The Progressive Conservatives are writing a new prescription for Ontario's cash-strapped health care system, starting with a change in who's making decisions about how billions of dollars are spent across the province.
The province should abolish regional organizations that decide where the money goes locally and instead rely on 30 to 40 "community hubs" created from existing hospital corporations and staffed by volunteer boards, the Tories said Monday.
The 14 Local Health Integration Networks set up by the Liberals, as well as the Tory-created Community Care Access Centres, aren't working and haven't been able to hit most of their targets, said Opposition Leader Tim Hudak.
The province should get rid of them, along with 2,000 "middle managers," and use that money to hire more doctors and nurses, he said.
"The sad reality is, if you have a loved one who's in the health-care system, far too often you've got to fight like hell to get anything done," Hudak said.
"We're going to change that. And we're going to put patients — not bureaucrats — at the centre of our health-care system."
Heath care now consumes nearly half of every dollar spent by the government, which is facing a $15-billion deficit.
More money is being spent on health care, but the government isn't achieving the results for the money it's taking, Hudak said. His party's "bold new ideas" would put patients first, create jobs and help grow the economy.
"This is not about a new coat of paint on an old system," Hudak said. "It's fundamental reform to take out layers of bureaucracy, invest in patient care instead and bring decisions closer to the communities where people actually live."
The Tories also want to accelerate patient-centred funding — where hospitals get money for every service they perform — and reduce the size of the Ministry of Health and Long-Term Care.
They're among the suggestions contained in one of two Tory discussion papers on health care, which aren't official party policy.
But they do raise questions about whether the integration of various health services, from hospitals to home care, would be left in the most capable hands.
'A recipe for privatization'
Many people share the concern that the current health-care system doesn't meet the needs of patients, said Natalie Mehra, executive director of the Ontario Health Coalition, a public health-care advocacy group.
But what the Tories are proposing is to simply replace the cabinet-appointed LHINs with "self-selecting hospital boards that aren't democratic and that answer to nobody but themselves," she said.
It's also unclear in the document paper how the ministry of health would assert any authority at all, she added.
"This is really a recipe for privatization," Mehra said.
The so-called "patient-centred" funding model would also starve rural and remote hospitals, who don't perform as many services as those in big cities, she said.
Health Minister Deb Matthews promised to take a closer look at the discussion paper to see if there are any ideas the government could adopt.
But it didn't take long for the Liberals to slam the Tories' record on health care when they were in government.
"They closed hospitals, they fired nurses, and when it came to our fight on behalf of Ontarians to lower drug costs, they chose the wrong side," Premier Dalton McGuinty said in the legislature.
"I think it's also interesting ... there are no specific commitments to enhancing home care hours, no specific commitments to increasing access to doctors, no reference to reducing the incidence of smoking, no reference to tackling childhood obesity."
Matthews noted that some of the ideas proposed by the Tories reinforce what the government is already doing. They've already started the ball rolling on patient-centred funding, she said.
"But what this plan does is it dismantles all of the oversight," she said.
Matthews acknowledged that Ontario is still grappling with long wait lists for nursing home beds and other services. But she defended the LHINs, saying they're doing good work with demonstrated results.
Last month, the London Science Centre had no patients waiting for long-term care because of the work done by the LHIN, along with the CCAC and other organizations, she said.
"I'm not saying everything is perfect," Matthews said.
"But what I'm saying is that we know what needs to get fixed and we have a very ambitious plan to fix those problems, and we're seeing the results."