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Exercise caution on health-care super agency, Ontario warned

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Before proceeding with the creation of a health-care “super agency,” Ontario would be wise to look closely at the experiences of other provinces that have gone down that bumpy road, health policy experts and leaders warn.

Nova Scotia, British Columbia and Alberta have undertaken similar reforms and found them to be more difficult, disruptive and distracting than anticipated, they caution.

“Everybody is thinking about the restructuring (while) the actual provision of services sort of gets ignored,” charged Katherine Fierlbeck, a political science professor at Dalhousie University, recounting Nova Scotia’s experience.

Nine regional health authorities were merged into the Nova Scotia Health Authority in 2015 with the aim of saving money and creating efficiencies.

But Fierlbeck argues there is no evidence to show that either goal was attained.

The Star reported in January that Ontario is eyeing the creation of a “super agency,” which would absorb more than 20 smaller agencies including Cancer Care Ontario, the Trillium Gift of Life, eHealth and 14 local health integration networks.

The provincial government has yet to confirm it intends to create a super agency, but the idea is being openly discussed in the broader public sector.

The provincial New Democrats have released numerous leaked government documents on health restructuring, including draft legislation to enable creation of a super agency.

Meantime, the Star has confirmed through a public record search with the Ministry of Government Services that the province incorporated, just over two weeks ago, an entity named Health Program Initiatives. The new entity and super agency are one in the same, said a source close to government who spoke on condition of anonymity in order to discuss the restructuring plan.

Asked if she had any advice for Ontario, Fierlbeck responded: “Don’t do it.”

Nova Scotia created a “huge monster agency” through the merger of smaller health agencies, she said, adding there was much inefficiency in decision making. Officials were unsure whether to get permission to make certain moves. There was a reluctance to make big decisions and a belief those should come down from on high.

An informal, blue-ribbon panel of Nova Scotia physicians, including a former deputy health minister, issued a report two years ago in which they wrote that merged organization “has quickly become a bureaucratic non-system which cannot respond quickly on behalf of dying or very ill people.”

Fierlbeck said primary care services in the province continue to be “a mess,” long-term care lacks planning and mental health services are improving but still not where they should be.

Thirteen years after health-care services in British Columbia were overhauled, the province’s cancer system continued to struggle, Dr. Don Carlow, former head of the B.C. Cancer Agency, wrote in a 2014 opinion piece in the Vancouver Sun.

The restructuring saw the board of the cancer agency disbanded. The agency was then taken over by the Provincial Health Services Authority, which had competing priorities.

Prior to the overhaul, the cancer agency reported directly to government. But after the changes, it reported to the authority, which in turn reported to government.

The cancer agency, which once had an international reputation for excellence and attracted top talent, had difficulty recruiting professionals and suffered from poor morale under the new structure, lamented Carlow, former president of the Ontario Cancer Institute/Princess Margaret Hospital and former executive director of the Canadian Association of Provincial Cancer Agencies.

Reached by phone, Carlow said Cancer Care Ontario is the envy of cancer systems around the world and he would hate to see it suffer a similar fate:

“This is an anachronism. You’ve got a good system and other people are looking at it and writing about it and praising it and copying it, and now they want to take it down? Oh no, I think that would be a mistake.”

Carlow pointed to a 2011 analysis by the Organization for Economic Co-operation and Development, which compared cancer systems in OECD countries. The best ones had good governance and leadership and took a systemic approach to cancer control through a lead organization like Cancer Care Ontario, he said.

Ontario’s former deputy minister of health, Dr. Bob Bell, said he is worried for the future of cancer care and organ donation in Ontario if both are moved under the umbrella of the super agency.

“Ontarians have enjoyed a system that continually improves without radical chaotic changes in structure,” said Bell, former president of the University Health Network and a former cancer surgeon.

“Incremental solutions are at hand to improve our current problems. Incremental change is not resisting innovation, it is introducing change in a responsible, safe manner that does not put patients at risk,” Bell added.

