Published on February 25, 2019

November 19, 2016

The Ontario Liberals have recently embarked on another grand experiment with the healthcare system by reintroducing Bill 41 — The Patients First Act.

Bill 41 is intended to transform the delivery of local healthcare throughout Ontario. However, after reviewing the bill, it should be named Bureaucracy First. This bill does little more than empower and expand beaucratic control. The promise is that somehow that will lead to positive change for the patient. Left out of much of the legislation is the patient who is supposed to be at its centre.

We have seen a number of failed experiments that sounded great at the time and which were supposed to benefit patients. They did not. The alphabet soup of experiments include: ORNGE, PSW Registry; E-Health, LHINS, CCACs not to mention the diabetes registry.

Many of these removed much-needed money from patient services and empowered bureaucracies. The promise was great, the goals were good, but they ultimately failed Ontarians.

Let’s quickly review these. Auditor General (AG) reports over the years have found that Local Health Integration Networks (LHINS) have failed in meeting their mandate to better integrate health services; Community Care Access Centres (CCAC) spend about 40 cents of each home care dollar or about $1 billion on administration; rapid care nurses deployed by CCACs aren’t meeting response times; despite more than $2 billion invested in e-Health, we still do not have a good digitized system that can move important information between care settings.

Despite these findings, Bill 41 rewards LHINs with increased powers and will import, largely intact, the bureaucracy of the CCACs. Together they will oversee all of health care.

To pay for all these experiments and new structures, we have seen care rationed and more chaos created for the 500,000 who wake up everyday to go to work in our health care system.

Here’s my question: How do two failed bureacracies come together to make the positive changes that Eric Hoskins, Minister of Health and Long Term Care has identified as the goal of this so-called transformation? If history serves us, they will not.

I would like to see an end to the constant experimentation with massive and expensive structural “transformations”. Let’s use dollars for more home care visits, more services to Ontarians who need it and more timely access to services.

It’s time to give patients and caregivers a real voice at the table so that we can address the irritants they experience in their patient journey. We need to find ways to bring the patient/caregiver voice to inform every policy so that it works for them.

We need to refocus the work of our civil servants to make services more user-friendly and responsive to the way patients and caregivers want to interact with the system, not what is more convenient for bureaucracies.

Enabling the system

There also needs to be a refocus of our civil service away from controlling everything to a role of enabling the system to better meet the needs of patients and those service providers who directly interact with patients. We need to stop imposing what the bureaucracy believes will work and refocus on implementing the great ideas that come from those in the trenches. We need to lighten their load not add to their burden.

The key to accomplishing much of this is moving towards a 21st century health care system that is in line with those around the world. Ontario is still in the 20th century in this regard. Our infrastructure is not keeping up with that of other nations. We need to be able to harness IT to improve management, care and quality and make these accomplishments more effortless. We need digital records that can effortlessly move crucial patient information between care settings and can properly cost things out.

While Ontario has embarked on building the eight track tape deck, other countries are in the iPhone age running on “tried tested and true” solutions — so should we.

Ontarians deserve an integrated system and one that delivers care when it is needed to those who need it first — everyone agrees this is the prize. I believe we need to change the way we get there. Bill 41 is not the medicine we need.