Bloated Ontario health agencies to face the axe

Posted on November 8, 2015 in Health Delivery System – Opinion/Commentary – Ontario is set to move on most sweeping changes in home-care system in decades.
Nov 08 2015.   By: Bob Hepburn, Politics

After years of inaction, the Ontario government is finally preparing to make dramatic changes to the way that community and home care is delivered to patients across the province.

The welcome move is aimed at eliminating wasteful duplication in the system and providing better service for hundreds of thousands of patients who need nursing, personal support and therapy treatments at home or in community settings such as schools and seniors residences.

Most importantly, it will spell the demise of the 14 controversial Community Care Access Centres (CCACs) across the province, the costly and bloated agencies currently responsible for overseeing home and community care.

The bold move will be the most sweeping change in the critical home- and community-care system in Ontario in nearly 20 years.  Health Minister Eric Hoskins hinted strongly at the move, first reported by Star health reporter Theresa Boyle, during a speech on Nov. 4 to the Ontario Hospital Association.

“The time has come for us to have a conversation about the structure of the system,” Hoskins said, adding it is imperative that the province break “the cycle of poor health outcomes” and address inequities across the province.
Privately, senior health officials told Boyle and other health professionals that the CCACs are on their way out, telling some pointedly to “read between the lines” in Hoskins’ speech.

As a first step, Hoskins is expected to create a powerful task force in the next few weeks that will look at how best to shut down the CCACs, which simply aren’t working, and transfer their duties to other existing agencies, such as the 14 Local Health Integration Networks (LHINs), which oversee and fund CCACs, hospitals and other community health services.

Hoskins deserves full praise for the move to dismantle the CCACs.

For years, health professionals, including the Registered Nurses Association of Ontario, have argued that the CCACs are too costly, inefficient and bureaucratically top-heavy. A series of major reports, the latest in October by Ontario auditor general Bonnie Lysyk, have highlighted how the CCACs are badly run and spend too much of the $2.4 billion they receive annually on administration rather than direct patient care.

But successive health ministers, especially Hoskins’ predecessor Deb Matthews, the current deputy premier, casually dismissed the criticisms, defended the CCACs and refused to tackle the problem of a system that was clearly broken.

For years, CCACs have been filled with high-paid executives who received whopping pay increases, built bureaucratic empires, used taxpayer dollars to hire high-priced lobbyists to defend their agencies at Queen’s Park and employed costly public relations experts to paint rosy pictures of their operations.

CCAC executives also created regimes of fear and intimidation that resulted in CCAC employees and private service companies terrified for their jobs or their service contracts if they dared to criticize how these government agencies were operating.

At the same time, CCACs halted or slashed services to patients in the name of cost-cutting while many front-line workers, such as nurses, speech therapists and personal support workers, went years without a pay hike.
Also, dedicated and hard-working CCACs employees were often overworked and received little support from senior executives.

In her auditor’s report, Lysyk confirmed earlier studies that barely 62 cents of every $1 received by CCACs goes to actual face-to-face patient care. Lysyk found that the rest, more than $900 million a year, goes to administration and overhead.

CCAC executives had bragged for years that 92 cents of every dollar went to direct patient care and had scoffed at anyone who disputed what turns out to be a false claim.

An Ontario legislative committee had requested the auditor’s report after a series of news articles and opinion columns in the Star in 2014 and early 2015 outlined the sorry state of home and community care in the province.

Once the CCACs are scrapped, most of its functions dealing with system planning, funding and performance reviews likely will be transferred to the 14 LHINs, which cover the same regions as the 14 CCACs.  The 3,500 care coordinators now working for CCACs would not lose their jobs. Rather, they could be shifted to primary care agencies, such as family health teams and community health centres.

Overall, Hoskins’ aim is to eliminate the bureaucrat duplication rampant in the system, get rid of many costly executive positions and direct the money to where it was originally intended, namely to providing fast, efficient and sufficient services to patients in need.

If he achieves that goal, then Hoskins will be justifiably viewed as one of the most visionary – and bold – health ministers in Ontario in decades.

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