Province eyeing creation of ‘super health agency,’ sources say

Thestar.com
Jan 17, 2019
Theresa Boyle, Robert Benzie, Rob Ferguson

The provincial government is considering a plan to shutter more than 20 health agencies -- including Cancer Care Ontario, 14 local health integration networks (LHINS) and eHealth Ontario -- and fold them into one “super agency,” the Star has learned.

Provincial bureaucrats have been asked to create a blueprint for a massive transformation of the health system, according to numerous sources in the broader public sector. They spoke on condition of anonymity because they have not been authorized to give media interviews.

Describing the plan as a work in progress and subject to change, they said the intent is to keep front-line and core services intact, but to run them out of one agency under a single board of directors and a streamlined layer of management.

The provincial cabinet met on Thursday, but it is unclear whether it has signed off on the plan. Following the three-and-a-half-hour cabinet meeting, Health Minister Christine Elliott did not deny the government is looking at getting rid of LHINs.

“We’ve talked from the very beginning about doing a review of all agencies in government so there’s nothing new here,” she said, referring to a health agency review announced shortly after last June’s provincial election.

“We’re continuing our review and working to create a patient-centred system of health care,” the minister said in a brief interview with the Star.

Asked if the government would get rid of Cancer Care Ontario by absorbing it into a new super agency, Elliott said: “All I can tell you is that we are looking at truly creating a patient-centred system of health care -- it’s the patient experience that is truly important.”

The Star has obtained a copy of an undated Ministry of Health document marked “confidential” and labelled “exploratory model,” which appears to point to the option of a large “provincial clinical and delivery agency” with a government-appointed board of directors, a chief executive and leadership team.

They would oversee three divisions with one in charge of measuring health system performance and including public health, a second division providing clinical oversight for cancer, organ donation, diabetes, critical care, mental health and chronic kidney disease, among others, and a back-office support division to handle procurement, digital health and human resources.

Below these high-level functions would be 60 to 70 “integrated delivery systems” across the province, which could care for defined patient populations by disease or geographical areas with a “comprehensive continuum of care” for common conditions like diabetes or mental health.

There are few details in the document, which is described as a “vision” for delivering health care so “everyone in the province can access seamless, integrated care no matter where they live or what care needs they have.”

There were no estimates of costs or savings in the document.

Sources said the government wants to “debureaucratize” the health system by eliminating numerous agencies, along with their boards of directors and executive “C-suites.”

Home care and long-term care would still be locally co-ordinated under a restructured health system and these sectors would work more closely with the hospital sector.

The idea to consolidate them was first raised in a report last September by the consulting firm Ernst and Young, which was commissioned by government to conduct a line-by-line review of provincial expenditures.

A section of the report, which called for a consolidation of transfer-payment agencies, stated: “There are currently more than 20 health agencies across 11 priority areas; these organizations operate independent of each other, and most have leadership teams and back-office functional teams.”

It went on to say that administrative costs could be reduced by cutting the number of service providers receiving transfer payments.

Ontario’s health system, like many in the developed world, has been criticized for being siloed. The province has long been trying to improve integration of health services. A super agency could help with that, sources said.

Cancer Care Ontario has been praised in the past for its work in co-ordinating cancer services, but in more recent times it has been criticized as “bloated.” It has gone beyond its original mandate and now manages the delivery of kidney care services and participates in quality improvement programs in the broader health system.

The Conservatives have long had Ontario’s 14 LHINs in their crosshairs. The agencies co-ordinate home-care services and entry into long-term-care homes. LHINs have been accused of devoting too many resources to administration and not enough to front-line services.

eHealth Ontario has a tortured history. A 2009 auditor general’s report found $1 billion had been spent on eHealth and its predecessor with little to show for it. Three years later, the auditor found that $24.4 million was spent on an electronic registry of diabetes patients that was unceremoniously scrapped before it was up and running. The organization also weathered an expense account scandal when it was revealed that private consultants earning $3,000 a day were billing taxpayers for $3.99 cookies and $1.65 cups of tea.

Sources say the following transfer-payment recipients are also being eyed for inclusion in a super health agency: The Trillium Gift of Life Network, which co-ordinates organ and tissue donation and transplantation; Health Quality Ontario, which aims to improve the quality of health services; and CorHealth, which organizes Ontario’s cardiac and stroke services.