Don’t harm Cancer Care Ontario while restructuring health agencies,
Reports from Queen’s Park suggest the Ministry of Health is planning a major consolidation of administrative services to create a new health superagency. This new superagency, similar to Alberta Health Services, will take responsibility for health services away from existing agencies with reduction or elimination of existing Local Health Integration Networks (LHIN).
There is no doubt innovation and new models of care are needed to improve customer service and sustainability in Ontario health delivery. However, one wonders what problem is being addressed by combining the existing agencies and moving to one superagency?
After all, under a superagency model, Alberta’s annual health cost per person in 2017 was $7,552. Ontario costs were the lowest per capita of any province at $6,584, and we offer the most generous pharmacare benefits in the country. From a quality perspective, Ontario also achieves better health results than Alberta as demonstrated by our lower premature mortality.
The history of new provincial governments in Canada is that they focus on structural change rather than working on incremental clinical and service improvements. It is much easier to lay off managers, create new boards and new executive positions than to do the hard work of implementing clinical best practices and improving customer service.
LHIN’s are an easy target. LHIN’s have been given the toughest job in health care — integrating local health delivery — without many of the tools (direction of primary care, realignment of hospital funding, ability to force integration of small health delivery organizations) necessary to do the job.
If the government’s plan is to enhance local integration of services, it should be remembered that moving to a rumoured five-entity model would create authorities with more people than most provinces.
Since the LHIN’s spend only about $90 million in administering a $30-billion plus budget, little savings can be expected from consolidation. The problems that LHIN’s are blamed for — inadequate long-term care beds, insufficient home-care services, inaccessible primary care — will not be solved by a reorganization of regional offices.
So, the jury is certainly out on whether reorganization of regional health authorities can improve integration of care. However, there is one planned change that should deeply concern Ontarians. Planning is underway to reduce the authority of Cancer Care Ontario (CCO) and move CCO under the new superagency.
As a former cancer surgeon, I am worried that decreasing CCO’s influence will hurt cancer patients in this province. Health system leaders that I am talking to share this concern.
Internationally, CCO is the most admired element of Ontario health care. In 2011, the eminent Lancet medical journal published a comparison of cancer survival in several Western countries. Canadian results led other countries with Ontario contributing more than half of the Canadian patients included in the study. CCO is responsible for waiting times for cancer treatment. Ontario and Nova Scotia are the only provinces that report time to see the cancer specialist in consultation as well as time to surgery. Generally, 80 to 90 per cent of Ontario patients achieve access to consultation and surgery within the clinical target set for each cancer.
The impact of CCO is not limited to better cancer survival or treatment access. CCO leads Ontario health care in listening to patients in designing its programs. The development of the most recent Ontario cancer plan was cochaired by a member of the CCO Patient and Family Advisory Council. The plan focuses on improving cancer patient and family experience.
CCO has also shown it responds quickly when cancer services fail the needs of Ontarians. When leukemia treatment was compromised by long wait times for stem cell transplants, CCO and the Ministry rapidly expanded transplant services. CCO leads the province in promotion of health equity. Engagement with Indigenous communities is a strong feature of CCO’s work, along with enhancing cancer prevention and screening in all communities.
Of course, Cancer Care Ontario can always improve its performance. But today, CCO is an internationally leading agency that is the envy of Western medical systems. If the government decides to create a new unproven superagency it must avoid damaging the best part of Ontario health care.