Alberta’s health system experienced much publicized disruption after it was centralized in 2008. Alberta Health Services was created out of 12 smaller health entities.

Opposition politicians and unions denounced the merger and called for AHS to be dismantled, charging health services were suffering.

Its first CEO, Stephen Duckett, lasted only 18 months, eventually returning to his native Australia. At the same time, some board members resigned.

Reached by email, Duckett described the restructuring this way:

“In my view it was handled badly but I think the outcome was good. There was unhealthy competition between the predecessor authorities which was not in the public interest. I do not think though that the merger process impacted adversely on patient care.”

Theresa Boyle is a Toronto-based reporter covering health. Follow her on Twitter: @theresaboyle

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Anglais

Nostalgia and much more with Starburst XXXtreme

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Get a taste of adventure with Starburst XXXtreme based on the legendary NetEnt Game. The nostalgic themes are sure to capture fans of the classic version as they get treated to higher intensity, better visuals, and features. The most significant element of the game is its volatility. Patience will not be an essential virtue considering the insane gameplay, and there is a lot of win potential involved. It retains the original makeup of the previous game while adding a healthy dose of adrenaline. 

Starburst Visuals and Symbols

The game is definitely more conspicuous than before. The setting happens over a 5-reel, 3-row game grid with nine fixed win lines, which function if a succession from the left to the right reel is present. Only those players that that attain the highest win per bet line are paid. From a visual standpoint, the Starburst XXXtreme slots illustrates lightning effects behind the reels, which is not surprising as it is inherited from the original version. Available themes include Classic, Jewels, and Space. The game is also available in both desktop and mobile versions, which is advantageous for players considering the global pandemic. According to Techguide, American gamers are increasingly having more engaging gaming experiences to socialize to fill the gap of in-person interaction. Starburst XXXtreme allows them to fill the social void at a time when there is so much time to be had indoors. 

Starburst XXXTreme Features

Players get to alternate on three features which are Starburst Wilds, XXXtreme Spins, and Random Wilds. The first appears on reels 2,3, or 4. When these land, they expand to cover all positions while also calculating the wins. They are also locked for a respin. If a new one hits, it also becomes locked while awarding another respin. Starburst XXXtreme offers a choice between two scenarios for a higher stake. In one scenario with a ten times stake, the Starburst Wild is set on random on reels 2,3, or 4, and a multiplier starts the respin. The second scenario, which has a 95 times stake, starts with two guaranteed starburst wilds on reels 2,3, or 4. it also plays out using respin game sequence and features. The game also increases the potential with the Random Wilds feature to add Starburst Wilds to a vacant reel at the end of a spin. Every Starburst Wild gives a random multiplier with potential wins of x2, x3, x5, x10, x25, x50, x100, or even x150.

The new feature is sure to be a big hit with the gaming market as online gambling has shown significant growth during the lockdown. AdAge indicates the current casino customer base is an estimated one in five Americans, so Starburst XXXtreme’s additional features will achieve considerable popularity. 

What We Think About The Game

The gambling market has continued to diversify post-pandemic, so it is one of the most opportune times to release an online casino-based game. Thankfully Starburst XXXtreme features eye-catching visuals, including the jewels and space themes. These attract audience participation and make the gameplay inviting. The game also has a nostalgic edge. The previous NetEnt iteration featured similar visuals and gameplay, so the audience has some familiarity with it. The producers have revamped this version by tweaking the features to improve the volatility and engagement. 

That is characterized by the potential win cap of 200,000 times the bet. Starburst XXXtreme does not just give betting alternatives for players that want to go big. The increase of multipliers also provides a great experience. If the respins in the previous version were great, knowing that multipliers can go hundreds of times overtakes the game to a new level. 

