Registed Nurses' Association of Ontario

Public-private partnerships

Public-private partnerships

May 9, 2006

Dear Premier Dalton McGuinty,

We are writing to express our strong opposition to your government’s policy of hospital financing through “P3s” or public-private partnerships.  “Alternative Finance Mechanism” or “Alternative Financing and Procurement” (AFM/AFP) hospitals are P3s under a new name.  In these hospitals, a group of financiers, construction companies, designers, and service providers build a hospital project and sell it back to the non-profit hospital board under a contract that stretches for 20 – 40 years. 

The companies make their profit through the financing deals, the long term privatization of some range of hospital facility management and support services, user fees and service charges for patients and their visitors, private development on hospital grounds, and technology or other ancillary business contracts. 

Based on the evidence, we conclude that the P3 hospital policy will lead to unnecessary additional costs, have a negative impact on work environments, reduce public control over our hospitals, and create a new and powerful stakeholder group invested in dismantling Medicare -- now from the inside.  The result will be only one: diminish the public health care system.  As nurses we value the ability to provide safe, competent and ethical care that allows us to fulfill our ethical and professional obligations to the people we serve. Nurses uphold principles of equity and fairness to assist persons in receiving a share of health services and resources proportionate to their needs and to promote social justice. We value and advocate for practice environments that have the organizational structures and resources necessary to ensure safety, support and respect for all persons in the work setting.  These values are at risk when P3 hospitals are introduced.

The British Medical Journal and other studies by Dr. Allyson Pollock report that the high costs of the P3 financing schemes are borne by cutting clinical and support staff budgets, and by reducing community health services. The rigorous analysis of the P3 in North Durham for example, shows that the P3 scheme led to cuts that fell mainly on the qualified nursing staff, reducing the number of qualified nurses by 12%.  In other studies, the BMJ reports that community health services in the P3 hospital areas are also reduced due to the higher costs of P3 financing. We are concerned that the LHINs will face similar problems as the P3s take money away from hospital budgets, beds and staff and reduce funding to local community health services.

The Ministry of Public Infrastructure Renewal states that the hospitals will be built faster, will be on time and in budget, and will be under public control.  The evidence does not support these claims. The authoritative study by the British Association of Certified Chartered Accountants found that the premiums charged by the for-profit companies exceeded any evidence of past cost overruns in publicly financed projects. The study by the UK Auditor General expressly did not conclude that the hospitals were cheaper than publicly financed hospitals, nor did the auditor look at cost increases from the outset of the negotiation of the long-term privatization deals.  Moreover, there are many examples of serious cost overruns and delays in the British P3 projects. Claims of public control are not based on fact as under a P3 it is no longer the hospital board that runs the hospital facility, lands and privatized services. Their power is circumscribed by the 20 – 40 year contract negotiated with the private companies.  And there is simply no basis for the claim that the hospitals will be built faster.

Hospitals are not commodities to be bought and sold on the stock market as revenue streams for investors. They are valued public institutions upon which our communities rely for life enhancing and life prolonging care. It will be less expensive to finance and manage our hospitals on a non-profit basis and to maintain public non-profit services throughout the hospitals. Ontario’s nurses are urging your government to stop the P3 hospital program and create a public financing system for our hospitals. 


