The Ministry of Health and Long-Term Care is looking to shake-up health care delivery in Ontario.
On Dec. 17 health minister Eric Hoskins released the Patients First discussion paper outlining the proposed next phase of the government’s plan to “truly integrate the health care system so that it provides the care patients need no matter where they live.”
“Too often health care services can be fragmented, uncoordinated and unevenly distributed across the province,” Hoskins wrote. “For patients that means they may have difficulty navigating the system or that not all Ontarians have equitable access to services.”
The paper noted changes were made over the past decade to improve access to primary care, provide more care for people at home, reduce hospital wait times, invest in health promotion programs and make the system more transparent and accountable – but improvements are still needed.
“The ministry believes that structural changes are critical to the success of Ontario’s health system as a whole,” stated ministry spokesman Mark Nesbitt in an email response to the Advertiser.
“The proposal in the discussion paper would see LHINs (Local Health Integration Networks) assume responsibility for home and community care and system integration, and have greater involvement with primary care, and improved linkages with population health planning.”
The paper says LHINs “would assume responsibility for planning, managing and improving the performance of all health services within a region, while still maintaining clinician and patient choice.”
By doing this all parts of health care would be better able to communicate with one another, officials say.
The Waterloo Wellington LHIN is ready for the challenge, according to communications lead Cheryl Evans.
“Some residents tell us they’re getting really good health care in the community and others have a different experience,” said Evans. “So I think we’re excited to work towards building a home care system that’s more effective and consistent and integrated with other services to make care better for residents.
“There’s a lot of work ahead of us.”
While 14 Ontario LHINs are responsible for the local health systems, they only manage planning and performance in acute care, long-term care, community services and mental health and addiction sectors.
One of the major changes suggested in Patients First is the elimination of Community Care Access Centres (CCACs), which currently receive funding from the LHIN, act independently and have their own boards, Nesbitt explained.
The recommendation in the paper is to “transfer direct responsibility for service management and delivery from the [CCACs] to the LHINs.
“With this change, LHINs would govern and manage the delivery and community care, and the CCAC boards would cease to exist.”
The oversight for primary care would shift from the government to the LHIN.
“As it currently stands, primary care is managed centrally by the province, with the ministry providing oversight at a great distance from where services are delivered,” Nesbitt explained.
“Empowering LHINs to play a greater role in primary care will ensure that these services are better tailored to the needs and priorities of local communities.
“The province will play a role in defining what is expected of LHINs by establishing performance expectations and accountabilities for primary care, while the LHINs will work with local communities to define how best to achieve these objectives.”
Front line CCAC employees would be integrated into the LHIN and there wouldn’t be a visible change in service for patients, according to Dale Clement, CEO of the Waterloo Wellington CCAC.
“CCACs in general have long advocated for improvements in the home and community care for Ontarians and basically full support for the minister’s proposal in the sense that we need to modernize home and community care and the vision really is about more integration … with health care providers, who would argue with that?” Clement told the Advertiser in a phone interview. “We need to be able to work together differently.”
She said a benefit of the proposed changes is that patients won’t have to repeat their story during every care encounter because providers will all have access to the same information.
“The information flow is something that with new systems and technologies we can do better,” she said. “I think the gist of the paper is really to strengthen that patient-centred care and really push equity in the system.”
Clement repeatedly reinforced that there should be no change in services for patients.
“The government’s doing their consultation on the paper over the next few months, they want to get some input to understand really the ‘how’ – not the ‘what’ but the ‘how’ some of these changes can come into play,” she said.
“The ultimate goal is to really have a positive impact on patients.”
The paper suggests the elimination of CCACs would “create an opportunity to integrate home and community care into other services.” For example, home care coordinators may work in community health centres, family health teams or hospitals.
Though employees that perform essential work will be employed under this proposal, Nesbitt said, “The discussion paper proposes a review of the CCAC management structure in conjunction with the management structure of expanded LHINs in order to support service planning and delivery in a way that maximizes care for patients and clients while improving efficiency.”
Another area of change will involve public health.
Nesbitt said public health is not formally connected with the rest of the health care system and there’s interest in strengthening its relationship with primary care.
“A key opportunity for deepening this relationship will be to leverage the capacity of public health for population health assessment and surveillance to establish a joint population health planning process with the LHINs and regions,” Nesbitt said.
One of the concerns voiced by Wellington-Dufferin-Guelph Public Health (WDGPH) medical officer of health Dr. Nicola Mercer at the Jan. 6 board meeting was language used in the discussion paper.
Mercer said the health unit and LHIN have different definitions of “population health and prevention.”
“[LHINs] think about primary care prevention as being what you get when you go to your doctor’s office and we make sure that your diabetes is well managed and … we’re trying to prevent you from getting complications with diabetes, but when public health talks about primary prevention we’re talking about much more upstream,” she said. “We’re talking about what are the things that we can do as a population prevention from ever getting diabetes, not how can we prevent you from getting the complications of diabetes.”
Mercer said a challenge is that the paper is written from an acute care lens and she wants to ensure the differences between public health and acute care are heard at the provincial level.
Another proposed change is that all provincial public health funding goes through LHINs and is then distributed to health units.
“The LHINs would ensure that all transferred funds would be used for public health purposes,” the report states.
The WDGPH board is unsure what that means.
“It doesn’t say the LHINs would ensure that all transferred funds would be transferred to public health units,” Mercer said.
“So if they determined that something else, maybe in primary care offices or family health teams, was a public health purpose, would they transfer the money from a public health budget into another agency?”
WDGPH board member and Guelph-Eramosa Mayor Chris White voiced concern that municipalities will be asked to foot more of the bill for local public health services.
“They’re going to make decisions that are best for what the LHINs mandates are, so the money for when you get down to something local like this board, which has some pretty good local programs that fit the local environment, they’re going to start to get squeezed because there’s no purpose to having the LHINs divvy the money out unless they’re going to have some control,” he said.
White continued, saying programs that were once fully funded may be only partially funded under the new system and the municipalities will be expected to step up and fill in the gaps.
Despite the challenges presented, Mercer commented the intent and vision of the paper is for everyone to see positive results and changes to the present health care system.
The health unit is preparing a report, which will be brought back to the board at its February meeting and will be sent to the ministry upon approval.
Evans said the local LHIN is well positioned to learn what is needed in local communities in a way the government cannot.
“I think it’s easier to work locally,” Evans said. “We live in the community, we work in the community, we speak with residents and work with local health service providers. Health needs will change and they tend to be different in different areas. We’re well positioned to look at health care locally.”
See a full copy of the Patients First discussion paper at http://www.health.gov.on.ca/en/news/bulletin/2015/docs/discussion_paper_20151217.pdf and submit comments to health.feedback@ontario.ca by Feb. 29.
Nesbitt said the ministry will review all feedback and intends to propose draft legislation for consideration in the spring.