Players should get excited about this offering. All of the features can be triggered within a single spin. Whether one plays the standard game or takes the XXXtreme spin route, it is possible to activate all of the features. Of course, the potential 200,000 times potential is a huge carrot. However, the bet size is probably going to be restricted and vary depending on the casino. It is also worth pointing out that a malfunction during the gameplay will void all of the payouts and progress. Overall, the game itself has been designed to provide a capped win of 200,000 times the original bet. 

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Anglais

‘We’re back’: Montreal festival promoters happy to return but looking to next year

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In downtown Montreal, it’s festival season.

In the city’s entertainment district, a musical act was conducting a sound check on stage Friday evening — the second day of the French-language version of the renowned Just For Laughs comedy festival. Tickets for many of the festival’s free outdoor shows — limited by COVID-19 regulations — were sold out.

Two blocks away, more than 100 people were watching an acoustic performance by the Isaac Neto Trio — part of the last weekend of the Festival International Nuits d’Afrique, a celebration of music from the African continent and the African diaspora.

With COVID-19 restrictions continuing to limit capacity, festival organizers say they’re glad to be back but looking forward to next year when they hope border restrictions and capacity limits won’t affect their plans.

Charles Décarie, Just For Laughs’ CEO and president, said this is a “transition year.”

“Even though we have major constraints from the public health group in Montreal, we’ve managed to design a festival that can navigate through those constraints,” Décarie said.

The French-language Juste pour rire festival began on July 15 and is followed by the English-language festival until July 31.

When planning began in February and March, Décarie said, organizers came up with a variety of scenarios for different crowd sizes, ranging from no spectators to 50 per cent of usual capacity.

“You’ve got to build scenarios,” he said. “You do have to plan a little bit more than usual because you have to have alternatives.”

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Anglais

MELS new major movie studio to be built in Montreal

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MONTREAL — MELS Studios will build a new film studio in Montreal, filling some of the gap in supply to meet the demand of Hollywood productions.

MELS president Martin Carrier said on Friday that MELS 4 studio construction will begin « as soon as possible », either in the fall or winter of next year. The studio could host productions as early as spring 2023.

The total investment for the project is $76 million, with the Quebec government contributing a $25 million loan. The project will create 110 jobs, according to the company.

The TVA Group subsidiary’s project will enable it to stand out « even more » internationally, according to Quebecor president and CEO Pierre Karl Péladeau. In the past, MELS Studios has hosted several major productions, including chapters of the X-Men franchise. The next Transformers movie is shooting this summer in Montreal.

Péladeau insisted that local cultural productions would also benefit from the new facility, adding that the studio ensures foreign revenues and to showcase talent and maintain an industry of Quebec producers.

STUDIO SHORTAGE

The film industry is cramped in Montreal.

According to a report published last May by the Bureau du cinéma et de la télévision du Québec (BCTQ), there is a shortage of nearly 400,000 square feet of studio space.

With the addition of MELS 4, which will be 160,000 square feet, the company is filling part of the gap.

Carrier admitted that he has had to turn down contracts because of the lack of space, representing missed opportunities of « tens of millions of dollars, not only for MELS, but also for the Quebec economy. »

« Montreal’s expertise is in high demand, » said Montreal Mayor Valérie Plante, who was present at the announcement.

She said she received great testimonials from « Netflix, Disney, HBO and company » during an economic mission to Los Angeles in 2019.

« What stands out is that they love Montreal because of its expertise, knowledge and beauty. We need more space, like MELS 4, » she said.

There is still not enough capacity in Quebec, acknowledged Minister of Finance, the Economy and Innovation Eric Girard.

« It is certain that the government is concerned about fairness and balance, so if other requests come in, we will study them with the same seriousness as we have studied this one, » he said.

Grandé Studios is the second-largest player in the industry. Last May, the company said it had expansion plans that should begin in 2022. Investissement Québec and Bell are minority shareholders in the company.

For its part, MELS will have 400,000 square feet of production space once MELS 4 is completed. The company employs 450 people in Quebec and offers a range of services including studio and equipment rentals, image and sound postproduction, visual effects and a virtual production platform.

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