Dr. Eric Hoskin, Ontario’s Health Minister, speaks about his top four priorities at HealthAchieve November 5.
Dr. Eric Hoskins may be signing his name, but the latest Toronto Star letter-to-the-editor from the Health Minister sounds as tired and exasperated as those served up by his predecessor. Given Ministers seldom pen their own letters, we conclude it must be hard to get good help these days.
Hoskins (or his ghost writer) insists that Star columnist Bob Hepburn is wrong – that in fact no cuts are taking place in home care. Never mind Erie St. Clair CCAC’s new executive director sent out a memo announcing a 33 per cent cut in daily nursing visits or that Care Coordinators at the Champlain CCAC are beside themselves having to recommend out-of-pocket paid alternatives to long-term patients who suddenly find themselves without a caregiver. Both CCACs are staring down millions in debt and are in freefall. But hey, aren’t we glad that no cuts are taking place?
It’s the same old song and dance coming out of the Minister’s office. Hoskins insists that Windsor got $3 million more in funding this year and that overall $270 million has been added for home care. Demand is far outstripping this funding due to a planned multi-year freeze to the base budget of Ontario’s public hospitals. Care Coordinators are telling us that not only is this placing the CCACs under great pressure, but it is changing the very nature of the work they are doing. It’s all about post-hospital care, not about longer-term chronic care management and support.
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.
What to do with the Community Care Access Centres?
Yesterday’s Toronto Star column by Bob Hepburn suggests we should roll them into the Local Health Integration Networks and send the CCAC CEOs packing. The urge to spank the CCAC board that approved a 50 per cent salary increase for their CEO is compelling, but blowing up the CCACs is likely not the answer.
There is no question that the CCACs are a very cumbersome way to deliver home care. Let’s not forget CCACs also are involved in discharge planning in the hospitals and coordinate placement into long-term care. They are also responsible for the Health Care Connect program that assists Ontarians to find family doctors or nurse practitioners. They directly employ nurses that go into schools to provide mental health support as well as rapid response nurses to assist with chronic disease management. Nurse practitioners are also working with palliative pain and symptom control.
Nobody seems to know how much of their work is taken up by administration. The CCACs say its 10 per cent, but that doesn’t count all the layers at the agency level. We don’t know what the CCAC spends on contract competitions or enforcement to existing home care providers. Let’s face it, accountability is not free.
Hepburn says administration and case management amounts to about 40 per cent, which seems to be as fair a guess as we’ve seen.
By anybody’s standard, that’s not the best bang for the buck.
The problem with the proposed alternative is the CCACs are not really parallel organizations to the LHINs.