A Historic Health Care Restructuring



some healthcare announcements are pretty simple the government breaks ground on a new hospital hospital purchases a new CT scanner a health clinic hires more nurse practitioners this next segment is not about anything that simple in fact this week's announcement by the Ontario government about healthcare restructuring may be the most consequential development in half a century but it's complicated so we've invited the Minister of Health and long-term care to go through the details so we can better understand how these changes will affect the care you get and with that we welcome Christine Elliot who's also the MPP for Newmarket Aurora to our studios again and it's nice to have you here thank you just before we get into the nitty-gritty and all the details can we start with this what is the problem that you are trying to solve with the announcement that you made this week the problem is with respect to patient care it's not connected people feel isolated from their health care experience and they feel that when they leave a hospital for example and they are supposed to be connected with home care that doesn't happen in every circumstance with the result that many people end up back in hospital again because of complications because they don't receive home care in a timely manner people are not happy I heard that during my time as opposition critic for health during my two years as patient Ombudsman and certainly I've heard a lot about it since I've been Minister of Health and long-term care you're not a newcomer to the health file right no no I'm not health critic patient Ombudsman Health Minister gotcha let's okay we're gonna take a moment here and go through all this so Sheldon let's go through all these graphics here because the province of Ontario is now creating a new centralized agency called Ontario health that will consolidate the missions of many other agencies for example Cancer Care Ontario and a health and the local health integration networks they're all now under one roof called Ontario health they're also going to create Ontario health teams comprised of healthcare providers that's hospitals family doctors home care organizations that as the Minister has suggested will function as one seamless caregiving team and the government expects to have 30 to 50 Ontario health teams with 300,000 patients apiece in three years time the Ontario health teams will be expected to use digital technology so patients can have access to their records and that crucial information will follow the patients throughout their healthcare journey you may for example also be able to book appointments online a new emphasis on virtual care is there so you may not have to physically visit your doctor or specialist and you can be assessed by video interface for example where appropriate and the government says any savings realized for more efficient administration will be invested back into care now you've heard the former Deputy Minister of Health Bob Bell describe this as possibly the most the biggest restructuring and the most significant change brought into the Ministry of Health in half a century what makes it so well there are many many parts to this of course we want to make sure that we Center care on patients we want to modernize our technology to have virtual care to allow people to have access to their own medical records we need to take down some of the silos that exist for provider funding for healthcare providers because they each get funding and separate envelopes with separate goals and missions sometimes they contradict each other so there's lots of changes that have to be made internally for this to provide that seamless care experience for patients let's do a real-life example here yes let's say somebody frail elderly is in the hospital has a procedure recovers to the extent that they can in hospital and then presumably is discharged to go home and needs follow-up home care how will the new processes that you're now putting in place deal with that patient journey well what happens now is often by the time that patient is discharged they don't know who is going to provide the home care when they're going to arrive and what care they will be providing from the providers side of things the home care nurse wouldn't know much about the patient's history what their their circumstances are and what care needs to be provided under the new system by the time the person is discharged from hospital in many cases they would already have met the nurse that's going to be coming to their home if they haven't done that they at least know who's coming when and they can be assured that the provider the nurse is going to know about their history and will know what care to provide them with and make sure they have the right equipment and whatever else they need in order to provide that care so it's it's a connected system from one end to the other and from the providers perspective the nurse for example they will be connected back to the hospital again so if complications arise they can speak with the physician the surgeon whoever it happened to be to find out what needs to be done and that care can be provided to that person in their own home so that they don't end up back in hospital again it's really centered around the patient all of the providers are connected to their care everybody has a role to play but it's about the patient experience making sure we have better health outcomes and better patient satisfaction hey I thought though that when the Liberals the previous liberal administration's created the lens the local health integration networks that the whole idea was to have this one central organization integrate all your care from beginning to middle to end yes is that not happening that was not happening at all we heard from many many patients that was the biggest issue that I heard about during my time as patient Ombudsman that people were not happy at transition points from hospital to home care or Hospital to long-term care that's continued since I've been minister so we've been examining the ways that we can fix that to change things and we came up with a plan that we did because it was clear to me that we can't just make incremental change around the edges that's what we've been doing for years and years and years in healthcare and it hasn't produced the results that we need we need this transformational change and that's why we're embarking on it don't take this the wrong way but with all due respect I I have heard many people say that this government is not great at consulting and you know we can make a list of the issues that are out there where the government has made its decisions without in the view of many adequately consulting have you adequately consulted all of the people who are necessary to make this work and ensure that they're on site yes I can tell you that I have consulted over the years because I have been involved I'm not a healthcare practitioner but I was involved as health critics for six years two years as patient Ombudsman and now in my role as Minister and that is that those consultations I have been ongoing for many many years but we did specifically consult with the Ontario Medical Association the interior Hospital Association Home Care Ontario registered nurses of Association and many other organizations about this plan and I'm very encouraged by how receptive they are to this plan and how they want to get started did you consult