1. Abram Oudshoorn, RN,     London
2. Adelinda  Zamboanguena, RN, Toronto
3. Adeline Falk-Rafael, RN, PhD – Professor, York University
4. Afsaneh Tabrizi, RN, York Region
5. Aisha Jahangir, RN, Guelph
6. Alanda Levy, BN student yr 3, Brampton
7. Alba Di Censo, RN, PhD Professor, Nursing & Clinical Epidemiology & Biostatistics; CHSRF/CIHR Chair in Advanced Practice Nursing; Director, Ontario Training Centre in Health Services & Policy Research; Lead Editor, Evidence-Based Nursing: A Guide to Clinical Practice, Dundas   
8. Alison Meikle, RN, Toronto
9. Alison Whitehead,RN, Newcastle
10. Amy Hunter RN, MScN, sessional lecturer, Hamilton’s McMaster University, Milton
11. Andy Summers, RN Vice-President Region 3, ONA
12. Anita Fisher RN PhD, Associate Professor, Nursing Community McMaster University, School of Nursing
13. Ann Schibli, RN, Region 2
14. Anne Clark, RN, Vice-President Region 2, ONA
15. Anne Egger, RNEC, Primary Care Nurse Practitioner, Toronto
16. Annette Ganzenberg, BScN, RN, Newmarket
17. Arif Ahamed, Student RN
18. Avanel Ricketts, Nursing student
19. Bailey Kerr, Student Nurse, London
20. Barb Craig, RN, Toronto
21. Barbara Bowles, RN, BSN(PNC), St Catharines
22. Barbara Daly, RN, Aurora
23. Barbara Harrison, RN, Kingston
24. Barbara Naykalyk-Hunt,    BA, RN, Port Colborne
25. Basanti Majumdar, PhD, MSc, MEd, MSc(T), RN, Professor in Nursing and Department of Family Medicine at McMaster University, Hamilton
26. Beatrice Sacher, Nursing Student, West Elgin
27. Becky Bulsza, Professor, Fanshawe College, London
28. Beth Schryer, RN, Sault Ste. Marie
29. Betty McNeely, RN, BHSN, Peterborough
30. Bianzheng, Zhang, Nursing Student, Toronto
31. BJ Macdonald, RN, CIC, Durham Region
32. Bonnie Ostwald RN BScN, Mississauga
33. Bonnie Schnittker RN PHN, Almonte
34. Bonny Johnson, Nurse Practitioner RN(EC), Beachburg
35. Brenda McNama, RN, Sault Ste. Marie
36. Brigitte Goar, RN, Kincardine
37. Brittany Beaton, 2nd yr. nursing student at University of Western, London
38. Carine Gallagher, Nursing Faculty Confederation College & Coordinator of PHCNP Program, Lakehead University, Thunder Bay    
39. Carl Phillips, RN, Toronto
40. Carla Campbell,RN, St.Thomas
41. Carla Terry, RN, St. Charles
42. Carol Oates, RN, Toronto/Durham
43. Carol Owens, RN, North Bay
44. Carolin Kaemmer, RN, Merrickville
45. Carolyn Davies, RN (EC), Essex County
46. Carolyn Montgomery, R.N., BScN, Toronto
47. Carran Watson, Public Health Nurse, Leeds, Grenville Lanark
48. Carrie V. Kasurak, Public Health Nurse, Gananoque
49. Catherine Mary Elizabeth Swimmings, RN BScN GNC(C),Ottawa
50. Cathy Crowe, RN, Street Nurse, Toronto
51. Cathy Goring, Education Coordinator, Toronto
52. Cecile Cooke, RN, BScN, Windsor
53. Cheryl Anne Fenton, RN, BHSc, Professor Mohawk College, Hamilton
54. Cheryl Rowe, RN, Grassie
55. Cheryl Taveroff, RN, Peterborough
56. Cheryl Yost, Director Patient Care Services, Manitoulin Island
57. Cheryle Kingsman-Ralph, RN, Belleville
58. Christa Poirer, Public Health Nurse, Ottawa Public Health
59. Christine Guindon, RN, Sudbury      
60. Clare Swanson, RN, Brantford                   
61. Colleen Gilbert,     RN, Hamilton
62. Colleen Hartwick, RN, Mattawa
63. Colleen Kearney, RN, Med, Toronto
64. Connie Ross, RN, Caledonia
65. Cristina Bautista, Student Nurse
66. Cynthia Hiemstra, RPN, BScN(2nd yr), London
67. Cynthia McNairn, RN, BA, BScN, Professor, Centre for Nursing at Toronto’s George Brown College, Oshawa
68. Daniel Goodman, Nursing Student, Niagara Region
69. Darren Day, RN, Toronto
70. Dave Atfield, RN, Brantford
71. David Reid, RN, Toronto
72. Deb Wood, RN, MHSc, CNS/NNP, Orillia
