Tory health platform review: Direct promise to scrap LHINs, CCACs missing

Diablogue Election Primer graphicCuriously after months of saying they’ll do away with both the Local Health Integration Networks and the Community Care Access Centres, both direct promises are conspicuously absent from the formal Tory election platform. That doesn’t mean they will stay in place either.

They do say they’ll instead place decision-making in the hands of “health hubs,” which will bring together “front line local experts from every aspect of health care together at the same table.” Elsewhere they define these local experts as “front-line professionals.”

“We think your nurses, doctors, community care organizations and hospitals know best what care you need,” the platform document states.

So what’s a health hub? Previously the Tories had described these not as some kind of broad-based panel of front line health professionals, but instead 30-40 large central hospitals which would run the health system within their sub-region.

The Tories may be massaging that pledge given it would strike at the independence of mostly local rural hospitals — which is where much of their electoral base resides. The first round of hospital consolidation under the Harris government created a lot of friction as smaller community hospitals found many of their services consolidated in larger urban sites. If the “health hubs” idea is to be implemented according to their earlier “white paper” it may be a vote loser in many smaller communities across the province. Nobody wants to see their hospital services taken away.

The platform is remarkably vague on how these “health hubs” would now be constituted. Watch for a possible name change, some new signs and a coat of paint applied to the Local Health Integration Networks.

The Tories lament that “key decisions are too often made at the Ministry of Health or in the so-called Local Health Integration Networks.” We wonder what a Tory Minister of Health would be doing if she or he is not making key decisions? Isn’t that what he or she was elected to do?

The Tories would also create something called “chronic care centers of excellence,” which would help patients cope with diabetes, heart disease or even Alzheimer’s. For chronic care patients with the highest needs, they would assign them a “dedicated care navigator” who will somehow ensure the patients “get the care they need when they need it, and that all of their sources of care work together.” Could this be the new model for the Community Care Access Centres?

Tim Hudak may be committed to expanding home care, but the existing workforce may be concerned about what he has in mind. The platform will provide “choice” between using existing government-provided home care services (of which the majority are private for-profit), or simply taking the money and contracting services yourself. This will essentially turn home care into a free-for-all with little accountability or standards.

The Tories also say they will expand access to long-term care, only by keeping more seniors in their own homes longer, not necessarily by expanding the number of long-term care beds. This contradicts his other pledge to eliminate the home renovation tax credit for seniors, which is intended to help them stay at home longer by installing hand rails, wheel chair ramps, wheel-in showers and other assistive devices. Evidently Hudak expects seniors to stay in their home longer without that stuff.

Hudak believes strongly in competition and contracting out. They not only want to do it with traditional hospital services – such as food services, building maintenance and IT – but also on such services as MRIs, dialysis and routine surgeries.

On this score there is remarkable consensus between the Tories and Liberals on contracting more health services to private clinics.

Pounding away on e-Health for years, the Tories now want to “enhance patient databases” to give doctors and nurses (there are no other professionals in their world) “real-world feedback” on what works.

The Tories say they will make mental health a priority, but offer no details beyond a promise to replace fragmented services with a “more comprehensive approach.”

There’s not much in the Tory plan around social determinants of health. After admitting he would lay off teachers and their assistants, Hudak is promising to “ensure that our children get 45 minutes of physical activity every weekday, through school-based activities and after-school sports.” How does that work with so many fewer workers?

For those working in the health system, Hudak has only promised to protect doctors and nurses from layoff. He would not only freeze wages another two years for the “entire public sector payroll,” but would “bring government benefits in line with those of the private sector.” Only pensions already earned by government workers will be protected. He says new workers would not get a defined benefit pension plan, but instead be relegated to a less efficient defined contribution plan. Hudak suggests that he would change the arbitration rules to place workers at disadvantage. “The public shouldn’t have to pay a premium for every government job, though the arbitration rules we now pretty much guarantee it.” He says arbitrators would have to compare public sector jobs to similar ones in the private sector and base decisions about pay on what “local taxpayers” can afford. (Just local ones? That may sound okay if you work in Oakville, not so much if you toil near Sarnia.) The document is silent on rising CEO salaries. Managers may stand to actually benefit if Hudak is serious about matching private sector compensation.

Unions are an itch that Hudak continues to scratch. He says he will introduce a bill that would hamper the political activity of unions and, like his federal counterparts, he promises to require unions to open their books to the non-dues paying public. This would put unions at a distinct disadvantage when bargaining with employers.

The document is vague on overall health funding, although the Tories have promised to exempt health care from the six per cent cut annual program cuts being implemented on the rest of the public sector. The platform warns that health funding for the past decade was unsustainable – even if the Liberals managed to balance the budget for three years straight while doing so. For Hudak, the present state of the economy has everything to do with the Liberals and nothing to do with world economic crash of 2008. It’s just an awful coincidence that the books hit the red around the same time. Of course what is sustainable in his platform are massive cuts in corporate taxes – 30 per cent – and a 10 per cent cut to personal income tax cuts after Hudak initially balances the budget. Those two cuts would be worth slightly more than $5 billion annually in provincial revenues.

Keep in mind that in the best of times the Harris-Eves PCs left the province with a $5.6 billion deficit before handing over power to the Liberals. Given the impact on the economy of massive public sector cuts – public sector spending usually has a multiplier effect of 1.5 on the provincial GDP — you shouldn’t count on that 10 per cent income tax cut happening any time soon. His current plan of massive pain calls for a surplus of $319 million by 2016-17 – not nearly enough to cover the $3 billion he would need to cut income taxes as promised.

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