.
The Manitoba PC government paid KPMG $740,000 for their report. Pallister earlier promised that 97 percent of the results would be released to the public with only the names of civil servants who had been asked for their opinions removed. Pallister explained: "My understanding wasn't that a lot of this information would be proprietary at the outset. And now I understand that it is legally my responsibility to protect the integrity of the process that was used... It's owned by the company that helped guide us." This contradicts the governments' own RFP (Request for Proposals) that it issued in December of 2016. which stated that all information, data, research, reports and other material produced by the consultant "shall be the exclusive property of Manitoba." Yet Pallister said: "Out of respect for the company and for future tendering processes I think it's important they have a manner of going about their business they've developed over many years and spent a great amount to develop that they want to protect, so that's part of the problem in releasing that information.:" No doubt Manitoba is quite happy for the public not being able to see the whole report. There could be reforms recommended that the government did not approve and reforms rejected that the government approves.
We should know soon exactly what changes are to made in home care services. We will probably never know if KPMG recommended changes that the government is not making or if it recommended against changes that the government is making. The KPMG report may have been produced with taxpayer money but it remains to be seen if the taxpayer will ever be able to see it all.

No comments: