Ontario’s new plan for health care echoes past prescriptions

Posted on February 28, 2019 in Health History

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TheStar.com – Politics/Political Opinion
Feb. 27, 2019.   By

Nothing is more personal — and political — than health care.

Whether it’s getting primary care for a pregnancy, emergency care for a heart attack, or long-term care for a disabling disease, you want to know it’s there when you need it.

And whether you’re humiliated by hallway medicine, relegated to a waiting list, or fall between the cracks of the system’s silos, you want to believe the politicians when they prescribe new remedies for our $52-billion health-care system.

The bold new reforms promised this week by the Ontario government certainly sound promising. Never mind that the Tories have christened it, with fatuous formality, the People’s Health Care Act, 2019.

Health Minister Christine Elliott should know where the bodies are buried and the skeletons hidden. After quitting as a Progressive Conservative MPP, she was hired by the previous Liberal government as the province’s first patient ombudsman.

Now back in politics as the minister in charge under Premier Doug Ford’s PCs, there is every reason to believe she is serious about healing our ailing health-care system. She surely deserves the benefit of the doubt — but without the benefit of certainty.

Read more:

New Ontario Health agency would overhaul ‘disconnected’ medical system, minister saysMassive health-care overhaul called ‘biggest change’ since medicare

Opinion | Bob Hepburn: Patients lose out in Ford’s health-care ‘reform’

After winning a “change election” in which hallway medicine emerged as a major issue, the Tories are casting themselves as “change agents” on health care — much like every party in power before them.

That’s good as far as it goes, but the record suggests that change won’t get you very far unless it’s the right kind of change. Because if the wrong changes are made, you end up undoing them down the road.

And the reality, as Elliott herself admitted this week after unveiling her ambitious proposals, is that we won’t know the outcome for years to come. Only time will tell, as the cliché goes — but over time, the vocabulary of change has been remarkably unchanging.

Elliott is now promising “transformation” of the system. She will deliver “patient-centred care.” And she intends to move people through a “siloed” system “seamlessly.”

That’s precisely the wording used by the previous Liberal health minister, Dr. Eric Hoskins, shortly after he too promised to be a change agent. Back then, Hoskins talked up “patient-centred care,” promised a “transformation,” and swore all “silos” would be smashed.

In late 2015, Hoskins promised to fix Ontario’s “fragmented” health-care system with “the biggest overhaul in a generation.” The Liberals disbanded those community care access centres first cobbled together by the Mike Harris PCs two decades earlier when the Tories tried — sound familiar?— to reform the system.

Hoskins also streamlined the controversial local health integration Nnetworks (LHINs) that he inherited from a previous health minister, George Smitherman, who a decade earlier decided to decentralize the bureaucracy at Queen’s Park. Smitherman introduced “family health teams” to break down “silos” with “transformational change.”

There’s that rallying cry yet again — “transformational change” — from Smitherman in 2005, Hoskins in 2015, and Elliott in 2019. A perennial ambition for transformation.

The problem is that, then as now, the minister of the day proposed bold measures, but no metrics. Over time, it’s hard not to feel that new governments are like new managements that promise to change the narrative and move the needle. And then move on before the epilogue is written.

Remember Smitherman? Remember Hoskins? Will anyone remember Elliott when the time comes to measure the success or failure of these measures?

The Tories decentralized two decades ago, the Liberals did it a decade ago, and the Tories are recentralizing today. B.C., Nova Scotia and Alberta have also experimented with right-sizing, but with mixed results.

Now Elliott has settled on super-sizing delivery with the merged Ontario Health agency that will reunify Cancer Care Ontario, Health Quality Ontario, eHealth, Trillium Gift of Life and others. And she wants health professionals to come together with “Ontario health teams” to co-ordinate care, but it is all remarkably undefined and embryonic.

Dr. Nadia Alam, head of the Ontario Medical Association, was never more right when she said this week, “the details matter.”

Connectivity can be a good thing but it is not a sure thing — it can’t conjure up co-ordination, efficiencies and extra beds on demand. Buzzwords are not benchmarks.

Is Elliott doing the right thing or merely the right-wing thing? The minister insists privatization is not on the agenda (at least not with these reforms), telling reporters that “there will be no more for-profit care in the system that we are envisioning.”

Words worth watching.

For those who worry about the system — whether as health-care professionals, professors or patients — the question is whether these reforms are truly transformational or merely aspirational. The one certainty, according to Elliott, is that “today is a new day for health care in Ontario.”

We’ve heard that before. Politicians, like pharmacists and physicians, are in the habit of renewing their prescriptions.

Martin Regg Cohn is a columnist based in Toronto covering Ontario politics.


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