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Ontario Health Minister Eric Hoskins says the government wants to reduce red tape in home and community care.

Chris Young/The Canadian Press

Ontario is releasing its long-awaited plans to overhaul health care, restructuring its troubled home-care system and proposing changes to the way primary care is organized to make it easier for people to find family doctors and get an appointment when they are sick.

The move, to be made public Thursday in a discussion paper, comes as the Liberal government faces mounting pressure to make changes to home care following a string of scathing reports and questions about its failure to act sooner. The timing of this move also raises questions, coming so close to the holidays when the legislature is not in session and opposition critics are in their ridings or out of the country on vacation.

At the centre of the proposal, as reported by The Globe and Mail last month, will be the expansion of the role played by the province's Local Health Integration Networks (LHINs) and the elimination of 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.

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The CCACs have long been criticized, and were the focus of a Globe and Mail investigation that found inconsistent standards of care and a lack of transparency that left patients and their families struggling to access services.

Two reports this fall from Ontario Auditor-General Bonnie Lysyk found as little as 61 cents out of every dollar spent by the agencies went to face-to-face client services, and few improvements had been made to correct problems identified years before.

Health Minister Eric Hoskins, in a statement Wednesday, said the government "wants to reduce bureaucracy and administration in home and community care."

Even so, the policy paper introduces the idea of a smaller, local organization to co-ordinate the delivery of home care and primary care – something those familiar with the plans have been calling a "sub-LHIN." Several sources stressed that unlike the discredited CCAC model, these organizations would not mean the creation of another layer of bureaucracy. The job could be given to existing organizations such as community health centres, some speculated, and will allow for better planning. There will be no change in the relationship between the government and doctors, who will not report to the new organizations, one source said.

"Our goal is to make it easier for patients to find a primary health-care provider when they need one, see that person quickly when they are sick, and find the care they need, closer to home," the Health Minister said in a statement.

"This proposal would help ensure that there is local planning so that health-care providers are available to patients where and when they are needed. Better care for patients means changes to local health networks so Ontarians get consistent care no matter where they live," the statement said.

There has been widespread speculation about how far the reforms would go and how the province can restructure primary care at a time when it is waging an increasingly bitter battle with doctors, who have been without a fee agreement for more than a year. After the government imposed two across-the-board fee cuts this year, the Ontario Medical Association, which represents the province's doctors, began a public campaign criticizing the measures that it argues are hurting patient care.

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Senior government officials stressed that the plans mapped out in the paper would be the basis of consultations in the new year, and that no changes would be "imposed" on doctors.

An OMA spokeswoman said the organization would not comment until it saw the paper.

Adrianna Tetley, head of the Association of Ontario Health Centres, said she will be looking for the government to lay out long-range goals along with the structural change. "We need to have a 10-year vision that we know where we are all going and we can work together to get there," she said.

With a report from Jane Taber

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