Monday, 1 April 2019

Ontario's Changing Health Care Landscape

When I first worked as a hospital social worker close to 30 years ago, there were no LHINs, no CCACs, no central processing agency. If you needed to arrange home care for a patient, you called the home care office; if you needed to arrange for a nursing home, you completed an old photocopied form and sent it to every home you wanted and hoped it made it to the top of their pile. There was no standardized waiting list, no organized way of ensuring your patient got the same priority as someone else and no verification that the patient was competent to consent.

When CCACs were created, there was some resistance on our part without doubt. We had to do things differently. There were different forms. More forms. Capacity of an applicant became an issue and something we had to assess for. We couldn't rely on relationships we had created with long-term care homes. And our script for talking to families had to change.  Eventually, we all got on board. There was no choice but also, we eventually recognized that it did make our lives easier and it was a far more patient-centred way of doing things.

And then, about a dozen years ago, came the LHINs. The LHINs were created out of the idea that in a province as large as Ontario, health care should be decentralized. Given that different areas had different populations, it was surmised that those who live, provide services and use those services within a defined community were best equipped to determine where they needed to direct their health care dollars. The concept that one central government agency was not conducive to making decisions for the whole province was why the 14 LHINs were created. Each LHIN was a non-profit entity with a board of directors and was allotted their portion of the health budget to provide health services to their community through hospitals, CCACs, community health centres, long-term care homes, mental health and addiction services.

Another change happened again last year. it was decided that the CCACs needed to be  be disbanded as an agency because of the money spent on unnecessary management salaries, so the agencies that were once CCACs simply became the LHINs. It did not seem to disrupt patients when the transition happened though I'm certain there were jobs lost and it caused some internal agency disruption.

And now with a change in the ruling political party, our province is seeking to get rid of the LHINs completely. In fact, not just the LHINs. We are going to a 'super-agency' model that will house a host of other health care agencies including Cancer Care Ontario, eHealth, Trillium Gift of Life Network, Health Shared Services, Health Quality Ontario and Health Force Ontario Marketing and Recruitment Agency. So essentially, we are going back to 30 years ago; to a system that was flawed enough to require the creation of CCACs and LHINs. Except now we have many more seniors. And more people in general in Ontario. And an established system for some of those agencies that worked well. Yes, there are problems. And a shortage of nursing home beds. And a shortage of  staff/money for home care. And too many people in hospital emergency rooms. There are parts of the system that are broken, but not the entire system. Do they need fixing or scrapping completely? Are we 'throwing out the baby with the bathwater'? Are we really going to save money by doing this or will it cost us far more in the long run? We only seem to be hearing about what is being 'taken away', not about what we will be given to function and live better lives. Will this massive overhaul really result in better service, more service, less people waiting in hospital hallways for beds or service? How will  we transition from one system to another one seamlessly; how do we ensure that people will be adequately and properly served during this time? And what about emerging private sector services; will we end up with a two-tiered system as our public sector gets lost in the monumental changes to the way they do business?

I don't believe there is one easy solution to the flaws in the current system. It's a complex mechanism that can take years to fix, if that is even possible. But to try to fix it, really means to understand it and its complexities by living in it and talking to the people that work in it. There are many, many questions that Ontarians have about this monumental change in healthcare delivery but unfortunately, no one is giving answers to some very fundamental questions right now. I, for one, am worried about what this means for us; for our children; our seniors; and everyone in between.

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