patients Canada I did yes okay I didn't know that but you having said that I now have to declare in the interest of full disclosure I think my wife's on the board of patients Canada so I should put that on the table right now we have an agency in Ontario now called Cancer Care Ontario and they are supposed to be a pretty good organization because the story goes they're able to laser-like focus on dealing with cancer related issues yes you're now going to take that organization and you're going to fold it into this bigger agency why should we think that that's a better way to deal with cancer if it's part of a much bigger organization as opposed to being on its own where it can focus laser-like on the process well I think there is a little bit of confusion about that and I appreciate the opportunity to clarify because Cancer Care Ontario is going to continue to do their work with the great people that they have there it just means that their board of directors now will be Ontario Health as it will be for the other agencies that are being moved in and for the health provider teams as they're ultimately called constituted locally so Cancer Care Ontario will keep doing their work and any patients with with cancer concerns need not worry at all because we think the Cancer Care Ontario was one of the best in the world for cancer care provision management looking at best practices bringing forward new procedures and so on also for renal indications they're doing great work that can be a model for chronic disease management strategy for other areas that don't have that kind of laser focus diabetes for example could probably use the Cancer Care Ontario model and certainly mental health and addictions doesn't really have much of an infrastructure at all that is something that they could use Cancer Care Ontario is a model and something that we're focusing on as a government as well I don't have to tell you that not everybody agrees with what you just said and perhaps the most notable exception to that and he's actually I mean he's got an op-ed in the Toronto Star today he's had one in the past he's been all over radio and television former Deputy Minister of Health dr. Bob Bell who's been around healthcare a very long time I heard him say the other day he likes the overarching vision that you have brought out but of course he thinks he thinks you're on the wrong track and that implementation will be far more problematic than you're letting on what do you say to that well of course I respect dr. Bell very much but we do have a difference of opinion on this issue I feel very strongly that this plan is what we need to bring forward in Ontario we do have an opportunity and I would say well clearly a responsibility to the people of Ontario to provide them with excellent quality connected care and so we do need to bring forward this transformational change just a few small changes here and there well it might be easy for us to do is not going to bring about the results that we need so we are prepared to take it on we have people working long and hard on this it's not something that we're just bringing forward because we thought that would be nice and wrote it on the back of an envelope not at all we know that this is significant change we know that the implementation is going to be important in many ways the work is just beginning and I'm prepared to put in that work so is our entire team at the ministry to make sure that this is successful for the people of Ontario dr. Bell has also talked about political interference that concerns him and obviously if you're gonna put what is it 19 or 20 agencies all into this new I know you don't like me calling it a super agency because that was in the leaked document but for lack of a better expression there's new big thing called Ontario Health the CEO of that organisation is going to be a really powerful player in healthcare and I and the board of this new organization will have significant responsibilities for vast far-reaching areas of healthcare and I think dr. Bell has made the point that you know are these gonna be staffed with former you know defeated Tory candidates or friends of the premier or that kind of thing or are they gonna be people who've got expertise in the field they will absolutely be experts in the field I can assure you only two that we I'm totally committing to that in fact we have third party assistants with an outside organization bringing candidates forward to us that do have that experience they are being interviewed by members of my staff by the deputy minister and they are being credentialed and we are assuring the people of Ontario that the people who will be sitting on this agency will be people who have the knowledge and the expertise to make sure that this job is done properly you make the board appointments I presume right ultimately I sign off on them but I can tell you I have not been involved personally in the interviews because I think it is really important that this be done with the assistance of the outside provider and that the candidates are chosen based on their merit okay and then the members of the agency once they are finally chosen and the board is complete they will be the ones that will hire the CEO which you will sign off on but not pick is that right that's correct yes got it here's a like a I guess a strange little example but I guess I understand how this is all going to work if you know if you live in a particular city or town in the province of Ontario and you need health care in that city in town of which you live let's say you're traveling or you're on vacation or you're at the cottage so you technically aren't in the place in which you typically live will there be a change to the way you access care going forward well first of all yes you will be able to access your own personal health record so that will apply whether you're traveling in Ontario or in other countries and that is really important because it is your record you should have access to it all of the people of Ontario what my hope is is that that will help people become more responsible for their own care be more proactive about attending tests that they need to resolve to attend take the medication they're supposed to take and so on and they'll be able to see how they're how they're progressing but as well the local health providers will also be able to help connect them to care in other communities if they are reassigned for work for example for a period of time that they will be able to connect the care from the one local health team to the other to make sure that the experience is seamless for the patient okay we should also put on the table here the notion that the opposition have brought forward numerous times during the whole course of the rollout on this and that is they've looked at the documentation that sets up this new organization and in their view it opens the door to increasing privatization and and procurement of private sector companies in the procurement of services in the healthcare system is that true no it is absolutely not true what is going to happen going forward as the local health providers come together and make an application to become a local Ontario Health Team they will be scrutinized so it may be a local hospital perhaps a home care provider and a mental health service provider they come together they decide they will make an application to Ontario Health to become a local Ontario Health Team they will then if they're accepted