Questioning P3's
No one has been a bigger salesman for the concept of “P3’s” than British Columbia Premier Gordon Campbell.
And on paper and at the hotel ballroom dinner, the notion of Public Private Partnerships seems full of good potential.
Let’s get the crafty, knowledgeable private sector, which know all the secrets of hiring workers and buying supplies and materials to join forces with governments to build those much-needed roads and dams and hospitals.
Costs will be cheaper and more efficient and the job will get done on time, on budget and with the liabilities shared among the participants.
But, as with all issues in life, intention is everything.
And from the outset, do we really know why Mr. Campbell favors so strongly this P3 model?
Is it the alleged efficiencies and cost benefits?
Or is it, as many suspect, that P3 is a not so elaborate pea and shell game whose sole purpose is to give business to friends and supporters?
The case of care homes for seniors on Vancouver Island is worth a look in this regard.
Cowichan Lodge had happily served the community for many years. That is, until the Vancouver Island health Authority, announced out of the blue that the Lodge would be torn down and replaced by a private facility called Sunridge Place and that the residents of Cowichan Lodge would be dis-lodged and moved to the new facility.
The community was understandably outraged. Rallies were held, 12,000 locals signed a petition in protest, and the news coverage chronicled people’s angers and fears. To no avail, of course. The one was closed, the other opened and the elderly residents were moved in.
Today, we learn that the elderly at Sunridge and the families who pay their bills are finding new costs and expenses at every turn.
Pharmaceuticals cost more. Wheelchairs, mattresses and underwear are more expensive at the shiny new P3.
The managers of Sunridge Place and the VIHA have their excuses at the ready. “We don’t have anything to do with the billing,” says the Health Authority.
Well, why the hell don’t you? If your going to uproot seniors and move them across the street or across town, the least you could do is be responsible.
Or was that part of the original intention?
As David Mamet says in Glengarry Glen Ross, “You don’t sell a guy a car. You sell him many cars over 15 or 20 years!” And service and tires and CD players.
Drugs are more expensive at the new P3 because Sunridge, unlike Cowichan before ir doesn’t buy in bulk. And oddly, residents are compelled to buy from the in-house, more expensive pharmacy. Why? Why can’t they buy down the road at Shoppers or Safeway?
Cloverdale’s Zion Park Manor is soon to close, to be replaced by…well, you know.
If governments are going to enter in to contracts with private suppliers for public services, they might consider having some dominion over ultimate costs to the consumers, who are called citizens.
5 comments:
this critique deserves wide coverage..Stein
Hi David.
I wanted to point out something regarding the use of an "in house" pharmacy.
The facility that I work for is non-profit and supported by Vancouver Coastal Health. We also use a specific pharmacy. They are not so much "in house" as a contracted pharmacy that operates as a full service pharmacy outside of my facility too.
Let's say that there are 40 individual Residents to a floor. The RN and/or LPN gives meds to their assigned individuals. Lets say I have 20 people to give meds to. Each person can receive from 1 to 10 different pills at any given time. So at 0800h, I might be giving 20 people a total of 100 pills.
Can you imagine my having to open up 100 little bottles to give these out. It would take forever and my hands would be killing me. Also, I don't think there is a med cart big enough to carry all of this.
For this reason, we use a specific pharmacy. Our pharmacy fills all the prescriptions, sends them to my facility in convenient baggies which are labeled with the patients name, the time, the drugs and doses. Each patient has a small box in my med cart. The box holds this roll of baggies. At each dosing time, again - say 0800h, I check the information on each baggie against my medication record (based on the doctors order) and give out the meds from the baggies.
In addition to having the medications conveniently packaged, the pharmacist has all pertinent information regarding the residents. Their diagnoses, allergies and medication history.
When a prescription gets sent to the pharmacist, he or she will check it against this information. If he or she feels that there is a problem - I (the nurse) and/or the doctor get informed straight away.
What's more - the pharmacist will come to the facility in person and review all the medications for each Resident periodically. They will suggest meds that could be discontinued (yes - you read this correctly - the pharmacist will encourage LESS drugs when this would be beneficial to the health of the patient).
I have often called our pharmacist when I have had a question regarding medications while working. When consulted appropriately - they are very helpful when planning for care.
Anyways, I just wanted to fill you in as to why Residents cannot just pick up their individual meds from any old pharmacy based on price comparisons. It just would not work in facilities and the facilities would lose the valuable expertise and consultation which comes from using one pharmacy.
Notwithstanding my sharing this information regarding drug administration in long term care - I admit - I also don't like P3's.
I work for non-profit and, based on my ten plus years experience, this is where the best care is.
Cheers.
Linda Yuill, LPN
To Stein,
Many thanks...I'll try to get someone in print or e-news to publish it.
To Linda,
I appreciate the detailed analysis. I think the key point finally is that you work in a not-for-profit facility. This is exactly the point I made this morning while doing volunteer work at a local not-for-profit seniors care home.
David, a wee off topic, but Campbell's P-3's are more of an accounting scam to take capital costs off the provincial ledger.
Look at RAV, Campbell's big P-3 hoo-haw. RAV is an underground metro or subway, being thus, needs an average hourly ridership of about 15,000 persons per hour per direction to sustain it. The international banks know this, they have invested in transit P-3's before. When SNC Lavalin went a calling for a loan they said 'nada' because the best RAV ridership figure available was a mere 3,000 pphpd!
The Campbell government then raided the public sector pension plan and funneled the money through InTransitBC to SNC Lavalin, to give the pretense of a P-3.
The taxpayer insures the public sector pension plan, so in SNC defaults, they don't pay! SNC/Lavalin can walk from the project at any time and not lose a penny.
Now a P-3, the private consortium takes on risk, but there is no risk on RAV, except for the BC taxpayer!
RAV is not a P-3, but a shell game where Gordo and his cronies are playing fast and loose with our tax dollars, on a project that would not have been built anywhere else in the world, due to the fact it was not financially viable.!
Now where is Bill Boring on this?
Rafe knew the shell game and was about to expose but he was given the toss by AM 600 before he could.
Where is the Asper press? Where is our investigative reporters? RAV is a scam that would be illegal in the real world.
MJ
This is an example of the transfer of 'wealth' from those who need it to those whose only reason is greed. Squeezing the last dime from the old is just elder abuse at its worst.
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