Social Policy in Ontario

Fear and loathing stalk health-care reform

Posted on March 27, 2016 in Health Delivery System

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TheStar.com – Opinion/Commentary – Ontario Health Minister Eric Hoskins is facing tough opposition to his historic health-care reform package
Mar 27 2016.   By: Bob Hepburn Politics

Behind closed doors at Queen’s Park, Health Minister Eric Hoskins and a team of senior bureaucrats are preparing to unveil a massive reform of the health-care system that will impact the lives of every single resident in Ontario.

But Hoskins is running into a wall of opposition and criticism from vested interests in the system as he tries to push ahead with the most significant health-care reform in 50 years in Ontario.

At the same time, a pervasive sense of fear has dominated the closed-door talks that Hoskins has been holding in recent weeks with health-care leaders — a fear that prevents many participants from speaking their minds openly lest they face reprisals from agencies they rely on for funding.

These issues are so prominent that they threaten to delay Hoskins’ proposals — or even derail the entire process.

This is important because Hoskins, who deserves praise for trying to clean up the mess in the health-care system, especially in the home-care sector, needs to win wide support for his proposals if they are to have any chance of success.

The reform package, expected to be presented to cabinet in April and then tabled in the legislature in May, is intended to improve dramatically how patients are handled from the moment they first need treatment until the day they no longer require services at home or in their community.

At the heart of the reform package is a dramatic reorganization of the home-care system.

The reforms come in the wake of a series of damning reports that showed the current system of home and community care is a disaster, with bosses at Community Care Access Centres (CCAC), which co-ordinate home care, receiving whopping pay raises and working in lavish offices while front-line health workers saw their wages frozen for 10 years and thousands of patients received inadequate or no care at all.

Hoskins is proposing to scrap the 14 bureaucracy-laden CCACs and to shift much of their work to the province’s 14 Local Health Integration Networks (LHINs), with the goal of saving more than $200 million and directing the savings to much-needed front-line services.

Over the past two months, Hoskins and his ministry have staged a series of “stakeholder engagement” meetings with hundreds of senior health-sector professionals. He had hoped these sessions would provide an opportunity to receive fair and honest feedback on the reform package.

Too often, though, the outside professionals have been holding back on their opinions, feeling it is too risky for them to stand up and speak out against the LHINs, who they rely on for money, or the health ministry itself.
This issue became apparent during a survey of senior health professionals released last week by Ted Ball, a respected health transformation analyst who has worked in the field for some 40 years.

Ball found that many of those who answered the survey said they did not feel “safe” speaking truth to their LHIN funder and to the health ministry officials.

Said one CEO, “The focused questions at these consultations were about implementation issues, so I was not going to put my organization at risk and stand up and tell the LHIN and [health ministry] officials that their plan to increase their micromanagement of the delivery system was a bad idea.”

Indeed, 69 per cent of the nearly 200 top officials answering the survey said they had little or no confidence in the consultation process. Some 61 per cent said they had little confidence in the LHINs’ ability to undertake the expanded role and nearly 60 per cent lacked confidence in the health ministry’s ability to manage the LHINs.

The three words most used to describe the LHINs were “inefficient,” “inexperienced,” and “bureaucratic.”

Three words used often to describe the health ministry were “controlling,” “insular” and “bullying.”

Hoskins knows the path forward in the next few months will be difficult.

He must win over the people who feel threatened, assuring them that their voices really do count. But it won’t be possible if only the bean-counters at Queen’s Park and the vested interests in the CCACs or big institutions are allowed to get their way at the expense of the needs and wisdom of patients, front-line workers and primary-care agencies.

Only by working together can our health-care system be fixed — and the fear and loathing finally come to an end.

< http://www.thestar.com/opinion/commentary/2016/03/27/fear-and-loathing-stalk-health-care-reform-hepburn.html >

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