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Ontario Health Minister Eric Hoskins has been hinting for some time that change was in the works, but the policy paper has been kept under wraps.Chris Young/The Globe and Mail

The Ontario government is preparing to overhaul health care in the province, including scrapping its troubled system for delivering home care and reforming primary care with the aim of improving patient access.

The proposed changes, mapped out in a paper to be made public in the coming weeks, will be the focus of consultations in the new year and are expected to touch on all aspects of the health system.

A centrepiece of the proposals will be the expansion of the role played by the province's Local Health Integration Networks. At the same time, the province would eliminate Ontario's 14 Community Care Access Centres (CCACs), the public agencies responsible for overseeing the delivery of services such as nursing, physiotherapy and help with personal care for the sick and the elderly in their homes.

The agencies have long been a lightning rod for criticism, and were the focus of a Globe and Mail investigation this year that found inconsistent standards of care and a lack of transparency that left patients and their families ‎struggling to access services.

A report this fall from Ontario Auditor-General Bonnie Lysyk found that as little as 61 cents out of every dollar spent by the agencies goes to face-to-face client services, and discovered gaps in the level of care offered across the province. A second report on home care will be included in the Auditor-General's annual report in early December.

Suggested changes to the way primary care is delivered by family doctors and other health-care providers are also expected to gain wide attention, especially from the province's doctors, who are in a battle with government over fees.

Ontario Health Minister Eric Hoskins has been hinting for some time that change was in the works, but the existence of a policy paper and its contents have been kept under wraps.

Individuals familiar with different aspects of the document, who spoke to The Globe on the condition that they not be identified, describe it as "transformational" – a term that has become a favourite of the Health Minister.

Earlier this month, Dr. Hoskins delivered a speech at a hospital conference in Toronto in which he repeatedly spoke of "system transformation" and the need for stronger "local governance."

The minister responded to questions from The Globe in a statement Monday night, saying that the ministry is "putting together a document which we hope will serve as a starting point for discussions and consultation about how we can better integrate various parts of the system and improve the patient experience."

"We plan to share that discussion document in the coming weeks and will be engaging with our partners, including care providers and the public, to solicit feedback on those ideas to achieve deeper integration," the statement said.

The plans for change come at a critical time for Ontario's Liberal government as it looks to cut costs and tame the provincial deficit. To do that, keeping health-care spending in check is imperative, but the minister has also pledged to make improvements such as ensuring more people have access to primary care, and are not reliant on walk-in clinics and emergency rooms for after-hours non-urgent care.

Any efforts to change how primary care is paid for or organized are likely to meet resistance from doctors, who are already at odds with the province after it imposed a contract and two rounds of fee cuts this year.

An expert panel report on primary-care reform – released quietly this fall and widely criticized by doctors – recommends dividing the province into "patient care groups," similar to school boards, with each group responsible for ensuring every resident in the area has access to primary care.

As a prelude to the coming reform, at least one merger plan among two hospitals and a CCAC was paused this fall after the ministry advised the boards involved of the coming changes.

John Davies, chair of the board of William Osler Health System in Brampton, said merger talks with the Central West CCAC and Headwaters Health Care Centre in Orangeville, Ont., were suspended after deputy Health Minister Bob Bell wrote to them a few weeks ago advising them to suspend talks because of the coming reforms.

Those familiar with the proposed reforms say the beefed-up local health networks will be given responsibility for overseeing home care, with front-line workers and case managers retaining their jobs.

"For the client, there will be no change," one source said.

Some aspects of home care involving patients who have been hospitalized will continue to move over to a new model called "bundled care," which has been piloted by St. Joseph's Health System in Hamilton and was recently expanded to six other sites, one source said.

The province will also look at tailoring care delivery to the needs of local communities, with different models possible for urban and rural settings, another source said.

With a report from Adrian Morrow

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