Conservatives’ health-care review process is backward
Ontario’s New Democrats dropped a bombshell on Thursday with the release of a leaked, draft copy of the government’s proposed health-care reform legislation.
This happened on the same day that the government made public a report from an advisory committee, detailing problems in the health system. The report, by the Premier’s Council on Improving Health Care and Ending Hallway Medicine, states that council members are now working on a second report, one that will recommend fixes to those problems.
But the release of the draft legislation raises questions about how serious the government is in seeking advice from the health-care experts it appointed to its council. Indeed, it reveals that the government has already come up with its own answers on how to fix those problems. This is concerning because Ontario’s health system is like a huge game of whack-a-mole. Make a change to one sector and unexpected problems can easily pop up in another.
As a guy who has worked in Ontario health care for more than 40 years, I am very aware that it’s important to proceed with caution and consult widely when making big changes.
The current process is just backward. The leak of the legislation reveals the new government’s health transformation plan is essentially a fait accompli.
That tells me it may be poorly thought out and makes me worry that implementation will be chaotic.
I have gone through the 81-page Health System Efficiency Act and it has left me particularly concerned about what will happen to patients after they move from hospital into the community. Chaotic implementation would pose real risks to the 750,000 vulnerable Ontarians who receive home care.
Here’s what I see in the draft legislation. It divides power and authority between the health minister, the board of a new “super agency” and 70 new structures under the umbrella of the agency, called “integrated care delivery systems.”
The legislation states that the integrated delivery systems would be created from organizations that provide at least two of the following sectors: hospital, primary care, home care, mental health, long-term care and/or palliative care.
It is likely that 70 existing hospitals would be designated as integrated care delivery systems and also made responsible for organizing out-of-hospital health care in their communities.
The health minister would have extraordinary powers under the new system. She could order that service providers be merged or eliminated, or that employees of such providers be transferred to the super agency. The minister could make binding orders upon the super agency, integrated delivery services and services providers to follow specific directives and standards.
These orders could be made with as little as 30 days notice, no community consultation and no right of appeal.
To me, this is the most important part of the draft legislation since it provides the opportunity for standardizing best practices in the provision of health services. But would it mean that primary care physicians would have to work according to standards developed at Queen’s Park?
Or would these standards simply be adapted from the work of Health Quality Ontario? (The legislation would see HQO, an existing organization that provides advice on best practices, absorbed by the super agency.) There is also much concern that the legislation would encourage the provision of private care under super agency. This arises from a section that seems to allow the health minister to develop “performance bonusing” if efficiencies are generated.
Under the proposed changes, Ontario’s 14 Local Health Integration Networks (LHIN) would fade into history. When that happens who would pick up responsibility for co-ordinating and paying for home-care services, as LHINs now do?
Would it be the super agency, out of Queen’s Park in downtown Toronto? Or would it be the 70 integrated delivery services across the province that have yet to be developed? Or would the super agency rely on existing home-care delivery agencies, many of whom are for profit corporations?
This is where my worry for 750,000 vulnerable home-care patients comes from. Ontarians should not have to parse through leaked draft legislation to determine what the future of health care will look like in the province. Again, this is backward. The government should develop its plans through consultations with experts, stakeholders and most especially citizens. When consensus is reached, a blueprint should be made public and Ontarians should be invited to comment on it.
Only then should legislation be developed.