Ontario moves ahead with health-care overhaul, but provides few details

Ontario is moving ahead with long-promised health-care reforms, including dismantling its troubled home-care agencies, but it is providing few specifics on when or how the changes will be made.

The province released its plans on Thursday in a discussion paper that also proposes changes to the way primary care is designed, to make it easier for people to find a family doctor or health team and get an appointment when sick.

The proposed reforms follow a series of reports that were critical of home care, and come at a time when the province is moving to shift care out of expensive hospital and nursing-home beds and into people's homes. For months, the Liberal government has faced mounting pressure to take action, and it chose to make its plans public a week before the holidays, when legislature is not in session.

The government is also proposing reforms to primary care while it is involved in a battle with doctors, who have been without a fee agreement for more than a year. The Ontario Medical Association (OMA), which represents doctors, has launched a Charter challenge against the province, as well as a public relations campaign.

Health Minister Eric Hoskins said the discussion document was released as soon as it was ready. The timing will allow people to "take it away over the holidays and digest it," he said in an interview. The dispute with the OMA is over compensation, he said, and the proposed reforms "will not impact compensation in any way."

At the centre of the proposed reforms is a plan to increase the role played by the province's Local Health Integration Networks (LHINs) and the elimination of Ontario's 14 Community Care Access Centres (CCACs), the public agencies responsible for overseeing the delivery of services such as nursing, physiotherapy and help with personal care for the sick and the elderly in their homes.

The CCACs have long been criticized, and were the focus of a Globe and Mail investigation that found inconsistent standards of care and a lack of transparency that left patients and their families struggling to access services.

Under the proposed changes, the boards of the 14 CCACs "would cease to exist," and staff involved in delivering care would be employed by the LHINs but could be located with family health teams, community health centres or hospitals. CCAC management structures – criticized for their high salaries – "would be reviewed," the paper states, along with the management structures of the LHINs.

In addition to home care, the reforms would broaden the reach of the local heath agencies, making them "responsible and accountable for all health service planning and performance," including primary care, as well as collaborating with public health units.

Under the reforms, Dr. Hoskins said, residents will be able to turn to local bodies – which the province is calling an "LHIN sub-region" – when they are looking for a primary-care provider, and that agency will be able to monitor and respond to demand. At the same time, he said, no changes will be imposed on doctors and the reforms will not affect existing compensation agreements.

"Nothing will be forced on anybody. No patient will be forced to change their doctor. No physician will be forced to accept one," he said.

The OMA responded by saying the proposed reforms include many of the principles advocated by doctors, but it questioned how they can be achieved in the current climate. "Given the magnitude of the changes being considered and the lack of details provided, Ontario's doctors have concerns with the timeline laid out for discussion," OMA president Mike Toth said in a statement.

France Gélinas, the NDP health critic, questioned whether the LHINs will have the clout needed to implement reforms, and took aim at the lack of detail provided. "It feels to me that they did the minimum that they need to do," she said.

The Health Minister said consultations will take place over the next two to three months, and the legislation needed to scrap the CCACs and increase the scope of the LHINs will be introduced early in the new year. He declined to give a date for implementing changes, but said many would come by the end of next year.

Kevin Smith, a member of a provincially appointed expert panel on home care and the chief executive officer of St. Joseph's Health System in Hamilton, said he is encouraged the government will be listening to consumers and providers to develop its plans.