A lasting legacy for Ontario patients

Of all the Ontario cabinet ministers, Health Minister Eric Hoskins may have the toughest job these days.

Almost from the moment he was sworn in 18 months ago, Hoskins has been under attack from all sides.

Doctors are furious over cuts to their fees, hospitals are fighting for more money, underpaid front-line healthcare workers are seeking a decent wage and patients and caregivers are crying out for home-care services they need but too often turn out to be inadequate or nonexistent.

Despite these assaults, Hoskins is forging ahead with two major reforms to health care that will have a dramatic and positive impact on patients for years to come.

First, he is moving on a radical restructuring of how home care is delivered across Ontario.

Second, and just as important, he is driving his own ministry to start paying serious attention to patients, rather than giving mere lip service to the notion.

Both are game-changers — and both are fraught with hurdles and bureaucratic resistance that Hoskins must overcome.

On home care, Hoskins has released a discussion paper which includes the likely scrapping of the 14 bureaucracy-heavy Community Care Access Centres (CCACs) that co-ordinate home-care delivery. Much of the CCAC work would be shifted to the province’s 14 Local Health Integration Networks (LHINs), with the goal of saving more than $200 million and directing the savings to much-needed front-line services.

However, CCAC bosses are pushing hard in recent days to have Queen’s Park simply move their entire teams to the LHINs. They have also been telling their staff that no one will lose their jobs.

The transformation will be difficult, but Hoskins needs to ensure it doesn’t amount to a mere juggling of the deck chairs, with high-paid executives who created the CCAC mess just transferring their entire bureaucracies to the LHINs.

On patients, Hoskins took his first step in December by appointing Christine Elliott, the former Conservative deputy leader, as the province’s first patient ombudsman to investigate patient complaints.

Now Hoskins is looking at appointing either an assistant deputy minister (ADM) or executive director within the health ministry responsible for patient and caregiver interests.

The idea of creating an ADM position was first floated to Hoskins last November by Francesca Grosso, a board director of Patients Canada and a caregiver and patient navigator herself.

Grosso, who formerly served as director of policy in the health minister’s office, argues that a high-level position is needed because many government policies aimed directly or indirectly at improving conditions for patients often fall short of that goal as a result of being negotiated to death by various interest groups.

Other health-care experts interviewed in the past week, but who asked not to be named, agree that while health ministry officials like to talk about making patient and caregiver concerns one of their key priorities, the reality is much different.

Instead, hospitals and doctors and drug companies often get top billing when it comes to input into new policies and regulations.

“Health ministry officials can shape policy, but there is no one in the bureaucracy whose prime role is to represent the patient voice and who is savvy about policy,” Grosso says.

An assistant deputy minister for patients, or executive director who reports directly to Hoskins or the deputy minister, could ensure that actions by the government take into account the needs of patients and that any new policy is truly vetted by patients and their families.

“The goal here is not to solve every issue, but rather to give the patient and caregiver a fair hearing” at closeddoor meetings where policy decisions are ultimately made, Grosso adds.

For Hoskins, who is expected to decide by this spring whether to create such a post, the critical first step will be to appoint someone who is passionate about patients, understands government policy and how it is shaped and has had professional experience on patient issues.

Also, the appointee should be given a small staff and possibly a three-to-five-year mandate to make patient concerns a true part of every bureaucrat’s thinking.

If Hoskins succeeds in both of these initiatives — overhauling the home-care sector and creating a true patient advocate within the health ministry — he will have created a lasting legacy for all Ontario patients.

Bob Hepburn’s column appears Sunday. bhepburn@thestar.ca