Social Policy in Ontario

Now, Ford’s Progressive Conservative government is embarking on an ambitious battle. But like the fabled war against terror, the fight against wait lists is a never-ending war of attrition, marked by temporary victories and recurring setbacks.

Dr. Rueben Devlin is leading the charge on Ford’s behalf. A former hospital CEO and orthopedic surgeon, he is also a family friend and former PC party president who enjoys the premier’s trust.

Devlin has assembled an impressive health care brain trust, which delivered its first reportthis week for the Premier’s Council on Improving Healthcare and Ending Hallway Medicine. Note the emphasis on “ending” hallway medicine.

Far better, perhaps, to offer a fix than a final cure, lest it fizzle out (like, say, buck-a-beer). And come back to torment you.

Remember Dalton McGuinty’s promise to cut wait lists for cancer and other surgeries? He set bold targets and, aided by the best medical minds, made impressive progress.

Or as Ford might say today of McGuinty’s achievements, “promise made, promise kept.” Until it unravelled again thanks to a growing and aging population.

While demand grew, spending couldn’t keep up, and efficiencies weren’t found fast enough. The spillover of patients in Brampton hospital hallways prompted both Tories and New Democrats to pounce on the Liberal government of the day.

Today, the fine print of Devlin’s first report is more circumspect than the grandiose name of the council he heads. Rather than promising to “end” it, Devlin seeks to “fix” it, and redefine the remedy:

He aims to “fix the problem of hallway health care … however, hallway health care is a symptom of broader challenges facing Ontario’s health-care system.”

Precisely right. More money for more hospital beds won’t buy our way out of waiting lists if we are still bogged down by so-called “bed blockers” — people seeking complex care, or “alternate level of care,” or long-term care, or home care outside of a high-cost, acute-care hospital. Similarly, more cash flow won’t penetrate health-care silos, whether between medical specialties or among regional bureaucracies.

These universal truths of universal health care were not discovered by Devlin. They were known to his fellow panellists, such as Michael Decter, a longtime New Democrat who morphed into a non-partisan deputy health minister in the Bob Rae government.

Indeed, Devlin’s declaration that we must “integrate care around the patient” is an echo of the “patient-centred care” that Dr. Eric Hoskins, the former Liberal health minister, made his mantra.

The report reminds us of another universal truth as Ford embarks on an era of austerity: “social determinants of health … play a critical role… Having a job, eating healthy food and having a safe place to sleep are foundations to good health.”

Despite the grand political battles that play out at election time, it turns out that the prescriptions are less ideological — and more logical — than people assume. While the Liberals took a beating for the bureaucratic structure of the health-care system, the much-maligned Community Care Access Centres (CCAC) that placed people in long-term care were the creation of the Mike Harris Tories in the late 1990s. The introduction of our unpopular Local Health Integration Networks (LHINs) was inspired by regional decentralization under Alberta’s Progressive Conservatives.

All that decentralization engendered duplication, as each LHIN and CCAC assembled its own bureaucracies and boards, leaving the available managerial talent stretched thin. It’s time to recalibrate and recentralize, breaking down barriers instead of creating yet more silos.

Both Devlin and Decter have been around the block, which is why they are not so much trying to reinvent the wheel as repackage it in search of greater traction. There is no magic bullet to make the patient better, for health care is more about good policy than good politics.

Yes, we need to manage the system and manage the patient, but also manage expectations. Devlin promised this week to be “transparent and accountable to the public” about our public health-care system.

Health Minister Christine Elliott followed up with a promise to safeguard that public system, dismissing opposition accusations that a privatized, two-tier approach is the magic bullet that Ford will one day deploy. But her denials were hardly categorical as she talked repeatedly (if somewhat ominously) of a “transformational” strategy to come.

If the Devlin-Decter duo is pondering a two-tier system for Ford, presumably they plan to be “transparent and accountable to the public” about it before delivering a fait accompli. Doctors call it informed consent, because patients deserve nothing less.

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

https://www.thestar.com/politics/political-opinion/2019/02/01/the-danger-of-two-tier-medicine-if-doug-fords-top-doc-doesnt-seek-informed-consent-first.html