Hoskins’ health reform falls short on promises

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.