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What does and doesn't make sense about Ontario's big changes to healthcare: expert

Ontario's new healthcare super agency plan has been tried before, one former deputy health minister says, and 'there is a tendency towards a period of chaos that can last as long as five years.' Dr. Bob Bell spoke with the CBC about what he says is the biggest change to healthcare in 50 years.

Six agencies including Cancer Care Ontario will be consolidated under Ontario Health

The province's 14 local health integration networks were created in 2007 by then-premier Dalton McGuinty's Liberal government to improve the integration of local health-care services. (St. Joseph's Healthcare Hamilton)
Ontario's new healthcare super agency plan has been tried before, one former deputy health minister says, and 'there is a tendency towards a period of chaos that can last as long as five years.' Dr. Bob Bell spoke with the CBC about what he says is the biggest change to healthcare in 50 years. 10:03
 

Ontario's new healthcare super agency plan has been tried before, one former deputy health minister says, and "there is a tendency towards a period of chaos that can last as long as five years." Dr. Bob Bell spoke with the CBC about what he says is the biggest change to healthcare in 50 years.

Health minister Christine Elliott announced, Tuesday morning, the creation of a health super agency. She plans to dissolve the 14 Local Health Integration Networks (LHINs) and merging their duties with existing health agencies.

It's a plan that will take take years to implement. 

Bell, the province's deputy health minister from 2014 until he retired last summer, spoke with the CBC's Conrad Collaco about the dramatic changes coming to Ontario's healthcare system. You can read an abridged and edited version of the interview or listen to the full audio interview by hitting the play button above. 

Dr. Bob Bell, former Ontario deputy health minister 
Dr. Bob Bell is a former Ontario deputy health minister. (University Health Network)

What is Minister Elliot proposing here?

The minister did a terrific job yesterday outlining her proposal for what constitutes the biggest change to the Ontario healthcare system in the last 50 years since medicare was introduced to Ontario. Two major changes: First of all a super agency that will terminate the Local Health Integration Networks. It will terminate Cancer Care Ontario and Trillium Gift of Life which provided us with world-leading cancer systems and organ transplant systems and bring these under a new, large health super-agency. There will be a board and a CEO who will have responsibility for leadership of all aspects of Ontario healthcare. 

In addition, the minister announced a new model called "Ontario Health Teams" — 30 to 50 teams across the province — which will attempt to integrate services better in local communities around the patient which is certainly the goal of every healthcare system in the western world. Those are the two big changes and believe me they are big changes.

"Right now, cancer providers around the world are scratching their heads and saying 'what's going on in Ontario? They've got one of the best systems in the world and they're destroying Cancer Care Ontario? That doesn't make sense.'" - Dr. Bob Bell, former Ontario deputy health minister

What major problems does the minister aim to solve with all these changes?

The government was elected based on three promises: one to end hallway medicine, two to invest in 15,000 long-term care beds immediately and, finally, to increase mental illness services. Those are the three commitments. None of these require the massive changes the minister described. I think she's hoping that the teams will help make services more navigable.

The province says they will shift to Ontario Health Teams made up of local healthcare providers. Aren't these just LHINs with a new name? 

They are different from LHINs which have regional responsibility for oversight of health service providers. The teams are actually healthcare providers coming together in voluntary fashion to merge their budgets and services and to provide what they believe to be better integrated care. Will they be hospital hub models? I think in many cases they will be since the hospitals tend to have intellectual leadership of regions across the province.

One of the big services provided by the LHINs is the oversight and management of home care. Home care keeps 750,000 frail Ontarians independent in their communities. It's unclear where those contracts for home care will be managed, where the coordination necessary for home care delivery will be controlled. Will they be in the super agency? Will they be in the regional teams? Right now that's unclear.    

When these plans were leaked, critics said this could pave the way for privatization. Some, like the Ontario Health Coalition, are still concerned about that. Is there anything here that to you signals privatization?

The minister said that Ontarians will continue to get access to healthcare through their OHIP card and not their Visa card. We have to take her at her word. I read the leaked legislation. I haven't had the chance to compare it line by line. It looks to me thematically similar. I don't see any enormous opportunity for increasing private healthcare. Will private companies engage in healthcare? Well, they have been. Thirty percent of care delivery in Ontario is private. Home care is virtually 100 percent private. Most primary care doctors are operating small businesses that are contractors to OHIP.      

"There is a tendency towards a period of chaos that can last as long as five years." - Dr. Bob Bell, former Ontario deputy health minister

If you don't see a risk of privatization, what does worry you about the Ford plan?

Well, a few things. The super agency model has been tried in other provinces, most recently Nova Scotia —  before that Alberta. There is a tendency towards a period of chaos that can last as long as five years. The recent review of the Nova Scotia experience demonstrates this chaos... I worry that this is an overwhelming task for any new CEO to take on the leadership of the entire Ontario healthcare system with all services responding to him or her. That's a big responsibility. It has not worked in other provinces. 

The second thing that worries me is that we have an internationally leading cancer care system. I'm a cancer surgeon for thirty years plus. Right now, cancer providers around the world are scratching their heads and saying 'what's going on in Ontario? They've got one of the best systems in the world and they're destroying Cancer Care Ontario? That doesn't make sense.'

The Ontario health teams — an intriguing concept but it's voluntary. How is that going to work? Is there going to be one board responsible? I don't think so. I think they're going to have to figure out how the hospital boards and the service provider boards in the community come together. There's a lot of change that's going to need to occur for these Ontario health teams to actually integrate their service delivery.

Many of these changes seem to be taking place at an administrative level. What will patients notice?

Let me start off with cancer care. Tomorrow, cancer care will be as excellent in Ontario as it is today. However, two years from now will we have the organization that is looking at the incredible complexity that is the frontier of cancer care, the investments necessary in Genomic medicine or in immunotherapy? Will we be at the leading frontier of what cancer care should be two years from now? I'm not convinced we will have the kind of planning or investments in technology necessary to keep us at the forefront of cancer care.

In terms of care delivery at the local level, will primary care providers actually get engaged with these health teams? Will primary providers merge their pay? It's hard to predict. What really worries me is the future for 750,000 frail Ontarians kept independent in their homes by home care services. These home care services are currently managed and coordinated by our LHINs. As the LHINs disappear, who is going to pick up that responsibility? Is it the super agency in Toronto? Is it the regional Ontario health team? Who is going to be ensuring those 750,000 frail Ontarians — vulnerable people — don't miss their home care visits. That, to me right now, is unclear.

About the Author

Conrad Collaco is a CBC News producer for CBC Hamilton with extensive experience in online, television and radio news. Follow him on Twitter at @ConradCollaco, or email him at conrad.collaco@cbc.ca.

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