Mar 21, 2009

Contracting Out: Enough to make you sick


There is now an accumulation of evidence, both international and domestic, that contracting out is good — but only if you happen to own shares in MDS, Sodexho, LifeLabs, Compass, Aramark or any number of other piggybackers. Unfortunately, if you are merely a patient, taxpayer and/or hospital worker you are probably getting sicker, paying more and/or earning less.

During the 1990s, the corporate health sector urged hospitals to focus on clinical patient care and to contract out non-clinical support to companies whose core business it was to provide such services (no conflict of interest there, of course). Provincial governments, too, encouraged hospitals to redefine their “core missions” in narrower and narrower terms. As administrators whittled away, Canadians saw laundry, food services, laboratory and many outpatient rehab services re-defined as non-essential, non-clinical supports that could be contracted out without compromising patient safety or quality. The mainly female hospital workforce who followed these jobs in to the private sector saw their wages slashed and their job security disappear.

What did Canadians get in return for this strategy? Here are a few enlightening statistics from a well-researched and documented booklet published by CUPE in January called Healthcare Associated Infections: A Backgrounder. The human and financial costs associated with contracting out are tremendous.

  • Between 1995 and 2006 the Canadian Nosocomial Infection Surveillance Program found that rates of MRSA in Canadian hospitals had increased 17-fold.
  • The rate of patients contracting C. difficile infections, the chief cause of health care diarrhea, increased almost five-fold between 1991 and 2003.
  • The Norovirus, which affects mainly seniors in long term care facilities, doubled in B.C. between 2002 and 2007.
  • Every year in Canada one in 9 hospital patients contracts Health Associated Infections (HAIs) which have been linked to between 8500 and 12,000 deaths per year. HAIs are now the fourth leading cause of death in Canada.
  • In BC, 7% of all patients infected with C. difficile are readmitted to hospital for an additional 13.6 days at an additional cost of at least $18,000 per patient.
  • In the Vancouver Coastal Health region alone, more than $3 million was spent by the health authority to treat 2,526 patients with C. difficule in one year (2002/03).

Are HAIs only a problem because services are provided by greedy multinationals? The answer is that infections are linked to understaffing, increased workload, high turnover and poor training of staff. The way that these companies earn the big bucks is by…hmmm… let’s see: reducing staff, increasing the workload, foregoing training of the workforce and maintaining poor wages and working conditions that lead to low morale and high staff turnovers.

On the other hand, studies have shown that when hospitals increase the number of cleaning and infection control staff, when they invest in training and education, and when stability in the workforce is maintained and encouraged, infections decrease.

The track record of increasing infections and related deaths in BC hospitals is the legacy of contracting out that started during the 1990s and continues to this day. Both the Liberals and the NDP should be challenged during the election to outline what steps they’re going to take to bring these services back in to the hospital system. But that won’t be enough: as CUPE’s excellent backgrounder emphasizes, we need evidence-based policies that protect patients from hospital acquired illness and death. That means ending and reversing contracting out. But that’s not all: we need reduced occupancy rates, trained staff, better wages for more workers in the hospital system, mandatory standards and increased transparency.

Read the booklet — it’s an eye-opener. If ever there was an overlap between the interests of health care workers and the public, this is it. And think about surgical services trotting down the same road.