In the last few days, we have learned a lot about what the new government has in store for our health system. Having heard the minister of health’s remarks on Tuesday, followed by technical briefings provided by the ministry, I am increasingly confused and concerned about the proposed changes.
This is the most massive change proposed for health care since medicare was introduced 50 years ago. Given the extent of the change, one would expect the purpose behind the transformation, as well as the desired future state, would be worked out well in advance.
Instead, the change seems to rely on a “we’ll figure it out as we go along” attitude, which is out of keeping with the extent of this transformation.
Let’s consider the government’s campaign promises for health during the election. Three commitments were made: to solve hallway medicine, to open 15,000 long-term care beds and to increase mental illness services. None of these commitments to enhance capacity required destroying the current system organized around Local Health Integration Networks (LHINs).
However, the new government insisted that LHINs had failed their role of integrating care around the patient. The LHINs therefore would be eliminated and replaced by two new structures. This is when the concept of radical overhaul of the structure of the system first became apparent, accelerated by leaked draft legislation.
In legislation tabled Tuesday, the government will create a super agency called Ontario Health, which will become the single point of accountability for all health services in the province. Unfortunately, Ontario Health will terminate two outstanding independent agencies, Cancer Care Ontario and Trillium Gift of Life. They will be unlikely to deliver world-leading cancer and transplant care when they become one of many “health verticals” within the massive super agency.
But we have learned from technical briefings that the LHINs will not actually disappear. Because the LHINs co-ordinate home-care services for 750,000 vulnerable Ontarians, the LHINs will stay for at least three years after Ontario Health begins. And the new Ontario Health will actually keep five “Legacy LHINs” in the super agency forever.
So rather than eliminating LHIN administrative costs, the super agency will keep all LHINs intact for several years and then morph our current 14 LHINs into five regional agencies. The super agency will be a net new bureaucratic cost, without any savings from closing LHINs.
This raises the question: Why not simply keep the LHINs, change their name, reduce them from 14 to five or seven new regional agencies and eliminate the super agency before it begins? The super agency is likely to damage cancer care and transplant care, and it is now revealed as a new bureaucratic cost that will require five “Legacy LHINs” in perpetuity.
Why are we investing in a new board, CEO and high-priced senior management team for Ontario Health? What purpose will it serve?
And then we learn about the “low rules” environment that will give rise to Ontario Health Teams: 30 to 50 teams will be selected through an iterative process with guidance not from the super agency, but from the ministry.
We learned on Tuesday that these teams would be voluntary groupings of hospitals and community providers, who would integrate care locally — mainly it seems by improving IT systems and providing navigators to patients transferring across the health system. Again, improving information systems and providing navigation does not require radical change in the system.
Also worrisome is that the ministry also says this transformation will not be completed for several years. In other provinces, the record of super agencies is that they stall all health progress for five or more years while everyone focuses on achieving the structural changes the transformation demands. It seems our ministry is forecasting several years of turgid inertia while Ontario Health and Ontario Health Teams organize their new structures.
This feels like the worst of all worlds. Massive new bureaucracy, maintenance of old bureaucracy and a low rules environment where we will design the future of Ontario health systems “on the fly.” Meanwhile some of the best parts of our system are left to wither on the new transformation vine.
Is it too late to suggest that the government should reconsider this poorly thought out, expensive and (based on other province’s experiences) chaotic change?
Bob Bell worked in Ontario health care for more than 40 years as a GP, surgeon, hospital CEO and Deputy Minister of Health.
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