Ontario Progressive Conservative Leader Tim HudakRafal Gerszak
Tim Hudak's Conservatives have finally found a meaty policy issue, as rich in substance as it is in the promise of scandal.
What remains to be seen is how far they're prepared to sink their teeth into it.
Since Ontario's Legislature returned on Tuesday, the Opposition has ostensibly picked up right where it left off before Christmas. There are the familiar charges of "Liberal-friendly consultants" getting rich off "sweetheart deals," and the Tories have again focused most of their attention on the health sector.
But this time, it's Local Health Integration Networks (LHINs) that are in their sights. And therein lies an opportunity for real debate about building a sustainable health-care system.
A consequence of the Tories' endless scandal mongering has been some grousing, including from interests that might naturally be sympathetic toward them, about their failure to lay out what they would do differently. Even their most successful attacks on the government, on the eHealth scandal, haven't given them much chance to present an alternative vision; few people disagree in principle with the idea of digitalizing health records.
But there are many people who would argue the Liberals' effort to regionalize health-care management is inherently flawed. And the most common criticism - that the LHINs are achieving little other than an extra layer of bureaucracy - must look pretty appealing to a party aiming to craft a smaller-government agenda.
Established late in the Liberals' first term, the 14 LHINs are supposed to be transitioning Ontario toward a more seamless system. The idea is that, rather than operating as silos, hospitals and other delivery hubs will better integrate their services, improving both efficiency and patient outcomes.
As one health policy veteran put it, each LHIN is supposed to function as a "strategic purchaser of health services for the regional population." That should force hospitals to compete for funding, based on who can best deliver services.
It hasn't worked out that way. Hospitals are mostly still funded through lump-sum payments. So despite nominally controlling nearly two-thirds of the province's health expenditures, many LHINs are doing little more than signing the cheques; power still rests primarily with hospital boards, and big-picture planning comes from the ministry.
The extent to which LHINs have any impact at all seems to depend on whether their leaders are willing to take initiative. But because their powers are so ambiguous, it's hard to attract strong leaders in the first place.
As the Liberals would point out, the LHINs remain in their infancy. It's entirely possible that, with time, they'll evolve.
But there's room for debate as to whether that's a desirable outcome. Should governments be made less accountable for some of their most controversial decisions by outsourcing them to faceless regional boards?
(The recent controversy over hospital closings in the Niagara region, reported extensively in The Globe and Mail, has demonstrated how the public can react to that perceived lack of accountability.)
Mr. Hudak has yet to tackle such questions. He's been more interested in using his party's freedom-of-information requests to paint the LHINs as graft-heavy Liberal proxies. That involves some very simplistic messaging; even as he's making hay over the stipends being paid to LHIN executives, Mr. Hudak has to know that the people needed to make LHINs remotely effective don't come cheap.
But then, simplistic messaging is what opposition parties trade in. The question is whether, by drawing attention to the LHINs, Mr. Hudak is laying the groundwork for providing an alternative down the road.
He could position himself as an enemy of bloated bureaucracy by vowing to do away with the LHINs altogether, much the same as Alberta did with its 15-year-old regional health authorities in 2008.
He could also pledge to do regionalization properly, by giving the LHINs a clearer role. That might require scrapping hospital boards altogether, or at least transferring some powers away from them and to the LHINs. It would also probably mean shrinking the number of LHINs, which many health insiders believe is necessary to make them effective - and which would again fit into his smaller-government message.
His advisers say Mr. Hudak is exploring his options. Whatever he comes up with, it's a golden opportunity to demon-
strate he can do more than just criticize the status quo.
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The McGuinty factor
The fastest way to get Ontario Premier Dalton McGuinty to inject funding into the province's cash-strapped hospitals is to trigger a by-election race, the Tories say.
Mr. McGuinty demonstrated during the recent by-election race in the riding of Toronto Centre that he is prepared to buy votes, Christine Elliott, the Conservative health critic, said in Question Period yesterday. The government injected $15-million into Toronto Grace Hospital, and Liberal Glen Murray sailed to victory.
But Mr. McGuinty didn't stop the closing of emergency departments in Fort Erie and Port Colborne, Ms. Elliott said. Local politicians want an inquest into whether the life of teen Reilly Anzovino was cut short because she didn't get to a hospital sooner.
"This scandal sends a clear message to any Liberal MPP who is frustrated at being ignored by Dalton McGuinty," Ms. Elliott said. "If it takes a by-election for McGuinty to start paying attention, all you have to do is resign."
Kim Craitor, Liberal MPP for Niagara Falls, was outraged at the suggestion. "They have no friggin' clue about health care," he said in an interview.
Karen Howlett
Adam Radwanski