For-profit hospital problems in England and Canada
`P3’ disasters elsewhere should be a warning
May. 4, 2003
MICHELE LANDSBERG
The SARS outbreak in Toronto was sad and scary enough. But imagine this: A new outbreak occurs, spreading across Ontario. Patients in Brampton and in Ottawa find, to their horror, that their lives depend on their spanking new “public-private partnership” hospitals. And the private owners don’t want to deal with the crisis, thank you very much.
Contracted-out maintenance crews balk at entering the hospital. Privatized cleaning staff demand danger pay, which the hospital owners can’t or won’t pay.
The public board of directors, responsible only for clinical care, finds itself at loggerheads with the private owners, who don’t want to pay for beefed-up security, screening, cleaning, dietary and maintenance crews. The board doesn’t even have access to the hospital’s books, let alone any power over the management of the physical plant.
Fighting back in defence of its threatened profits, the hospital sues the Ontario government for billions of dollars in unanticipated costs.
Bogged down in legal battles and unable to pass even minimal preventive hygiene standards, both hospitals dramatically shut down.
Yes, this scenario is a fantasy, but not so far-fetched. This year, the Ontario government is pushing ahead stubbornly with its Brampton and Ottawa “P3” arrangements — the friendly little nickname for “public-private partnerships.”
If they get away with it, they plan on creating lots more, in reckless disregard of the consequences.
The idea, and the only idea, behind P3 public facilities is that it gets the capital costs of building hospitals, schools and even police stations and city halls off the government’s books.
Private companies build and own the facilities and lease them back to the public for 30, 40 or 60 years — at the end of which, the private owners, not the public, usually own the building.
P3s are different from the usual mode of construction, because the people who put up the capital also own and manage the building. And they certainly don’t intend to open their books to the public or be responsive to public demands.
In fact, in a blood-chilling example of capitalist thinking, P3 lawyers in Vancouver, in a city hall presentation, deplored what they called “the Inherent Diseases” of the public sector. The diseases? An emphasis on process, transparency and public justification. In other words, the P3s think that democratic accountability is a “disease” akin to typhoid.
Everywhere these P3s have been tried, they’ve crashed in disaster. In England, shoddy construction in P3 hospitals has led to grotesque accidents, ceiling cave-ins and frightening mechanical failures, along with emergency sale of public land and assets to ensure private profit.
Britain’s auditor-general, looking at the P3 accounting schemes, called them “pseudo-scientific mumbo-jumbo.” The British Royal College of Nurses says that privatization of hospital cleaning services is closely related to a rise in infections. The British Medical Journal reports that P3 hospitals have cut medical and service staff by 30 per cent.
Costs have been astronomical. Hundreds of millions of dollars have been spent on consultant fees alone; legal costs are a bottomless pit as the private owners try to wiggle out of contractual obligations in patient care. And because all these deals are done in secrecy, in the interests of “corporate privacy,” corruption is rampant. Just what we need for the next globalized epidemic: dirtier hospitals, management secrecy, shoddy building practices and profit-taking at the expense of patient well-being.
Apparently, Health Minister Tony Clement hasn’t read all those alarming reports — especially last year’s McMaster University study showing that private for-profit hospitals have a higher death rate because they skimp on care.
Listen, Mr. Minister, stop long enough to consider the Canadian evidence that P3 really means Profligate, Perilous and Profiteering.
Nova Scotia cancelled its P3 schools project but is stuck with costly 35-year leases, plus $32 million in extra costs.
Construction was shoddy, siting arbitrary and public access limited. Students had to drink bottled water for a year after arsenic was found in one school’s water supply, and the school’s private owner refused to take responsibility.
In P.E.I., the government cancelled a P3 hospital when it realized how expensive it would be.
In B.C., a P3 information system in Vancouver General Hospital racked up an extra $82 million in costs instead of the $72 million it was supposed to save.
In Alberta, the public board of a P3 school is grimly shouldering the extra expense caused by cheap and hazardous building techniques.
In every case, from England to Australia, government auditors have found that the sole reason for building P3 facilities is to get capital costs off the government’s books in order to fool the public into believing the budget was “balanced.”
When Tories argue that we can’t afford health care or hospitals without private money, they are playing three-card monte. Believe their sleight-of-hand accounting at your peril. Huge sums of public money are poured into those P3 long-term leases, going straight into private pockets instead of public service. But those costs show up on the books of some future government — and that’s their sole point.
Most of Ontario’s citizens believe firmly in public medical care and public hospitals. They’d be horrified to see our public institutions slip away into private hands, where we can’t demand answers, insist on access or hold the owners to account.
We do, however, have one last way to fight back.
On Saturday, May 10, the Ontario Health Coalition will launch its Caravan of Protest at the corner of Front and Bay Sts. at 2:30 p.m.
The march will wind through the financial district, stopping at the Bank of Montreal and Borealis Building, two of the bidders on P3 medical facilities.
Join in, even if you’ve never marched before. The weather forecast looks fine, there will be a double-decker bus to symbolize two-tier medicine (but also to make it easy for tired walkers), and there will be entertainment by Samba Allegra, Sizzlestick Theatre, Tintower Puppets, Judith Thompson, clowns and street theatre.
Make a noise to save our public system. If we can’t do that much, we’ll deserve what we get when the next epidemic strikes.
Michele Landsberg’s column usually appears in the Star Saturday and Sunday. Her e-mail address is mlandsb@thestar.ca.
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