Social Policy in Ontario

What’s worse is that Premier Kathleen Wynne is either deliberately ignoring clear signals that the mess is growing or has tacitly approved sweeping cuts in services affecting tens of thousands of patients in Ontario.

Evidence of Ontario’s declining health system is everywhere, especially in the home-care sector, and will only worsen unless radical surgery is performed now.

Increasingly, health-care experts are crying out for a total reorganization of the current home-care system, including shutting down the Community Care Access Centre system that governs home care across the province.

They say CCACs have become costly bureaucratic nightmares that waste money, micromanage front-line workers and arbitrarily cut funding for services, leaving patients to dig into their own pockets to pay for needed care or go without.

Privately, some experts go so far as to say Wynne should dump Matthews, suggesting she is ineffective, in the dark and over her head in the health portfolio.

Since she became health minister in 2009, Matthews has repeatedly dismissed complaints, including from Ontario’s auditor general, about the operation of CCACs. These government-created agencies, created under Harris in 1996, receive about $2.2 billion annually to provide health services for patients living at home or in long-term care facilities. The 14 CCACs in the province serve 653,000 patients a year.

But under Matthews, the CCACs have grown out of control, with soaring executive salaries, bloated bureaucracies and duplicated services.

In addition, with little need for approval from Queen’s Park, CCAC executives can make unilateral health-care decisions, often slashing funding for critical services, such as physiotherapy, in an effort to balance their budgets.

At the same time, Matthews has repeatedly turned her back on patients abandoned by CCACs. Growing numbers of them have been forced to resort to public fundraising events to help pay for services just to help them walk, use their hands and arms, speak and swallow.

Some groups, such as the Registered Nurses’ Association of Ontario, are trying to fight back, raising serious concerns about transparency, duplication of services, value for money and conflict of interest of the CCACs.

They are urging Matthews to shut down the CCACs over a three-year period and move their planning role to Local Health Integration Networks, another health agency that plans overall health services in various regions.

“Nobody thinks we need both structures (CCACs and LHINs) on the ground,” says Michael Decter, a former deputy Ontario health minister and current chair of Patients Canada, a grassroots patient-advocacy group. “A good case can be made for one bureaucracy.”

The main CCAC complaints include:

• CCAC executives’ salaries have soared in recent years while salaries for front-line health workers have stagnated for the past decade.

For example, Cathy Szabo, CEO of Central CCAC, which serves large parts of north Toronto and York Region, saw her salary jump by 50 per cent from $180,005 in 2009 to $271,734 in 2012 — an increase of more than $91,000 in just three years. And Melody Miles, CEO of Hamilton-Niagara CCAC, had a 24-per-cent pay hike over the same period to $265,949.

• CCAC managers are paid wages far above most of the health-care providers who actually see and touch patients. For instance, in the Central East CCAC, which serves eastern Toronto, 35 staffers earned more than $100,000 in 2012. By contrast, most personal support workers make less than $20,000 a year.

• In a shameful bid to save money, CCACs are slashing vital services, particularly in rehabilitation areas. The latest move will see CCACs no longer funding patient assessments in long-term care facilities by speech-language pathologists, all of whom must have a master’s degree to be certified to work. Although there are official denials, rumours are rampant in rehab circles that dietitians could now conduct these assessments as part of their normal tasks even though they have little or no training in the field.

Such bureaucratic cost-cutting is potentially life-threatening.

• CCACs spend only about 60 per cent of their budget on front-line delivery of services to patients. The rest, almost three-quarters of a billion dollars, is spent on administration and case management, which determines if patients are eligible for home or community care and how much they need. That means a disproportionate amount of money is being spent on management and assessment of need rather than on the actual delivery of care.

The list goes on.

To stop the slide, Wynne can take some immediate steps, say a number of health-care professionals interviewed this week.

First, the premier should demand a full audit of the 14 CCACs. The audit should focus on their cost structures to determine if the CCACs are in fact providing true value for money for taxpayers.

Second, Wynne should order a full review of the CCACs’ overall roles and practices, with the aim of possibly closing them and transferring their duties to the LHINs.

Third, she should immediately freeze all CCAC executive and managerial salaries.

Fourth, Wynne should cancel all pending CCAC decisions to cut funding for current home-care services.

Fifth, listen closely to critics who want to see Deb Matthews replaced. Matthews has obviously lost the confidence of key health-care workers — and the very patients they serve.

Because of this growing crisis in this increasingly important part of our health-care system, it’s critical for Wynne to step in now.

More inaction will only lead to more chaos than Ontario patients have already seen under Matthews’ time as health minister.

< http://www.thestar.com/opinion/commentary/2014/02/05/kathleen_wynne_fails_to_act_on_growing_healthcare_mess_hepburn.html >