Residents of Northern Ontario could be disproportionately hurt by a new Tory plan to consolidate health agencies, a local critic fears.
“There’s going to be a big shakeup here that will impact not just patients and their welfare but really impact the North,” said Dot Klein, head of the Sudbury chapter of the Ontario Health Coalition.
The People’s Health Care Act, outlined last week by health and long-term care minister Christine Elliot, calls for the integration of multiple programs and agencies into one ‘super agency,’ with the goal of reducing duplication and costs, while also creating more consistency and oversight.
It would make more than a dozen Local Health Integration Networks, including the North East version that coordinates funding and care in Sudbury, obsolete.
Klein is concerned, however, that the loss of a regional voice will mean our area won’t have its particular needs reflected in Toronto-based decision making, and could be shortchanged when it comes to funding.
“It looks to us that they will just allot money to a region and it hasn’t been identified whether it might be the whole Northern region, one lump sum between the Northwest and Northeast (previously served by separate LHINs),” said Klein.
Klein said there are many unanswered questions as to how the funds will be doled out.
“Who’s going to administer it?” she asked. “It is going to be administered according to population, or according to need and your demographics? All of that is left up in the air.”
She said the North as a whole has “less population than Metro Toronto,” but its needs “are to a great extent different. We have an older population and a lot of distance, so access to services is more difficult.”
Klein worries a centralized bureaucracy won’t appreciate those challenges and will allocate resources only on a per-capita basis.
“The way I see it, and most within the Ontario Health Coalition see it, is that a business model such as this does not fit people,” she said. “Health care is people and it has to be people-oriented.”
Those who toil in the health-care sector may also be forced to work for less as the super-agency model takes effect, warns Klein.
“It’s a different employer, and as an employee you have to accept the job they offer at the pay they offer,” she said. “Say you are a registered nurse making $35 an hour. They could offer you $21, and no benefits.”
Klein is skeptical that pressure on hospitals will be alleviated by the new approach.
“We really feel this new rollout is not going to solve the problem at all,” she said. “We in the North feel we will be left out. Our services are inadequate now, and they are going to become worse than they are.”
Dominic Giroux, the CEO of Health Sciences North, is more optimistic about the direction the Ford government is taking.
“The health-care sector in Ontario is very complex — 14.8 million patients, 1,800 health service providers and 22 provincial agencies under the purview of the Ministry of Health and Long-Term Care,” he said. “And so I think it makes sense to increase synergies between these board-governed provincial agencies.”
Apart from folding 20 agencies into one, the ministry also announced it will be creating local health teams to improve patient experience and facilitate smoother transitions between parts of the system, such as hospitals and home care.
“The devil will be in the details, but I find this an empowering mechanism,” said Giroux. “What we’re hearing from government is a desire to see innovation and a desire to see outcomes, and that’s consistent with what we heard in our strategic planning consultations across Northeastern Ontario in the past year.”
In its new strategic plan, HSN has articulated five key goals “in a way that partners could see themselves,” he noted, which fits with the collaborative approach laid out in the government plan.
“Irrespective of who we are called to partner with, based on what we’ve heard over the past year in terms of engagement across Northeastern Ontario, is we need to patient- and family-focused, we need to be digitally enabled, we need to be socially accountable, we need to support and develop our people, and we need to grow and strengthen our academic and research impact.”
Those five goals “resonate with people I speak to in the region, and it’s in line with the narrative you are hearing from the province, as well,” he said.
Another focus of the government is to improve access to digital tools, including online health records and virtual care options, according to the announcement from the health minister.
“I’m pleased to see that,” said Giroux. “Patients expect digital access to their medical imaging and lab results, and expect the opportunity to schedule or reschedule their appointments from the convenience of their smartphone or laptop.”
HSN has already made digital improvement a key priority — it’s No. 2 of the five strategic plan goals — and is committed to “implement a regional electronic medical record, launch a patient portal and also a human resources information system,” he said.
The Queen’s Park announcement offers encouragement for hospitals to go digital together, he said, in a concerted and organized manner.
“I think what the province is signalling, as it had been before, is please don’t plan such efforts in isolation,” he said. “Some hospitals in the past may have pursued their own implementation of (online) medical health records, but I think Northeastern Ontario is a model of collaboration in the IT sector, where most hospitals have their software infrastructure housed here at Health Sciences North, and we host the digital imaging.”
As the largest hospital in the region, HSN could have also pursued an electronic system for medical records on its own, but “we made the deliberate choice in our new strategic plan to implement an integrated regional medical record, because patients come and go in Northeastern Ontario.”
The government also reiterated its pledge to address overcrowding in hospitals. “By relentlessly focusing on patient experience, and on better connected care, we will reduce wait times and end hallway health care,” Elliot said in last week’s announcement.
Giroux said it will “take a while to see the tangible impacts” of the administrative revamp, and “in the meantime we still have over 50 patients in the emergency department waiting for a bed, or in unconventional bed spaces.”
But the CEO was encouraged that, simultaneous with the province’s announcement on health-care reform, HSN was engaged in discussions with the ministry on how to address its specific, immediate space crisis.
“So while there’s a desire to look at the provincial structures, at the same time this is not to the detriment of conversations we need to have today to provide short-term solutions, especially around ending hallway medicine,” he said.
Giroux also noted the transition from multiple agencies to one might go faster and smoother than expected, given people in the sector knew a shakeup was coming and had already begun to discuss different ways of working together.
“Just the anticipation of change, in my view, stimulated conversations that might not have necessarily happened in the past,” he said.
The shift to a new model “is easier said than done, and the complexity of the sector can’t be overlooked,” he said. “It’s going to take a lot of work, as any change brings. But we look forward to the implementation.”