What’s holding up reforms to home-care mess?

Posted on December 6, 2015 in Health Delivery System

TheStar.com – Opinion/Commentary – There’s growing evidence that the Ontario home-care system in dire need of major overhaul. So what’s taking so long?
Dec 06 2015.   By: Bob Hepburn, Politics

After months of planning and false starts, Ontario Health Minister Eric Hoskins finally has all the proof he needs to push ahead at full speed with sweeping changes to the province’s troubled home-care system.  So what’s holding him up?

For weeks, Hoskins has been signalling he will release a “discussion document” outlining radical reforms, including scrapping the beleaguered 14 Community Care Access Centres (CCACs) that co-ordinate home-care delivery across the province.  He received even more evidence this past week that it’s time to transform the system with the release of Auditor General Bonnie Lysyk’s annual report.

Lysyk listed a wide range of mismanagement, poor oversight and horror cases in which patients failed to get services, such as nursing, physiotherapy and personal support, on time or in enough quantity to make a lasting difference in their health. In many instances patients had to wait almost a year just for an initial assessment.

In recent days, Hoskins has been telling key health-sector players he will release his discussion paper “before the holidays.”

The document is expected to propose shifting much of the CCACs’ home-care planning and oversight roles to the 14 Local Health Integration Networks (LHINs) that now are responsible for overall regional planning, funding and health-care integration. The job of co-ordinating face-to-face services, which now falls to CCAC staffers, may be moved to primary care agencies, such as hospitals or community health clinics led by doctors or nurse practitioners.

The goal is to save more than $200 million by eliminating the bureaucracy-heavy CCACs, with their high-paid executives, and directing the savings to front-line services.

More than 700,000 Ontario residents receive care annually at home or in community settings. The province spends $2.5 billion a year on home and community care, about 4 per cent of its total health budget.
Despite overwhelming evidence that the system is in dire need of reform, Hoskins seems reluctant to move ahead with any speed.

Two months ago his office cancelled a private lock-up for home-care stakeholders at which they were to discuss a “white paper” on reforms. Hoskins also scrapped plans for a special home-care task force on the grounds it would be viewed as just another stalling tactic.  Still, Hoskins is indeed moving, albeit slowly.

On Nov. 20, he spoke privately with the board chairs and chief executive officers of the 14 CCACs about the coming changes.  On Nov. 30, Deputy Health Minister Bob Bell met with the same CCAC bosses and while he didn’t share any “concrete plans,” he did suggest health ministry officials will consult with CCACs and other agencies about the proposed changes “in the new year.”  And on Dec. 1, Hoskins wrote to the CCAC bosses to explain that his ministry has every intention of “working together with CCACs to build a health care system that truly responds to the needs of patients and their families.” Again, no specifics were mentioned.

Clearly, Hoskins is dealing with a health-care establishment that is reluctant to change. That includes the CCACs, LHINs, doctors and his own bureaucrats.

LHIN officials, for example, don’t want to be in charge of direct delivery of care. They have few staffers who actually know how to run a big health system on a day-to-day basis.  At the same time, the LHINs have their own troubles, as Lysyk noted in her report. She said their “marching orders are not clear enough” and performance gaps are widening, especially on wait times.

In the weeks ahead, Hoskins must address whether the LHINs are ready to assume greater duties, whether they should be in the health-care delivery sector at all and how to achieve better integration between hospitals, public health, primary care and home-care agencies.  Also, he should look at whether all — not just some — home-care delivery should be left to private and non-profit service providers.

Hoskins and his bureaucrats may be delaying the reform push until they develop “the perfect plan.”  But Hoskins, who has shown true vision in this initiative, should view the document as the starting point — not the end point — for wholesale reforms that cut out an entire layer of costly bureaucracy and that improve the delivery of services that patients need and deserve.

Everyone in the health-care sector is primed and ready to act, although not eagerly in all cases.  Just as important is the fact that more delays and more wasted tax dollars won’t fix the broken system.  So it’s time for Hoskins to end the needless holdups and move swiftly and boldly on behalf of the people who really matter — Ontario patients.

< http://www.thestar.com/opinion/commentary/2015/12/06/whats-holding-up-reforms-to-home-care-mess-hepburn.html >

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