Last chance to fix ailing health system?

There must be something rotten deep in the bowels of the Ontario Ministry of Health.

That’s a harsh indictment of a ministry filled with many hard-working people and whose main purpose is to ensure everyone living in Ontario receives quality health care in a timely manner.

But how else can you explain a bureaucracy that touts home and community care as one of the key elements of our cash-strapped health system, then either silently encourages or turns a blind eye as local agencies slash vital services for thousands of sick and elderly patients?

How else can you explain a bureaucracy that lets senior executives at provincial health agencies get huge pay raises of up to 50 per cent, or $90,000, over three years?

How else can you explain a bureaucracy that lets these same executives get away with forcing some of their key employees to work without a contract for a year and then offer them no pay raise, prompting them to go on strike?

How else can you explain a bureaucracy that lets its new boss, Health Minister Eric Hoskins, deliver a major speech earlier this week about a new “action plan” that was filled with public relations buzzwords about “transparency” and “transformation,” but lacked real details and, at its worst, was a rehash of an “action plan” issued in 2012 by his predecessor Deb Matthews?

Those questions should haunt Hoskins as he tries to move forward on fixing the province’s ailing health-care system.

Indeed, these are difficult days for Hoskins, who is dealing with a strike by about 3,000 home-care nurses and care co-ordinators in nine of the Community Care Access Centres across Ontario who have been without a contract for almost a year and have had hardly any pay increase in the last three years.

Hoskins is also facing a showdown with the province’s 28,000 doctors. Negotiations with doctors broke down last month and starting this week the government is unilaterally cutting their fees by 2.65 per cent.

His biggest challenge, though, will be to fight through the bureaucratic malaise within his own ministry, go beyond their nattering about “transformation” and bring about real change in home and community care.

The reason for this is simple: it’s far cheaper and more patient-friendly to deliver care, ranging from nursing to rehabilitation therapy to personal support, at home than in a hospital.

The problem is that Queen’s Park bureaucrats have been forcing hospitals to push patients out their doors as fast as possible, but have failed miserably in providing enough money to offer patients more than just a few token visits — in some cases as few as one or two — by a health-care worker once they are back home. Even Hoskins admits the system is a mess. “The current experience of our loved ones in this section, as we know from the feedback we have received from thousands of individuals and families, is uneven and disjointed. And I know our caregivers feel that every single day,” he said in his speech on Monday.

If that isn’t a clear condemnation of the job done before him by his Queen’s Park bureaucrats and Matthews, then I don’t know what is.

The current strike by CCAC workers, who help co-ordinate home care and transition patients from hospitals to rehab or long-term care facilities, is a prime example of a system gone wrong.

Community-care nurses are the only sector of nurses being asked to have their wages frozen. The strike, which started Jan. 30, will soon begin to affect patients set to be discharged from hospitals and who need continued care at home.

How can Hoskins claim the home-care sector is critical, but won’t do anything to get high-paid CCAC executives to resume serious bargaining with the nurses?

At the same time, these CCAC bosses have told private companies whose health-care workers actually deliver services to patients at home that they won’t get an increase in the rates they can charge. Also, some firms have seen their work reduced anywhere from 10 to 50 per cent because of pennypinching by CCACs.

The result is that most home- and community-care health workers haven’t seen a pay raise in years.

The message is clear: community-care work doesn’t pay. As one worker from outside Toronto told me this week in an email, the “people who take care of you at home are not there for the money. They are committed to you and they love their job, but enough is enough.”

On Thursday, Hoskins announced Ontario will allocate $75 million this year to support more home care for patients who need help in such things as dressing and bathing. It’s not much, but anything helps.

For his part, Hoskins admits home and community care is ripe for change, stressing he is “committed to seeing it through.”

But to that he will have to deal first with the rot, indifference and inaction within his own ministry.

That may be his best — and maybe his only — chance to fix Ontario’s ailing health-care system.

These are difficult days for Ontario Health Minister Eric Hoskins as he deals with striking home-care nurses and care co-ordinators