Health care 'super agency' wrong solution for Ontario's four big problems
I am a healthcare rink rat. Like the kid who can’t wait to get to the local arena, I love Ontario health care.
I love our operating rooms, ER’s, and the clinics where dedicated teams provide compassionate care every day. I admire the homecare workers who keep frail seniors independent in their communities and have enormous respect for private companies like Schlegel Villages, which operate world-class nursing homes.
After spending a lifetime working in a variety of roles in Ontario health, I cannot help but speak out when I see that our health care is being put at risk.
For the last 30 years, Ontario has developed an enviable reputation for making improvements to its health system, one step at a time and avoiding the radical gyrations that have damaged other systems across Canada.
Incremental improvement has come from all sides of the political spectrum. Premier Mike Harris accomplished the controversial work of hospital restructuring and his Health Minister Tony Clement reformed Cancer Care Ontario to create one of the best cancer systems in the world.
Former Liberal Health Minister Deb Matthews created a quality culture you can feel today at the front lines of care with clinicians who grew up under her quality legislation. And Premier Bob Rae’s NDP government introduced the original home care legislation in 1994.
This non-partisan attention to improving health care has resulted in a system that is the least expensive in Canada, has the best wait times, has dramatically improved the risk of Ontarians dying prematurely and brings medical trainees from around the world to learn how we do it.
Being the least expensive system in Canada, however, has resulted in a shortfall in capacity that has caused hospital overcrowding and hallway medicine. Thankfully, most of the answers to this problem are straightforward and will be addressed by tackling four big problems in Ontario right now:
- We urgently need to build and open 15,000 new nursing home beds. Thereafter, we need to keep increasing nursing home beds and home care capacity (not necessarily budgets) at 3 to 5 per cent annually because the population of Ontarians over the age of 75 is going to increase at this rate for years to come.
- Poor customer service.
- Expanding mental illness treatment.
- Improving health for Indigenous Ontarians.
All four of these areas require focused incremental work.
But none of these problems require blowing up the Ontario health system as proposed in the draft super agency legislation leaked by the opposition last week. To understand the risk of the super agency, let’s look at the experiences of other provinces that have gone down this road.
In 2017, a blue-ribbon panel in Nova Scotia evaluated its equivalent of a super agency two years in and found a “nonsystem — disconnected, not communicating, non-agile, non-people-centred as well as front-line staff and managers who feel helpless and unable to effect the changes they know have to happen.”
Based on this analysis, the review panel strongly recommended that any agency should be independent of political interference from the government. The Ontario super agency will be directed by the health minister, the opposite of what is recommended by the Nova Scotia review.
But what worries me is that the Ontario super agency would take over responsibility for cancer care and organ transplantation with Cancer Care Ontario and Trillium Gift of Life disbanded and the Cancer Act repealed.
These two organizations have created world-leading cancer and transplant systems that have saved many thousand Ontario lives. It is possible that this good work would continue under the super agency, but that has not been the case in other provinces when super agencies were created.
Nor can we expect to save money. Based on the Alberta experience, introducing an Ontario super agency could increase annual health-care costs in this province by an extra $14 billion (Alberta health costs $1,000 more per person than Ontario).
Ontario’s health system has continuously improved without chaotic changes in structure. Incremental change is not fear of innovation — it is introducing change in a responsible safe manner that limits patient risk.
We have a proud history of health-care improvement under governments with varied political principles. Our premier deserves to be known as the man who fixed hospital overcrowding in Ontario — not the man who damaged world-class organ transplant and cancer care.
Bob Bell worked in Ontario health care for more than 40 years as a GP, surgeon, hospital CEO and Deputy Minister of Health.