Drummond Report: Will Dalton McGuinty really implement this mess?

Two days after the Drummond Report was publicly released it is fair to wonder what will actually be implemented for health care. After all, it is not Don Drummond running the province, but Dalton McGuinty.

McGuinty is the master of building firewalls between his policies and the decision-makers at Queen’s Park. For example, how many times did we hear McGuinty and his MPPs suggest unpopular health care decisions were not theirs, but those of the Local Health Integration Networks? Now Don Drummond is the latest lightening rod that separates a long list of nasty trial balloons from the politicians who would like to see how much austerity the public will accept.

The government treated the release of Drummond’s report much like it does the budget, locking up journalists and opposition politicians until the official release at 2:15 pm Wednesday. This is hardly standard protocol and suggests the government was taking the recommendations very seriously. Or was this just optics?

Drummond has also shifted the frame, suggesting on CBC Metro Morning that this was all part of a cycle, where good times had allowed spending to get fat, and like the 1990s, it was time to reign in public spending costs.

This is complete nonsense. As an economist, Drummond knows perfectly well the deficit exists because of the recession, not because of excessive spending on public health care or other government services. And we all know who caused the recession.

Those who work in the front lines must be scratching their heads, missing the exact moment when they had it so good.

Drummond’s proposals on mergers and realignment of health care services could result in restructuring costs that would eat up the entire increase in health funding for the next four years. If health is to be held to increases of 2.5 per cent per year, it amounts to a little more than $1 billion per year. Restructuring costs at the beginning of the last decade amounted to close to $4 billion. It is hard to imagine it costing less 12 years later. This has the potential to leave nothing for a long list of priorities ranging from addressing mental health to beefing up home care and accelerating implementation of e-Health.

The Health Minister has already nixed the idea of inviting for-profit companies to take on work she wants delivered away from the hospitals – what has become a standard ask for Drummond.

It is also unlikely that the McGuinty government would want to focus so many resources on the proposals to dramatically increase health care bureaucracy. Health Minister Deb Matthews said a few weeks ago she wants to reduce administration, not grow it.

Drummond’s focus on creating more bureaucracy is mind-blowing:

Drummond envisions the 14 LHINs effectively becoming powerful mini-Ministries by gutting the one real Ministry of Health. He wants to create new “coordinating bodies” for Mental Health. Another for Heart and Stroke. He wants to beef up Health Quality Ontario and give a larger role to the Institute for Clinical Evaluative Sciences. He wants to “explore” the idea of a national organization that “collates and enhances evidence-based policy decisions.” He wants to organize some kind of “collective administrative support” for physicians. He wants to hire workers to help patients with paperwork. There would be more bureaucracy around the administration of the Ontario Drug Benefit program to determine which seniors are eligible for the program and at what levels they have to pay increased premiums. He wants to establish a “central mechanism” to locate and transfer surplus goods to hospitals in need. He wants to establish another Commission to guide health care reforms. He wants to create another “entity” to represent the network of long-term care homes.

While Drummond would gut the Ministry of Health – for a second time after the LHINs were created in 2006 – he would also give it much more work to do.

That work includes a mission to draft a comprehensive plan to address health care challenges for the next 20 years. This is despite the fact that the plan of the Health Restructuring Commission became obsolete after a decade. Twenty years are way past any reasonable best before date. Consider it took three years to draft a mental health strategy for three years, we won’t hold our breath on the 20 year plan. When the LHINs were created in 2006, the Ministry was supposed to have developed a central plan to guide the 14 regional bodies. No such plan was ever made public – if it existed at all. Not only is 20 years a ridiculous planning window, but the Ministry will never get such a large endeavor airborne.

Ironically, despite delivering a highly politicized document, Drummond says he wants to take the politics out of health care. He says the leadership of the LHINs should not be appointed by order in Council, but be subject to executive searches. Nowhere does he say how the LHINs would balance their extraordinary new powers with the need to be accountable beyond the desk of the Minister of Health.

Will the politicians really let go of health care? Don’t count on it. Why would we want to take major decisions further from the communities that would be affected? Regardless of who makes the decision to close a community hospital, for example, the government of the day will likely still pay at the ballot box. The LHINs will not be given that much freedom.

One of the most controversial recommendations – to force “alternate level of care” patients into the first available community bed – is unlikely to fly. The Liberals were already embarrassed by families complaining about having their elderly parents threatened with huge – and illegal – hospital fees if they didn’t go to the first long-term care home available. In a minority government situation, this recommendation is a non-starter.

It’s true there are many good things in Drummond’s health recommendations, such as the expansion of the scope Medicare. The fact that he spends so little time on this would suggest it was put there for the only purpose of making some of us say, “but it’s not all that bad.”

There is much that will be implemented in Drummond’s health care plan – mostly recommendations that already reflect the government’s direction, including the shift away from the global funding model for hospitals to the Health-based Allocation Model (HBAM), implementation of ALC strategies, more community-based care, shifting of scope of practice for professional staff, addressing labour shortages, freeze new long-term care beds licenses in favour of more home care alternatives, and greater transparency around executive compensation, just to name a few.

Watch for more in the coming days, including some of Drummond’s thinking WAY WAY outside the box and his less than noble plans for public sector workers.

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