Ontario moves to scrap troubled health agencies, reorganize primary care

Posted on in Health Delivery System

TheGlobeandMail.com – News/National/Ontario
Dec. 17, 2015.   Elizabeth Church

Ontario is moving to scrap the troubled agencies responsible for home care and is proposing changes to the way primary care is organized to make it easier for people to find family doctors and get an appointment when they are sick.

The move, made public Thursday in a discussion paper, comes as the Liberal government faces mounting pressure to make changes to home care following a string of scathing reports and questions about its failure to act sooner. The timing of this move also raises questions, coming so close to the holidays when the legislature is not in session and opposition critics are in their ridings or on vacation.

The discussion paper includes no timeline for any of its proposals. It raises many questions and proposes changes in four areas, but provides little indication of how the changes would be implemented.

At the centre of the proposal, as reported by The Globe and Mail last month, is the expansion of the role played by the province’s Local Health Integration Networks (LHINs) and the elimination of Ontario’s 14 Community Care Access Centres (CCACs), the public agencies responsible for overseeing the delivery of services such as nursing, physiotherapy and help with personal care for the sick and the elderly in their homes.

The CCACs have long been criticized, and were the focus of a Globe and Mail investigation that found inconsistent standards of care and a lack of transparency that left patients and their families struggling to access services.

Under the proposed changes, the boards of the 14 CCACs “would cease to exist,” and care coordinators and other staff involved in delivering care would be employed by the LHINs but could be located with family health teams, community health centres or hospitals, the paper suggests. CCAC management structures – criticized for their high salaries and large pay hikes – “would be reviewed,” the paper states, along with the management structure of the LHINs.

Two reports this fall from Ontario Auditor-General Bonnie Lysyk found as little as 61 cents out of every dollar spent by the agencies went to face-to-face client services, and few improvements had been made to correct problems identified years before.

Health Minister Eric Hoskins, in a statement Wednesday, said the government “wants to reduce bureaucracy and administration in home and community care.”

Even so, the policy paper proposes dividing up the province into smaller, local organization to co-ordinate the delivery of home care and primary care – something it calls “LHIN sub-regions.” The paper states that “there will be no new layer of bureaucracy between Ontarians and the health-care services they need,” but does not make it clear how these “sub-regions” would be organized to avoid this. The job could be given to existing organizations such as community health centres, it suggests.

In the case of primary care, there has been widespread speculation about how far the reforms would go and how the province can restructure the system at a time when it is waging an increasingly bitter battle with doctors, who have been without a fee agreement for more than a year. After the government imposed two across-the-board fee cuts this year, the Ontario Medical Association, which represents the province’s doctors, began a public campaign criticizing the measures that it argues are hurting patient care.

Senior government officials stressed that the plans mapped out in the paper would be the basis of consultations in the new year, and that no changes would be “imposed” on doctors, but the paper itself provides little insight into how the new system would operate.

The province is proposing that the new LHIN “sub-regions” will “match unattached patients to primary care providers,” but the discussion paper stresses patients will still be free to choose their doctor and clinicians will not be compelled to take patients. It also states that doctor compensation would continue to be negotiated directly with the province.

“Our goal is to make it easier for patients to find a primary health-care provider when they need one, see that person quickly when they are sick, and find the care they need, closer to home,” the Health Minister said in a statement.

“This proposal would help ensure that there is local planning so that health-care providers are available to patients where and when they are needed. Better care for patients means changes to local health networks so Ontarians get consistent care no matter where they live,” the statement said.

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