they will then be given an allocation of funds for the provision of care within their geographic area if that's the way that they're applying and that applies to all of the health providers not just them but all of the health providers but they will be responsible both on a fiscal basis and a quality of care basis and on the basis of ensuring that patients and families and caregivers are still involved in the decision making with respect to what's happening locally in care to proceed so that will be one funding allocation if there is any money left at the end of the year that money will then be pushed directly into healthcare for them for the next year it will not be divided up amongst those agencies that will go towards the provision of care for the entire community for the next year you've heard critics also say that this is essentially at the end of the day a play to have less administration of health care more money towards frontline services and that the expectation is that you know once it's fully implemented hundreds if not thousands of people fewer will be working in this system jobs will be lost you speak to that I have heard that but that is not the point of this transformation the point why we were doing it is to Center care around patients and to make sure that they are supported and their care is connected throughout their lives whatever time whatever they need health care that they should know that their health care system is ready for them so to be one number to call and no gaps we want to make sure that we can actually put more people on the front lines in our health care system and the people that are already there in the local health integration networks for example that provide homecare nurses personal support workers we still need them we want to have more of them out there to provide home care so it's a reorganization really within the structure around patients that we're talking about does anything in that reorganization take anything away from the single-payer nature of our system or allow people to jump the queue or use if they have more financial means use that ability in the healthcare system no there is nothing in the legislation that would allow that to happen people will continue to pay for their health care services using their OHIP card as they always have and no one will be able to jump ahead in line because they have more money than others that's not what our health care system was designed for I believe strongly in our public health care system that's what makes us all proud Ontarians and we want to continue that the premier is big on customer service I know he is and his late brother you know they're legendary for their phone calls to followup on customer service if people have problems with this new system as you are restructuring it who do they complain to they can ultimately complain to me well not everybody call the Minister of Health and get the Minister of Health on the phone well they can certainly make a complaint through the Ministry of Health and they can make it to our office our contact information is on the Ministry of Health website they can certainly let us know what their what their feelings are about the system how they feel we are doing because we need to to know that this is going to be a transformation that is going to take several years because we want it to be seamless for patients so we will not be handing care over to a local Ontario health teams until we can be assured they are ready to take on that mantle and that they are they can assure us that patients care will continue on an uninterrupted basis you you used to be the patient Ombudsman obviously has that role been filled now that you're no longer occupying it there the the executive director is still filling that role but that role will absolutely continue I am committed to the patient Ombudsman's office as well as to the Premier's Advisory Council on healthcare that is a group of people who are patients or former patients who have healthcare experience who provide me with advice and guidance from the patient's perspective and if we're building a patient-centered system we absolutely need that to continue okay in our remaining moments here I want to read you know Greg Sorbara the former Minister of Finance and Ontario he's got a letter of The Globe and Mail today he says years from now a newly elected Ontario government will announce with much fanfare a dramatic new approach to health care it will consist of a regional / local delivery model that is patient focused and eliminates a bloated centralized bureaucracy file under quote the circle of life and take it to the bank that's Greg cerbera in The Globe and Mail today you know I'm not a cynic on this but but I've been around long enough to see that it was the NDP 30 years ago who brought in multi service agencies and then the Conservatives came in under Mike Harris and they became the Community Care Access Centre CC ACS then the Liberals came in and in 2006 they created the Lynn's the local health in local health integration networks and the whole idea ever east of the way was to restructure and reform healthcare to make it work better for the patients and now here you are again reinventing yet again so why should we have confidence that this is the right mix because the status quo is no longer acceptable we're seeing major strains now in our healthcare system we've got 30,000 people waiting for long-term care bed placement we've got a thousand people every day receiving care in hospital hallways and storage rooms we've got thousands of people waiting for mental health and addiction services and if you're a parent of a child who's expressing suicidal thoughts to be told that you have to wait a year for service that's not acceptable I cannot stand for that so that will endure we are going to reduce those wait times we are going to bring forward comprehensive mental health and addiction service and so while many many the government's have planned changes that are going to center around the patient we are redesigning the entire system around the patient and that's what makes it a fundamental change in difference and that's why I am confident that our plan is going to be successful so the days of hallway medicine are over people are not gonna be waiting on cots in the hallway it's going to take a little while but we are going to end it with this plan will help bring that forward because if we have a comprehensive system for chronic disease management and we can help people with mental health and addictions problems stay out of our emergency departments because many of them cycle in and out that reduces the number of people in hospitals if we can people keep people in home care to recover and not come back because they have complications that reduces the number of people in hallways in in hospitals so every step along the way we are working at that and that is how we are going to end hallway healthcare that's Christine Elliot she's the MPP for New Market Aurora also deputy premier also Minister of Health of long-term care and we're grateful for your visiting us at Evo tonight thanks so much great pleasure thank you the agenda with Steve Paikin is brought to you by the chartered professional accountants of Ontario helping businesses stay on the right side of change with strategic thinking insightful decisions and business leadership are you on the right side of change ask an Ontario 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