Ontario’s health-care system should offer more virtual check-ups, improve access to digital medical records and design more “financial incentives” to make the system work better for patients, according to the latest report from an expert panel on eradicating hallway medicine.
The Premier’s advisory council – led by Rueben Devlin, a long-time hospital chief executive and former president of the Ontario Progressive Conservative Party – is also calling on the government to invest more in home care and community programs that would help frail seniors leave the hospital, freeing up beds for acutely ill patients.
“Success would mean that when patients come to the emergency department, they’re seen quickly,” Dr. Devlin said in an interview with The Globe and Mail on Tuesday after the report’s release. “When they need to be admitted to hospital, they’re admitted quickly. … We should have a system where, if [patients] think there’s another option to receive their care, they can go there.”
Dr. Devlin’s second report comes at a tumultuous moment for Premier Doug Ford’s government and the health-care system it oversees.
In the past week alone, Mr. Ford has split the Ministry of Health and Long-Term Care into two ministries as part of a major cabinet shuffle; presided over the elimination of 825 “back-office” health-care jobs; and accepted the resignation of his chief of staff, Dean French, over a cronyism scandal.
In the meantime, as many as 1,147 Ontario patients languished in hospital hallways last month, the new report said.
On Tuesday, NDP MPP Marit Stiles pointed to the appointment of Dr. Devlin as the Premier’s special adviser on health care as an early example of a patronage posting.
Dr. Devlin, who served as a senior adviser to Mr. Ford during the 2018 election campaign, was offered a $348,000 annual salary and a three-year term shortly after Mr. Ford took office.
“Let’s not forget, this is a good friend of the Premier,” Ms. Stiles said. “It’s a lot of money that Mr. Devlin is earning to … regurgitate what the government has already said they’re going to do.”
The 10 recommendations in the council’s new report acknowledge the decisions the government has already made to overhaul the health-care system, including scrapping regional health organizations called Local Health Integration Networks (LHINs) and centralizing management in a new superagency called Ontario Health.
Most of the recommendations contain high-level advice that is widely supported among health-care professionals, but difficult to achieve. The first recommendation is to “put patients at the centre of their health care,” and the last is to “champion collaborative and interprofessional leadership development focused on system modernization capabilities.”
The report also provides concrete examples of programs that could be expanded, including six “bundled care” pilot projects in which the government provided defined payments to hospitals to manage single episodes of care, such as hip replacements, even after patients left the hospital.
The bundled care projects – which saved money and reduced the time patients spent in hospital by an average of 1.26 days – were held out as an example of the “financial incentives” the council is recommending.
Adrianna Tetley, CEO of the Alliance for Healthier Communities, which represents more than 100 community health organizations, said she was struck by how many of the recommendations mentioned digital solutions or virtual care. "If it’s meant as a solution for ending hallway health care, then it’s too narrow,” she said.
Alan Drummond offered similar criticism from his vantage point as an emergency physician in the eastern Ontario town of Perth.
“There’s a vast amount of human suffering that goes on on a daily basis in our province’s emergency departments,” said Dr. Drummond, the co-chair of public affairs for the Canadian Association of Emergency Physicians.
“What is in this report that is at least going to mitigate [hospital] crowding in our province in the next five or 10 years? I see nothing.”
Dr. Devlin acknowledged there would be no quick fixes – especially considering that much of the overcrowding problem can be traced to a shortage of nursing-home beds, and they cannot be built overnight.
“This is a long-term transformation and it probably takes more than one mandate,” he said.
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Kelly Grant
Laura Stone