About a year and a half ago, I wrote a series of posts outlining the faulty logic behind Ontario's Patients First Act, a strange piece of legislation that would reshape primary care and bring the province's home care bureaucracies under the auspices of the LHINs, the 14 regional health "authorities" (I use quotation marks because the LHINs remain essentially toothless extensions of the Ministry of Health).
The most galling aspect of the Patients First plan isn't the ill-fated "sub-LHIN" entity, which remains not much more than a laughable waste of time and money. Rather, it's the decision to expand the LHIN Boards and executive teams with the same people that made a dog's breakfast of home care in the first place (minus the CEOs that sued for wrongful dismissal).
Now it would appear the province is muddying the waters even further, creating a new home care agency directly under the control of the Ministry of Health. The new agency will both administer home care, and directly hire personal support workers (PSWs) to deliver non-clinical services to clients. Clinical care i.e. nursing will remain with the LHINs for now.
A brief recap is in order: for over a decade, home care in Ontario was organized through regional Community Care Access Centres, or CCACs. A doctor or hospital faxed a referral to the local CCAC requesting services for the patient. The CCAC would in turn assess the patient's needs, and contract out delivery to local agencies, both for-profit and not-for-profit. In 2015, the province's Auditor General issued a scathing raises, and diverting money meant for service delivery to promotion. The Auditor General's report was a major driver of the Patient's First bureaucratic overhaul, which remains an ongoing and painful process.
This new provincial agency, though, is a major head-scratcher. If a stated aim of the Patients First Act was to bring home care under the LHINs, does this not directly undercut that goal? How do you coordinate care if the patient's needs change from clinical to basic personal care? Will there now be two case managers for every home care recipient?
What's to become of those expanded LHIN Boards and executive teams? Are these people supposed to be reshuffled to the provincial agency? If so, why go through the dissolution of the CCACs in the first place (deserved though it was)? And if not, what's the cost to the treasury of letting all these people go?
Side note: the CCACs have millions in unpaid liabilities on their books representing banked sick/vacation days, along with God knows what else. Those liabilities would transfer to the LHINs under Patients First, which might explain in part why the same people were being rehired by the LHINs.
With the province now poised to directly hire personal support workers (PSWs) to deliver services, what will the pay scale be? Not that nurses and PSWs don't earn every dollar they're paid, but a provincial workforce would almost certainly unionize. How does the increase in wages and benefits affect the health budget, independent of changing the volume of services provided? How does that affect wages in other public sector health agencies (hospitals, community health centres)? Is the government opening itself up to legal action by private sector home-care providers, that cannot possibly show the same largess to employees as the province can?
Doctors, hospitals, and even patient advocacy groups have raised concerns that Patients First is at best a waste of time and money, and at worst a power grab by the central Ministry that is already rife with impossibly complicated bureaucratic layers. With a new provincial home care agency set to launch within months, the Ministry now appears to be at odds with (if not itself) its own government, a government that remains bizarrely devoted to the LHINs, LHINs that themselves caused dismay with provincial auditors.
Whatever the machinations and backroom discussions, policymakers need to accept that it's the service that matters, not which fax machine takes the referral or which letterhead gets printed on the pay stub. Twenty years of inadequate home care and long-term care is bringing the entire acute-care sector to the brink of collapse. No managerial tinkering will change that, and a new bureaucracy won't help matters either.
The most galling aspect of the Patients First plan isn't the ill-fated "sub-LHIN" entity, which remains not much more than a laughable waste of time and money. Rather, it's the decision to expand the LHIN Boards and executive teams with the same people that made a dog's breakfast of home care in the first place (minus the CEOs that sued for wrongful dismissal).
Now it would appear the province is muddying the waters even further, creating a new home care agency directly under the control of the Ministry of Health. The new agency will both administer home care, and directly hire personal support workers (PSWs) to deliver non-clinical services to clients. Clinical care i.e. nursing will remain with the LHINs for now.
A brief recap is in order: for over a decade, home care in Ontario was organized through regional Community Care Access Centres, or CCACs. A doctor or hospital faxed a referral to the local CCAC requesting services for the patient. The CCAC would in turn assess the patient's needs, and contract out delivery to local agencies, both for-profit and not-for-profit. In 2015, the province's Auditor General issued a scathing raises, and diverting money meant for service delivery to promotion. The Auditor General's report was a major driver of the Patient's First bureaucratic overhaul, which remains an ongoing and painful process.
This new provincial agency, though, is a major head-scratcher. If a stated aim of the Patients First Act was to bring home care under the LHINs, does this not directly undercut that goal? How do you coordinate care if the patient's needs change from clinical to basic personal care? Will there now be two case managers for every home care recipient?
What's to become of those expanded LHIN Boards and executive teams? Are these people supposed to be reshuffled to the provincial agency? If so, why go through the dissolution of the CCACs in the first place (deserved though it was)? And if not, what's the cost to the treasury of letting all these people go?
Side note: the CCACs have millions in unpaid liabilities on their books representing banked sick/vacation days, along with God knows what else. Those liabilities would transfer to the LHINs under Patients First, which might explain in part why the same people were being rehired by the LHINs.
With the province now poised to directly hire personal support workers (PSWs) to deliver services, what will the pay scale be? Not that nurses and PSWs don't earn every dollar they're paid, but a provincial workforce would almost certainly unionize. How does the increase in wages and benefits affect the health budget, independent of changing the volume of services provided? How does that affect wages in other public sector health agencies (hospitals, community health centres)? Is the government opening itself up to legal action by private sector home-care providers, that cannot possibly show the same largess to employees as the province can?
Doctors, hospitals, and even patient advocacy groups have raised concerns that Patients First is at best a waste of time and money, and at worst a power grab by the central Ministry that is already rife with impossibly complicated bureaucratic layers. With a new provincial home care agency set to launch within months, the Ministry now appears to be at odds with (if not itself) its own government, a government that remains bizarrely devoted to the LHINs, LHINs that themselves caused dismay with provincial auditors.
Whatever the machinations and backroom discussions, policymakers need to accept that it's the service that matters, not which fax machine takes the referral or which letterhead gets printed on the pay stub. Twenty years of inadequate home care and long-term care is bringing the entire acute-care sector to the brink of collapse. No managerial tinkering will change that, and a new bureaucracy won't help matters either.
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Monday, November 6, 2017
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accountability,
bureaucracy,
health policy,
home care,
Ontario,
politics,
regional health authorities
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