73. Debbie Baston, RN, Sudbury
74. Debbie McCrank, RN, Kirkland Lake
75. Debra Knight, RN, Sudbury
76. Debra McAuslan,RN,MScN,London
77. Denise Duckett RN, Sudbury, ON
78. Diane Cropp, RN, Toronto            
79. Diane Parker, RN, Vice-President Region 1, ONA
80. Dianne Brunton, RN, Courtice
81. Dianne Farquhar, RN,  Haileybury(Temiskaming Shores).   
82. Dianne LeClair, RN, Vice-President Region 4, ONA
83. Dolores Golob, Clinical Research Coordinator, Toronto
84. Donna Capel, RN, Mississauga
85. Donna Elizabeth Evans Title RN(EC) Community Brantford
86. Donna Harrison, RN, Sudbury
87. Donna Hess, RN, Georgetown
88. Doris Grinspun, RN, MSN, PhD, (c) O. Ont. Executive Director, Registered Nurses’ Association of Ontario (RNAO)
89. Dorothy McParland, Regional Cardiac Care Coordinator, Mississauga
90. Dorthyanne Brown, RN, BNSc, MSc, Kingston
91. Dr. Margaret Elizabeth Black, RN, BScN, Med, EdD, Toronto
92. Elizabeth Contestabile, RN, BScN, Ottawa
93. Elizabeth Hooper, RN, Sault Ste. Marie
94. Elizabeth Howe, RN, Hearst                                                                        
96. Elizabeth Smith, Nursing Student, London
97. Emily Lamothe,     RN, Peterborough
98. Erin Johnston, Nursing Student
99. Esther Gaudet Retired RN, Pembroke                                   
100. Esther Rosete, RN, Toronto
101. EunJu Lee, RN, Toronto
102. Evelyn C. Adams, RN. MScN. PhD, Toronto
103. Fern Young, RN, Sault Ste. Marie
104. Frances Legault, RN, PhD, Assistant Professor, School of Nursing, University of Ottawa
105. Gary Dove, RN, Grimsby
106. Genevieve Blanshard, BA, RN student, Toronto
107. Gilda Merciales, RN, Markham
108. Gillian McLean, RN, BA, B.NSc, B.Ed, Ottawa        
109. Glenda Hubley, RNFA CPN(c), ONA l.46 Bargaining Unit President, Sault Ste. Marie Health Services & Policy Research; Lead Editor, Evidence-Based Nursing: A Guide to
110. Heike D. Lackenbauer, RN, BScN, CHPCN, Kitchener
111. Helle Little, RN, BScN Windsor
112. Hugette Leonard, RN, Ottawa
113. Ian Turpin, RN, Sault Ste. Marie
114. James Chu, BN Student, Toronto
115. Jamie Crawley, RN, BScN, BA, BA, MBA./HCM, Windsor
116. Jan Lachance, RN, Hamilton
117. Jane Burns, RN, BScN CON (c), Cambridge
118. Jane Heath, RRT, Bowmanville
119. Janet Guembel RN.C.Neph (c), Sudbury
120. Janet Menard, RN(EC), MN/ACNP (c), Russell
121. Janice Kaffer, Region 8 BOD, Northumberland
122. Janiesa Moore, RN, BScN, London
123. Jean Dobson, RN, Staff Nurse, London
124. Jean Morrow, RN CNCC(C), London
125. Jean Walsh, RN BScN CP/MHN(C), Niagara Falls
126. Jeanne Soden, RN, Vice-President Region 5, ONA
127. Jennifer Gale, BScN Nursing Student, Shelburne
128. Jennifer Murdock, RN, Professional Practice Nurse Consultant, Peterborough
129. Jennifer Reguindin, RN, BScN, MScN(c), Mississauga
130. Jeri Dunne, Public Health Nurse, York Region
131. Joan Lesmond, RN, BScN, MSN, Ed.D. (c) Past-President, Registered Nurses’ Association of Ontario
132. Joan Rivard, Critical Care Nurse, London
133. Joan Wight, Grad Nurse, Toronto
134. Joanna Balinski, BScN (cand.), Mississauga
135. JoAnne Hunter, Primary Care Nurse Practitioner Family and Community Health, Toronto      
136. Joanne Ready, RN CRRN TOHORCC, Ottawa
137. Jody Smith, Toronto
138. John Agius, RN, North Bay
139. Joseph Gajasan, RN, Mississauga
140. Josephine Field, RN (Ret'd), North York
141. Judie Surridge, RN, Toronto
142. Judith Asfour,  RN, Brampton
143. Judith Picotte, RN, BScN, Kingston
144. Judy Brethour, RN, BN, Norwood
145. Judy Carlson, RN, Kenora
146. Julie Latreille, Clinical Informatics Coordinator, Ottawa
