Ontarians will eventually see their cradle-to-grave health needs co-ordinated by teams of providers – including hospitals, doctors and home-care agencies – as the Ford government rolls out a major overhaul of the province’s health-care system.
The centrepiece of the plan that Health Minister Christine Elliott unveiled on Tuesday is the creation of between 30 and 50 “Ontario health teams” that would each be responsible for the well-being of as many as 300,000 patients.
The idea, Ms. Elliott said, is to have local organizations such as hospitals, community health centres, home-care providers and doctors voluntarily form a team, then apply to the government to be the central point of contact in a geographic area, or for specific kinds of patients such as the frail elderly or children with complex needs.
The minister’s announcement was short on details about how the teams would work and long on promises that the new arrangement would keep patients from slipping through the cracks in the system.
“The whole reason why we are doing this change is to create patient-centred care that connects patients to their health-care system throughout their lives,” Ms. Elliott said.
As expected, the minister also confirmed that a new superagency, Ontario Health, would absorb the functions of six health-care agencies, including Cancer Care Ontario, and 14 local health integration networks (LHINs), the organizations that currently oversee home care and manage the waiting lists for nursing homes.
Detractors warned that the overhaul could lead to job losses, mass confusion for patients and more for-profit delivery of care – all of which Ms. Elliott denied.
Vicki McKenna, the president of the Ontario Nurses’ Association (ONA,) said the government’s plan makes this a “destabilizing time” for nurses, especially for the nearly 4,000 nurses that her agency represents who work for the LHINs. Most co-ordinate home care.
“We don’t want anyone to lose their jobs, because what they [nurses] do is desperately needed in our system,” Ms. McKenna said.
Ms. Elliott, who rebuffed repeated questions about layoffs, said that care co-ordinators would not lose their jobs. They would just report to a new employer.
Right now, the LHINs oversee health care for geographic areas whose total populations range from 231,000 in the North West LHIN to 1.9 million in the Central LHIN, north of Toronto. Nearly 9,000 people work at the 14 LHINs, including care co-ordinators.
The six agencies slated to close employ a total of more than 2,500 people, nearly 1,000 of whom work for Cancer Care Ontario, according to a spokeswoman for the Ministry of Health and Long-Term Care.
Ms. Elliott refused to say how many people would lose their jobs, or how much money would be cut from provincial health spending, which is expected to be nearly $62-billion, or 42 per cent of overall spending, this fiscal year.
The transition is expected to be gradual, with the LHINs staying in place for about three years – or as long as it takes to get new health teams up and running across the province. The government tabled proposed legislation called the People’s Health Care Act on Tuesday to enact the changes.
The government is promising to release guidance documents in March explaining how groups can apply to become early adopters of the health-team program.
Ms. Elliott said about 30 ad hoc groups have already approached her government about applying.
Kevin Smith, the president of the University Health Network in Toronto, was enthusiastic about putting local teams in charge of health care. His hospital and community partners already have a team proposal ready to go, as do at least two other Toronto hospitals.
“The announcement does what I’ve been asking government for for a long time, which is don’t tell us how to do to something that you don’t know how to do, which is deliver care,” Dr. Smith said. “Tell us what and why and when and with how much and then hold us to account.”
Health-care restructuring has a mixed record in Canada, and some experts warn that disruptive mergers can be more trouble than they’re worth.
Kevin McNamara, Nova Scotia’s deputy health minister from 2009 to 2013, said his province’s decision to combine nine district health authorities into one in 2015 diminished local control and led to too much top-down meddling.
He saw similar problems in other provinces, including Alberta and British Columbia, where the pendulum has swung between local and centralized health-care delivery without clear improvements in patient care.
“What’s happened in health care in this country is we’ve become experts at merging and unmerging, rather than providing health care,” Mr. McNamara said.
Bob Bell, Ontario’s former deputy health minister, said the Progressive Conservative government is taking a big risk, especially considering that the health-team model is relatively untested.
“If it works, great. I’ll gladly eat crow,” said Dr. Bell, who has been a vocal critic of the proposed changes. “Realistically, I’d like the Ontario health system to get better. But this looks like it could be a recipe for chaos.”
With a report from Laura Stone