Social Policy in Ontario

Ontario’s bold bet on health-care reform

Posted on June 5, 2016 in Health Delivery System

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TheStar.com – Opinion/Commentary – Hoskins’ vision praised, but concerns remain over changes in home care
June 5, 2016.   By BOB HRPBURN, Politics

With a vision and a prayer, the Ontario government is launching the most revolutionary change in the provincial health-care system in the last 20 years.

If they succeed, the reforms will mean Ontario patients will be huge winners, receiving care faster, more frequently and with less hassle than ever before.

The sweeping changes, introduced Thursday in the Ontario legislature by Health Minister Eric Hoskins, are designed to provide quicker access to family doctors, help patients transition from hospitals to home care and save money by eliminating an entire layer of health-care bureaucracy.

Called the Patients First Act, the 50-page bill would scrap the 14 controversial Community Care Access Centres (CCAC), beef up the role of the 14 Local Health Integration Networks (LHIN) and require amendments some 20 other legislative acts.

The vision, as expressed by Hoskins, is to develop a system that is streamlined, more seamless and ultimately results in more money for services that front-line workers provide for needy patients in their homes and communities.

The prayer is that government bureaucrats and vested interests in the health-care sector actually co-operate, rather than fight to protect their own silos, and to work through what is shaping up as a difficult and at times possibly cumbersome transition to the new system.

At the heart of the reform legislation is the decision to disband the CCACs, which currently are responsible for home and community care. The CCACs have been at the centre of a storm of controversy after a series of Toronto Star columns and articles dating back to 2012 investigating lavish salary increases for CCAC executives and huge administrative costs.

In the wake of those revelations, the health ministry launched extensive consultations on how to improve the home-care system, consulting with more than 6,000 individuals and groups across Ontario in the last year alone on proposed reforms.

Under the new legislation, all of the duties of the CCACs will be transferred to the LHINs, which to date were responsible primarily for overall planning and financing of health care within 14 geographic areas of the province.

Most of the CCACs 6,000 employees, including care co-ordinators, will be absorbed by the LHINs. The care co-ordinators will initially at least be paid by the LHINs, but placed in primary care facilities, such as hospitals and local health clinics.

Although Hoskins declined to say how much money will be saved by the move, a reasonable estimate pegs the figure at up to $50 million a year. That money would be redirected to providing more one-on-one care for patients who have been released from hospitals.

LHINs’ executives have already been told that Hoskins expects eventually to see a minimum 5- to 10-per-cent attrition in administrative staffing.

For patients, if the system works as Hoskins envisions, there should be less bureaucracy in trying to get care for when they leave hospital and return home or to another care facility.

That’s because an entire level of bureaucracy will have been eliminated.

For example, currently patients are assessed by a hospital discharge planner, a CCAC care co-ordinator, and then by front-line health professional, such as a physiotherapist, working for a private company that actually provides care at home. In the new system, patients would need to be seen by only a care co-ordinator and the front-line worker.

Overall, the vision is good. Even some critics concede that.

However, there are legitimate concerns about whether the reforms will lead to more — not less — bureaucracy and, more importantly, whether they will have any real impact on patients.

Additionally, there are doubts on whether the LHINs are good system managers. Auditor general Bonnie Lysyk heavily criticized their performance in a report last fall.

Also, there are questions about the LHINs’ lack of expertise in the delivery of home care and about the LHINs turning into service providers, which puts them in conflict with private and non-private organizations contracted to actually deliver home care to patients.

Michael Decter, chair of Patients Canada, an independent, non-partisan organization that advocates on behalf of patients, has praised Hoskins for tackling the home-care mess.

But the group will adopt a wait-and-see approach to Hoskins’ claims about patient benefits. “We are unable to see how a major restructuring of boards and more bureaucratic management and oversight of health providers and health organizations will result in more responsive, effective, compassionate delivery of health care services to patients,” Decter says.

Patients and others will have a chance to voice their formal support, or their fears, about the legislation when a legislative committee begins public hearings on it this fall.

Final passage will likely occur next spring, with full implementation of all the proposals expected to take at least a year.

Still, despite its massive size and scope, the Patients First Act is not the end of health-care reform. There are still lots of good ideas for Hoskins and the health ministry to pursue.

That’s why the bill should be judged as a first step — not a last one — to a complete overhaul of a health-care system that too often has failed too many Ontario patients.

< https://www.thestar.com/opinion/commentary/2016/06/05/ontarios-bold-bet-on-health-care-reform-hepburn.html

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