147. Karen Antoni, RN, MHSc, ACNP, NP - Acute Pain Service, Hamilton
148. Karen Bertand, RN
149. Karen Edgeworth, RN, Kingston
150. Karen Guzzo, RN, Sault Ste. Marie
151. Karen M. Kelly, RN(EC), MN, Professor of Nursing, Toronto
152. Karen MacDonald, RN, ONA L.046 Treasurer, Sault Ste. Marie
153. Karie McConnell, RN, Sault Ste Marie
154. Karin Gailer, RN, Peel
155. Katarina Renata Stanisic, BN, RN(T), Toronto
156. Kathleen Janke, RN, Orangeville
157. Kathleen Kaye, RN, Toronto
158. Kathleen Krakana-Palmer, RN, London
159. Kathryn McDougall, RN, Sudbury
160. Kathryn Morrison, RN, BScN, Barrie
161. Kathy Downs, RN,
162. Kathy Hardill, RNEC, Primary Care Nurse Practitioner, Toronto
163. Kathy Iwing, RN, Shelburne
164. Katie McMullen, Graduate Nurse, Ottawa
165. Kelly Dickson, RN, Hamilton
166. Kelly Gagnon, RN, Ottawa
167. Kelsey Kinch, RN, Kenabeek
168. KeriAnn Mahoney, RN,BN,MA, Certified Gestalt Psychology , Certified Chemical  Dependency Counsellor Community RNAO Region 1
169. Kimberly Fragomeni, RN, Sault Ste. Marie
170. Kristina Quilang, Nursing Student, Toronto
171. Laura Pridham,     RN, Halton
172. Laura Sarvari, BScN Student, Durham Region
173. Laurel Lefebvre, RN, Iroquois Falls
174. Laurie Panagiotou, RN(EC), Brantford
175. Leah Mills, RN, Sudbury
176. Leigh Fairbrother, RN, BScN, Barrie
177. Leona Skilling-DiStasi, RN, BScN, Toronto
178. Lesley Bell, RN, MBA, CEO Ontario Nurses’ Association (ONA)
179. Leslie Inglis, RN, BScN, Toronto
180. Leslie Laporte, RN, Sudbury
181. Letitia Chapchynski, RN, Sudbury
182. Lila Ongaro, RNFA, formerly of Sudbury now practicing in Tennessee
183. Linda Becker, RN, RNFA, Kitchener
184. Linda Belec, RN, Ottawa
185. Linda Dove, RN, Grimsby
186. Linda Haslam-Stroud, RN, President Ontario Nurses’ Association (ONA)
187. Linda Hefferman, RN, Simcoe
188. Linda Oliver, RN, Oakville
189. Linda Olson, Public Health Nurse, London
190. Linda Stevenson, RN, BScN, Nurse Clinician, Chatham
191. Linda Waterman, RN -Nurse Manager, York Region
192. Lisa Anne High, RN, MScN, Lecturer University of Windsor, Chatham-Kent
193. Lisa Leckie, BscN student yr 2, London
194. Lisa Nguyen. Student RN, Brampton
195. Lorian Fretz, RN, Waterloo Region
196. Louise Koen, RN, BN, Scarborough
197. Luba Martinuzzi, RN, Oakville
198. Lynda Fortier, RN, Parish Nurse, Windsor
199. Lynda Meneely, RN, Toronto
200. Lynda Mochrie, RN, Bracebridge
201. Lynn Anne Mulrooney, RN, MPH, PhD, Burlington
202. Lynne Strathern, RN, Oakville
203. Margaret Lim, RN, Markham
204. Margaret McGuire, RN, Guelph
205. Margaret Skulj, RN, BSc, Clinical Leader, Toronto
206. Maria Molly, RN
207. Marianne E. Cochrane,    Professor, Collaborative BScN ProgramUOIT/DC, Oshawa
208. Marilyn Blair, RN BA CPMHN, Oakville
209. Marilyn Deachman, RN, BA, CHCPN(C), Nursing Consultant, Oakville
210. Marilyn King, Senior Public Health Nurse, Huron County
211. Marion Willms, RN, Rockwood
212. Marjorie Johnson, RN, London    
213. Mary Anne Millar, RN DPHN, BScN, MN (C)
214. Mary Clarke, RN, Toronto
215. Mary Ferguson-Pare, RN, PhD, CHE President, Registered Nurses’ Association of Ontario
216. Mary Ings, RN, Brampton
217. Maureen Barry,     RN, MScN, Senior Lecturer, Faculty of Nursing, University of Toronto
218. Maureen McLeod, RN, Toronto
219. Maureen Michea, RN, Scarborough/Toronto
220. Maureen Montemuro, Clinical Nurse Specialist, Hamilton
221. Maureen Mouritzen, Public Health Nurse, London
222. Michael Raymond, Nurse Practitioner, Sudbury East
223. Mickey Turner, RN, CHPCN(c) - Palliative Care Coordinator, Milton
224. Millicent Stanley, RN, Pickering
225. Miranda Keay, RN student (wfn2), London
226. Moira J Korus, BA, RN, Toronto
