Hoskins’ health re­form falls short on prom­ises

Toronto Star - - OPINION - Bob Hep­burn Bob Hep­burn’s col­umn ap­pears Thurs­day. bhep­burn@thes­tar.ca

In less than six weeks from now, the On­tario govern­ment will kick off the big­gest re­form of the prov­ince’s health-care sys­tem in the past 50 years.

On the eve of the launch, though, se­ri­ous ques­tions are be­ing raised in health-care cir­cles about how much money will ac­tu­ally be saved and about the pos­si­bil­ity of more — not less — bu­reau­cracy than first promised by Health Min­is­ter Eric Hoskins.

In­deed, these con­cerns threaten to over­shadow the smooth in­tro­duc­tion of what Hoskins be­lieves will ul­ti­mately be a ma­jor im­prove­ment in how pa­tients re­ceive care in their homes or com­mu­ni­ties.

On May 1, the first of On­tario’s Com­mu­nity Care Ac­cess Cen­tres (CCAC), which are now re­spon­si­ble for home­care, will be shut down and most of its em­ploy­ees trans­ferred to the 14 Lo­cal Health In­te­gra­tion Net­works (LHIN), the agen­cies in charge of over­all health-care plan­ning and co-or­di­na­tion in their re­gions.

By late June, all 14 CCACs will be dis­man­tled, af­fect­ing more than 7,000 work­ers and some 640,000 pa­tients who re­ceive home-care each year.

The clo­sures are at the heart of the govern­ment’s re­form leg­is­la­tion, known as the Pa­tients First Act, which Hoskins un­veiled al­most a year ago. The orig­i­nal goal was to pro­vide quicker ac­cess to doc­tors, help pa­tients move from hos­pi­tals to home-care and save money by cut­ting an en­tire layer of bu­reau­cracy. Hoskins was praised for mov­ing to re­form a sys­tem that had been a mess for decades. And he still mer­its praise for push­ing the plan for­ward de­spite crit­i­cism from politi­cians, doc­tors and pa­tient ad­vo­cates.

Con­ser­va­tive Leader Patrick Brown has at­tacked Hoskins, claim­ing the LHINs will be hir­ing 84 “high-priced vi­cepres­i­dents.” He also sug­gests the cre­ation of about 70 new sub-LHINs that will bring home-care plan­ning closer to in­di­vid­ual com­mu­ni­ties will only lead to more bu­reau­cracy. Even the Reg­is­tered Nurses As­so­ci­a­tion of On­tario, once a cheer­leader for the re­forms, has now voiced crit­i­cism, sug­gest­ing Hoskins should have cut at least 20 per cent of se­nior man­age­ment.

Get­ting rid of the CCACs was a good move. The agen­cies had be­come dis­cred­ited af­ter a series of Toronto Star col­umns and ar­ti­cles re­vealed lav­ish salary in­creases for CCAC ex­ec­u­tives and huge ad­min­is­tra­tive costs. At the same time, the CCAC bosses were or­der­ing ser­vices to pa­tients halted or cut to re­duce costs and wage freezes on front-line work­ers. Only one of the 14 cur­rent CCAC chief ex­ec­u­tive of­fi­cers has ac­cepted a role in the new LHIN sys­tem. But the prom­ise of ma­jor cuts in the bu­reau­cracy and of huge sav­ings that could be shifted to pa­tient ser­vices won’t likely be met. In­stead, Hoskins is now look­ing at just 59 fewer man­age­ment po­si­tions, out of a to­tal of more than 7,100 jobs in the com­bined CCAC-LHIN sys­tem. To­tal sav­ings? A mere $10.7 mil­lion a year — a far cry from the $50 mil­lion-plus some experts had ex­pected. Se­nior health min­istry of­fi­cials say the “sav­ings” amount to 8 per cent of man­age­ment and ad­min­is­tra­tive costs and 10 per cent of se­nior man­age­ment and ad­min­is­tra­tive staff.

In the past, though, the CCACs bragged that only 8 per cent of their to­tal bud­get of $2.5 bil­lion a year went to ad­min­is­tra­tion and over­head. By that ac­count­ing, the 8-per-cent “sav­ings” should amount to at least $20 mil­lion.

But it’s just as pos­si­ble the “sav­ings” could have to­talled some $75 mil­lion. That’s based on the find­ing in 2014 by On­tario Au­di­tor Bon­nie Lysyk that barely 62 cents of ev­ery $1 re­ceived by CCACs went to face-to-face pa­tient care and that more than $900 mil­lion was spent on ad­min­is­tra­tion.

Of­fi­cials now claim the re­form pack­age was never about sav­ing money. Rather, it was aimed at im­prov­ing pa­tient ex­pe­ri­ence in pri­mary and home care and bet­ter in­te­grat­ing those sec­tors. In their view, home care has suf­fered for years from tremen­dous lack of stan­dard­iza­tion and has stood alone as a sep­a­rate silo from the rest of the sys­tem, prob­lems that the re­forms are de­signed to im­prove.

As for Brown’s claims, the of­fi­cials say all of the 84 new LHINs’ vice-pres­i­dent po­si­tions al­ready ex­ist in CCACs and are just be­ing shifted to the LHINs. Also, the of­fi­cials in­sist the new sub-LHINs won’t be hir­ing new staff, but will just be “re­pur­pos­ing” ex­ist­ing man­agers.

De­spite the fears, some­times un­sub­stan­ti­ated, of more bu­reau­cracy, Hoskins’ re­form plan re­mains a much-needed step on the path to fix­ing the troubled home-care sec­tor.

Still, it’s dis­ap­point­ing to see Queen’s Park fall short of the prom­ise of sig­nif­i­cant cuts to the bloated bu­reau­cra­cies that suck up way too much money, cash that could be bet­ter spent on pa­tients in need.

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