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Health Care In Danger

Worrying breakdown in Ontario reforms

By David South

This Magazine (Canada), October-November, 1992

The Senior Citizens’ Consumer Alliance for Long-Term Care’s report on the Ontario New Democratic government’s health care reforms, released in July, documents what many people suspected: the much-needed reforms are mismanaged and dangerously close to chaos.

The report compares the present crisis to the failed attempt in the seventies to move psychiatric care out of institutions and into communities by closing 1,000 beds. Patients were left with inadequate community services, resulting in many homeless and jailed former patients. The alliance fears seniors – the biggest users of health services – could fall victim to reforms in the same way.

According to many health care reformers, Bob Rae’s government seems to have lost control of the issue, resulting in massive job losses and a worrying breakdown in services.

The NDP’s health care document “Goals and Strategic Priorities” reads like a wish list for progressive health care reformers, ranging from disease prevention programmes to improved access to health care for minorities, natives and women. To many, the debate isn’t over these goals but how they are achieved and what the government’s true motives are. Under pressure from big business and its lobby groups, the NDP is desperate to save money where it can, and as Ontario Health Minister Francis Lankin says, “not disrupt or destroy business confidence.”

Emily Phillips, president of the Registered Nurses’ Association of Ontario, is blunt: “The NDP’s plans sound good on paper, but they can’t give a budget or direct plan on how they hope to carry out reforms. They are going about things backward. They cut hospital beds and lay off staff without having community health care services ready.”

The national trend in health care is to deinstitutionalize and bring services to homes and communities. It is hoped that emphasizing prevention and healthy living will significantly reduce the need for hospitals, expensive drugs, surgery and high-tech equipment. The NDP has pledged to spend $647 million to reform long-term care services by 1997 – creating services that will allow seniors to stay in their own homes.

Problem is, the NDP has embarked on radical down-sizing of hospitals – closing beds and laying off thousands of health care workers – right now. Lankin claims that in the worst-case scenario, layoffs this year wouldn’t exceed 2,000, but the Ontario Hospital Association claims 14,000 jobs are in jeopardy. Phillips believes it will be hard to estimate job loss: “It is hard to even record the number of nursing jobs lost, because for every full-time job cut many part-time and relief positions go with it.”

Chaos will result when people who depend on hospitals have nowhere to turn but the inadequate community health care services, which are uneven and narrowly focussed. To make things worse, the same funding restrictions placed on hospitals have also hit the services that are supposed to save the day.

“I haven’t heard of any change in the quality of care. It is just too early,” says Phillips about the effect of layoffs on hospitals. “Right now the nurses are picking up the slack, but soon they will burn out. I don’t feel confident this government has the management skills to do this. I’d like to see a plan in place before moving people into the community.”

Training for laid-off hospital workers will have to come from the $160-million allocated for retraining workers laid off by cities, universities and school boards – all of whom are coping with record-low budget increases.

In February, Lankin appealed to hospitals to do everything in their power to make layoffs painless and to trim doctors and administrators first. But the NDP has yet to pass legislation that would bind hospital boards to make the right cuts. The boards operate at arm’s length from government and continue to make unnecessary decisions, ignoring the NDP’s moral pleas.

Rosanna Pellizzari, a member of the Medical Reform Group and chair of the Ontario Association of Health Centres, wants better community accountability for hospitals before they lay off staff and cut services: “Sometimes it makes sense to bring people to hospitals. Planning must be at the community level and open and democratic. Health care workers, who are mostly women, should not be scapegoated for financial problems. Doctors and management should go first. Physicians experience very little unemployment.”

Carol Kushner, co-author of the book Second Opinion, which evaluates the country’s medical system, sees chaos resulting from the conflicting agendas of governments and health care reformers: “Will the tremendous contradictions of institutions be transferred to the community? The federal government is rapidly draining money from medicare while provincial governments are having a hard time. This hasn’t produced extra funds for re-allocating services to the community – which was recommended by reformers. You have to ask: who is going to fall through the cracks?”

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ORCID iD: https://orcid.org/0000-0001-5311-1052.

© David South Consulting 2022

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Hannah Institute For The History Of Medicine | 1992 – 1994

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Publisher: Hannah Institute for the History of Medicine

Location: Toronto, Canada

Editor and Writer: David South

I worked as Editor and Writer for the newsletter of the Hannah Institute for the History of Medicine (under the direction of the Editor-in-Chief and Hannah Executive Director Dr. J.T. H. Connor) in the early 1990s. Located close to the University of Toronto and within a neighbourhood claiming a long association with medical and scientific discovery (Sir Frederick Banting, co-developer of insulin for the treatment of diabetes, lived at 46 Bedford Road,), the goal was to better connect Canada’s medical history community of scholars and raise the profile of the funding resources available to further the study of medical history in Canada.

The Toronto Legacy Project and Heritage Toronto plaque marking the location of Sir Frederick Banting’s former home.

I also revamped the application process for awards, scholarships and grants to make them user-friendly and compatible with word processing software packages of the time.

The Hannah Institute was the adminstrator for the grants and awards funded by AMS (Associated Medical Services). It has had a profound impact on the medical history field in Canada, as the AMS website states:   

“As a result of the growth of the discipline and the burgeoning of scholarship, as well as financial support from other funding bodies, in 2006, the AMS Board of Directors decided not to provide new competitive grants and further, decided to bring AMS- administered competitive grants to closure by 2011.

In the 1970’s when the Hannah Chairs and the Hannah Institute were established, the discipline of the history of medicine was an “orphan’ within the Canadian scholarly community. Three decades later with the support of AMS, history of medicine and healthcare continued to thrive in universities and colleges across Canada.”

It funded groundbreaking medical history research and scholarship, including books such as Eugenics, Human Genetics and Human Failings: The Eugenics Society, its sources and its critics in Britain By Pauline Mazumdar, Copyright Year 1992.

The publishing impact of the Hannah Institute’s support according to WorldCat.

At the time I also worked as an investigative journalist and medical reporter. Some health and medical stories I wrote at the time are below:

Taking Medicine to the People: Four Innovators in Community Health

Take Two Big Doses of Humanity and Call Me in the Morning

The archive of newsletters is held at the Wellcome Collection Library in London, UK and at the University of Toronto.
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“Professor puts chronic fatigue into historical perspective” announced the launch of a new book by the University of Toronto’s Hannah Professor Edward Shorter.
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Abstracts in Anthropology, Volume 43, Issues 3-4: “… in recent years it has become a pursuit for a growing number of researchers. … Behind much of this growth has been the Hannah Institute for the History of Medicine which has encouraged writing …”.

More on the Hannah Institute’s history here:

John B. Neilson and G. R. Paterson, Associated Medical Services, Incorporated: a history, Toronto, Associated Medical Services and the Hannah Institute for the History of Medicine, 1987, 8vo, pp. 445, illus., $15.00.

The Hannah Institute: promoting Canadian history of medicine (Can Med Assoc J. 1983 Jun 1; 128(11): 1325–1328.).

The Hannah Institute For The History Of Medicine, Vol. 1, No. 1

By BARR, Murray L.; HART, Gerald D.; SALTER, Robert B

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ORCID iD: https://orcid.org/0000-0001-5311-1052.

© David South Consulting 2017