Action Plan Year 2: Progress report more politics than substance

Reflecting on two years of “progress” under Ontario’s Health Action Plan, Health Minister Deb Matthews published her list of “accomplishments” in an on-line pamphlet posted in January.

After two years there’s not a lot to show.

Some of the list of accomplishments have not actually happened yet – such as passing legislation that will require chain restaurants to post calorie counts and other nutritional information on their menus.

Thankfully neither have they yet “moved procedures into the community” through a dubious plan to run competitions for hospital services such as endoscopies and cataract surgeries. Given hospitals are allowed to compete with private clinics for their own services, it is theoretically possible that no procedures could be moved into the community – although we doubt it.

The province has established 47 community Health Links covering off about half the province – likely the most widely support initiative in the Action Plan. However, there is no data yet to suggest Health Links is working to enhance care to complex patients or better utilizing resources.

Other claims are somewhat blurred by inclusion. For example, it was only last summer that the government changed the structure for publicly-funded physiotherapy, so its hard to believe that the changes would have made a difference so soon, particularly when some of the same providers are providing the same service in the same location just under a different payment scheme. By tossing in exercise and falls prevention programs, the government claims it has expanded access to 200,000 additional seniors and eligible patients. We’d like to see the details on that one. There is no analysis of how much physiotherapy was reduced in hospitals as outpatient rehab clinics were closed while all this was taking place.

In mental health there is very little going on. The government says in First Nations Communities it has funded five new Community Wellness Development Teams that will expand telemedicine access to mental health care. Ontario has also contributed to a mostly federal project to help homeless people into supportive housing. That’s it. If you are not homeless or in a First Nations Community, there is no progress on mental health listed in the report.

You would never know based on such an absence of planning that parents are still complaining they have to wait as long as a year to get support for children and youth with mental illness or that the police chiefs are complaining they are becoming the first point of contact for individuals with mental illness or that the corrections system was recently described as “medieval” in its treatment of those trapped waiting in jail for placement to a forensic hospital bed. This is just plain embarrassing for the government.

Given home care is the centerpiece on which the new health system is being built, the accomplishments there are limited too. Over two years Matthews claims to have extended home care to 46,000 more seniors. What she omits is that many of these seniors urgently required home care because the hospitals were told to dump them out of a bed as soon as they were able to do so. The Advocacy Centre for the Elderly reported last year that they had almost as many requests for assistance with hospital discharge in the first six months as they did in all of 2012.

It’s interesting to note the new language used around primary care. Instead of providing a family doctor for ever Ontarian who wants one (who doesn’t?), the government says its goal now is to provide a family doctor for every senior who wants one. Of those who have registered with Health Care Connect – a government service meant to assist patients to find a regular doctor or nurse practitioner – the progress report notes 91 per cent of seniors who have registered have been referred. Referred? How many are actually attached to doctors or NPs?

Hospitals have been practically left out of the report despite making up slightly more than a third of the health budget. Hospitals have had their base budgets frozen for two years, and were limited to increases of 1.5 per cent annually for two years before that. Needless to say, there are few happy stories of “progress.”

The NDP insisted on limited additional funding for small and rural hospitals in return for supporting last spring’s budget. That additional funding “support” is listed as progress. Pick up any small community newspaper and you’ll discover that this funding has not stemmed the tide of cuts. The most recent is the Renfrew Victoria Hospital, which will close its obstetrics department in June (they claim its not budget, but demographics — seven nurses are still getting the axe). Local Moms will have to travel up to an hour to have their babies.

Coincidentally, the progress report says it is giving expectant mothers MORE options by opening birthing centres led by midwives in Toronto and Ottawa. Midwives have to be within a certain distance of a hospital to perform home births, so it is likely those in Renfrew County and other rural communities will have much less choice despite the government’s cheeriness.

Given how numbers driven the province is, the progress report is very thin on measureable outcomes. It’s more about outputs at this point – something we would have expected to change after year two.

The biggest bit of spin in the report is the suggestion that Ontario is somehow bending the cost curve through this grab bag of initiatives. This is the biggest whopper in the report. It is far too soon to think that any of this activity would be producing significant financial dividends. If the cost curve is being bent, it is by starving health care providers of sustaining funding, not by innovation.

Matthews would have likely preferred to undergo system transformation at a time when the government wasn’t implementing deep austerity. This might have looked different back when six per cent funding increases were the norm. Health and education were supposed to be carved out from government’s austerity pain, but at a little over two per cent annually it’s clear that health funding is not keeping up with inflation, population growth and the impact of an aging population. That makes system transformation all the more difficult. There is nothing left at the margins to play with.

Two years in there is little evidence to show for the health minister’s action plan.

Given attacks from surprisingly quarters – including Toronto Star columnist Bob Hepburn’s call for the health minister to be replaced – the Wynne government may want to pay a little more attention to the health file.

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