The day after: health care issues still smoldering

There’s got to be a morning after.

Tim Hudak has announced he is stepping down and the Kathleen Wynne Liberals now have a majority parliament.

So what happens now?

There are several outstanding issues in health care.

The first is the fate of the Local Health Integration Networks. The standing committee charged with conducting the legislated review travelled the province holding hearings over the winter. Despite Tim Hudak’s promise to replace them with “health hubs,” there was little interest in the issue on the campaign trail. The likely result will be some minor tinkering and they will soldier on. After eight years the LHINs appear to have found their legs although clearly there are still some community members who feel left out of the process. Last year’s five per cent cut to their budgets likely didn’t help the LHINs connect with those communities.

We’ve noticed that despite a province-wide Ontario Health Coalition campaign opposing the siphoning off of hospital services to private clinics, the province is moving forward with competitions to auction cataract surgeries, endoscopies and other diagnostic services. The Windsor Regional Hospital is already in one of these competitions with the private MyHealth Vision Care. MyHealth manages 16 Independent Health Facilities in Ontario and say they are developing 18 more. The hospital is the midst of capital planning for a new outpatient facility. Being caught in these kind of arbitrary competitions makes it difficult to plan. CEO David Musyj told the Windsor Star that the cataract decision will have an effect on the entire health system. “We don’t want to do something prematurely that negatively impacts what we’re trying to create into the future for the community.” The Wynne government could find themselves in a considerable battle over this issue. The Ontario Health Coalition have collected nearly 100,000 postcards from Ontarians who don’t want to see private clinics take over this work. They plan to present the postcards to Queen’s Park soon.

Home care may be a more interesting case. Last year the Wynne government was running pilots that would give far more autonomy to the private contract providers that deliver nursing, therapies and home care support. Given the history of no-shows with many of these providers, we felt this was a very bad idea. It would also mean fewer case managers at the Community Care Access Centres. Now that most of the pilots are complete, it’s not clear where the government is going with this issue. The Ministry of Health has been burned before on granting this level of autonomy – let’s not forget ORNGE and e-Health. We had applauded the fact that the CCACs were hiring direct service providers for new initiatives, including new mental health and rapid response nurses. The Ontario Hospital Association also is calling on the government to make massive investments in home care to alleviate pressures. It would be much easier to do this by expanding the capacity of the CCACs rather than take a leap of faith in a disparate group of private players.

Last year we were pleased to see the government hire 100 new long-term care inspectors. The problem is that none of these are permanent hires, yet Health Minister Deb Matthews says the new recruits are necessary to provide an annual RQI (Resident Quality Inspection) for every nursing home in the province. How can you provide these detailed annual inspections if the professionals you hire are only given one-year contracts? The Wynne government will also be facing pressure to increase front line staffing in the homes. The facility owners, unions representing front line staff, and community advocacy groups have all been calling on the government to do the right thing and increase staffing to four hours of direct care per resident per day based on average acuity. That’s what the best evidence is telling us is required to improve outcomes for residents. The Ontario Health Coalition just completed an extensive tour across the province with a giant rocking chair to draw attention to the issue. The government would do well to set out a plan to reach those numbers and at least revise the budget to include a down payment on staffing.

The Ontario Hospital Association has long bought into the idea of delivering more care in the community, but even they must be wondering when the funding taps get turned on again. The base budget for hospitals has been frozen for two years, and the original Sousa spring budget proposed to take it to three. Ontario already has the lowest beds per capita not only in the country, but in most of the developed world. Our hospitals also have the lowest worked hours per weighted case, which is perhaps even more alarming. Overall public funding for health care is now the lowest in the country. Clearly something’s gotta give. The OHA has been calling for capacity targets so they at least have some sense of where the end game lies. We should at least try to objectively determine how many beds are appropriate. As we also mentioned, the OHA is calling for massive investment in home care so that patients have somewhere to go upon early discharge.

In the primary care sector the Liberals see the introduction of the Family Health Teams as a winner. The sector offered a considerable premium to attract doctors, but gave little consideration to the rest of the team. Last year the interprofessional primary care sector reported to the Wynne government that uncompetitive wages in the sector were hampering them from hiring health professionals, including nurse practitioners. About one in five NP positions were vacant within the sector last year. According to the National Post, the province has been paying anyway for these professionals even though the positions are vacant. Further, governance issues have created turmoil at several FHTs, including the Mel Lloyd FHT in Shelburne where the Post reports that the board has twice resigned and staff turnover is at 51 per cent. That FHT is also facing two wrongful dismissal suits. The Auditor General has also noted that many patients the government is paying to be rostered at the FHTs are not actually receiving care there. In some cases, the government is paying twice – once to roster them, once again to pay the OHIP claims from the health care providers these patients are in fact seeing. Clearly there needs to be a firm hand on the tiller here as well as an evaluation of the program to date.

One of the first decisions Kathleen Wynne will have to make is who to appoint as Health Minister. A fresh mandate might be an opportunity to change horses in health. It may be difficult to say the Premier has turned the page on the Liberal scandals if she reappoints Matthews to the post. Matthews was widely criticized for her lack of oversight during the ORNGE scandal. She herself came to the seat after David Caplan resigned over the previous e-Health scandal.

It may be time for a fresh start.