227. Mona Racicot, RN, Smooth Rock Falls
228. Nancy Christensen, RN, BScN, BEd, Hamilton
229. Nancy Gordon, RN, BScN, Toronto
230. Nancy McDonald, RN, Mississauga
231. Nichole Adams, RN, Kanata
232. Nicole Beaudry, RN, BA, BN, Sudbury
233. Nicole Cusson-Asselin, RN, Sudbury
234. Nicolette Parant, RN, BA, Milton
235. Nikki Morley, RN, Espanola
236. Olga M. Muir, SCM, BScN, Nurse Manager, Toronto
237. Pamela Blokzyl, Nursing Student, Niagara Region
238. Pamela Bushell, RN Clinical Educator, London
239. Pamela Giroux,     RN, Toronto
240. Pascal Karerangabo, RN, Mississauga
241. Pat Ciufo, RN, Toronto
242. Pat MacDonald, RN, Hamilton
243. Patricia Evans, RN, MA Nursing, Sutton
244. Paula Dawson, RN, Hamilton
245. Pauline Lebeau, RN
246. Priscilla Morin, Grad Nurse, Quinte
247. Rebecca Ganann, RN, MSc(cand) Public Health Nurse, Toronto
248. Robert W. Harwood, RN, BA, Kitchener
249. Robin Hoy, Professional Practice Coordinator, Brockville
250. Rochelle, Nurse clinician, Toronto
251. Rod Bayliss RN
252. Ronna-Lee Grimard, RN
253. Roseann Blake, RN, BScN, Clinical Practice Leader, Ajax
254. Rosemarie Vandenbrink, RN, BScN, Rodney
255. Ross Sutherland, RN, Kingston
256. Ruby Jordan, RN, Toronto
257. Ruth Blyth, RN, Brantford
258. Ruth Schofield, RN, MSc(T), Assistant Professor, Hamilton
259. Sandra Bearzot, RN, Toronto
260. Sandra Jarva, BScN Grad 2006, Thunder Bay
261. Sandra Murphy, RN, Milton
262. Sarah Innis, RN, MN, Toronto
263. Shamim Waljee, RN, Toronto
264. Sharon C. Jackson, CoMac BScN Level II, Guelph
265. Sharon Fair, RN, Kingston
266. Sharon Teklu, RN, Ottawa
267. Sheila Clark, RN, BScN, MS, Barrie
268. Sheila Nesbit, RN, Elliot Lake
269. Sheri Hatcher, RN, MScN, Owen Sound
270. Sherri-Lynn Vester, RN, Hamilton
271. Shona Mackenzie, BScN, RN (EC), Toronto
272. Shoshana Melech-Shalom, RN, Toronto
273. Simone Bollaerts, RN, BN, Hamilton
274. Sophie Normand RN, Ottawa
275. Stefanie Berza, RN student, Mississauga
276. Stephanie Catherine Blaney,  2nd yr nursing student (RN), Sault Ste. Marie
277. Stephanie Kellington, RN BScN Clinical Resource Leader, Palmerston
278. Sue Macfarlane, Clinical Nurse Educator, Emergency RN, Goulbourn
279. Sue Ryckman, RN, Matheson
280. Susan Bard, Retired RN, Guelph
281. Susan MacNeil, RN, BNSc,  BA, CCN(C), GNC(C), Kingston
282. Susan White, RN, Niagara
283. Susan Whitehouse, RN, London
284. Susan,     Public Health Nurse, Dryden
285. Suzanne Desylva, RN , Rockwood
286. Suzanne McVety, Respiratory Therapist, Oshawa
287. Suzanne McVety, Respiratory Therapist, Oshawa
288. Suzanne Olsen, RN, Sault Ste. Marie
289. Teresa Campagna, student RN, Vaughan
290. Teresa Hughes, RN, Toronto
291. Teresa Protz, RN, Guelph Wellington
292. Terri Dowding, RN, Hillsburgh
293. Terry Toscani, RN, Hamilton    
294. Tracie Armstrong, RN, London
295. Tracy Nyssen, RN, London
296. Trudy McCanna, RN, Sault Ste. Marie
297. Valerie Bruinse, RN, BScN, Newmarket
298. Valerie Lay, RN, Mississauga
299. Valerie Neely, RN, BA, BScN, MEd - Nursing Professor, Hamilton  
300. Valerie Wilson, RN, Sudbury
301. Vicki McKenna, RN, First Vice-President, ONA
302. Victoria Chrapchynski-Bell, RN, Sudbury
303. Victoria Thomas, RN Toronto
304. Wendy Azzopardi, Professor, Kitchener/Waterloo
305. Wendy Franz, RN, Niagara Falls
306. Wendy He, RN, Scarborough
307. Wendy James, Coordinator, Infection Prevention and Control, Wellington
308. Wendy Mckay, RN, Sarnia
309. Wendy Vlasic, RN MScN ACNP, London
310. Whitnie Irving, RN, Waterloo
311. William Wade, RN, Toronto
312. Yolanda Tomaszewski, RN, London
313. Yvonne Dale, RN

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