Massive health-care overhaul called ‘biggest change’ since medicare

Thestar.com
Feb. 27, 2019
Teresa Boyle

What has been described as the “biggest change” in Ontario’s health system since medicare was created half a century ago could dramatically impact how patients receive care and workers deliver it, health-care leaders say.

The massive transformation unveiled by Health Minister Christine Elliott on Tuesday is aimed at making the health system easier for patients to navigate.
Health Minister Christine Elliott unveiled details of the Ford government’s plan to overhaul the health system at a news conference at Bridgepoint Active Healthcare in Toronto on Tuesday.

The weak links in the current system are the transfer points between various sectors, including hospitals, primary care, home care, long-term care and mental health. Most complaints come from patients who fall between the cracks of those sectors, particularly after being discharged from hospital.

The plan for the reformed system will see those sectors come together under the oversight authority of a single super-agency known as Ontario Health, Elliott told a news conference. Employees from the various sectors will work together in teams, silos will be eliminated and patients will ultimately be able to move through the health system “seamlessly,” she said.

Twenty existing agencies will be absorbed into Ontario Health, including 14 Local Health Integration Networks, Cancer Care Ontario and eHealth. None of these agencies will disappear overnight as the rollout of the new system is expected to take years, senior ministry bureaucrats explained in a technical briefing later in the day.

Elliott said the health system of the future will see fewer patients treated in hospital hallways, more seniors get care in their homes, less bumpy discharges from hospital and fewer unnecessary trips to emergency departments.

A major emphasis will be placed on improving digital health so that patients will have easier access to primary care providers, such as family doctors and nurse practitioners, the minister said. Patients will be able to make appointments online, have “virtual” appointments, and get computer access to their own health records.

Former deputy health minister Dr. Bob Bell described the overhaul as “the biggest change since we started medicare in this country 50 years ago” and questioned why such “radical change” is necessary.

Until now, the biggest changes Ontario’s health system has seen were the merging and closing of hospitals by the Health Services Restructuring Commission more than 20 years ago and the elimination of community care access centres two years ago, he noted.

The Progressive Conservatives ran in last year’s provincial election on a health platform that promised to end hallway medicine, improve mental health and addiction services and create new long-term-care beds.

“You don’t need this kind of radical change to achieve those goals,” Bell remarked. “This requires a huge leap of faith and is based upon some untested hypotheses.”

He pointed out other provinces that have made such changes have not fared that well and questioned why Ontario would want to mess with world-class agencies such as Cancer Care Ontario.

He said he is especially concerned about the impact on home-care patients.

Bell said he was pleased to hear the minister assure patients they will still be able to access services with their “OHIP card rather than their credit card.”

There will be a reduction in “back office” positions as a result of the changes, said several health-care leaders who spoke on condition of anonymity because they were not authorized to give interviews. Services such as human resources and communications will be centralized, but because the transformation is to roll out slowly, positions can be eliminated through attrition, they said.

Sue VanderBent, CEO of Home Care Ontario, said one of the biggest problems in the sector right now is that home-care workers such as visiting nurses do not have real-time access to patient records. So hospitals, primary care providers and home-care providers are not on the same page when it comes to caring for patients, she explained.

It’s not unusual for a family doctor to change a prescription after a patient has been discharged from hospital, VanderBent said. It can then take up to two days for a home-care worker to learn of the change.

In the interim, the patient can get worse and be rushed to the emergency department by panicked loved ones, she said, noting such journeys put unnecessary stress on patients, families and the health system, and contribute to hospital overcrowding.

“Technology will be a huge enabler in terms of being able to deliver better care,” VanderBent said.

Kevin Smith, president of the University Health Network, said he welcomes the focus on eradicating hallway medicine. He estimated that 20 patients were being cared for in the corridors of the emergency departments at Toronto Western and Toronto General hospitals on Tuesday.

“My hope is that we allow providers the tools that they need to provide outstanding care in a system that is not struggling to operate with hospitals that are at over 110 per cent occupancy every day,” he said.

It will take money to ensure the transformation rolls out smoothly, Smith said.

“The elephant in the room is money,” he said, noting hospital inflation alone stands at 3 per cent annually.

“In order to protect patients, we need to see some investment that will allow us to preserve front-line staff and the teams that will allow that staff to become integrated,” Smith added.

Doris Grinspun, CEO of the Registered Nurses’ Association of Ontario, said care co-ordinators who now work for Local Health Integration Networks -- which are to be scrapped -- will likely see some changes to their jobs. She said she expects about 4,500 of them, who now work out of LHIN offices, to be transferred to primary-care settings.

The aim is to better integrate the different health sectors, Grinspun said, adding she expects care co-ordinators will like their jobs more with the changes.