Ontario Premier Doug Ford sent a New Year's letter to all members of the Ontario Public Service recently, announcing his three main priorities for the next year. Happily, for those of us who provide front-line health care, fixing Ontario's troubled health care system continues to be one of those priorities. Ford also specifically emphasized "embracing change and innovation, deploying technology more effectively, and committing to new models of collaboration and patient care." But what exactly does that mean?
There's been much written about the rather unique, even disruptive, style of the Ford government to date. However, from a health care perspective, while Ford has moved quickly, he also, to date, seems to have moved pretty fairly — aside from the hiccup around arbitration with the Ontario Medical Association.
First, he appointed Christine Elliott as Minister of Health (MOH). She's clearly one of, if not the most experienced minister in his cabinet. Immediately after, deputy health minister Bob Bell retired and was replaced by Helen Angus. Angus herself is a consummate professional and very highly regarded amongst the health care community. There was clearly a feeling that steady hands were going to be on the tiller when these appointments were announced.
The first thing that Elliott and Angus did was streamline the MOH bureaucracy, reducing the number of assistant deputy ministers from what looks like 21 to 11. What's that you say? Didn't former Liberal health minister Helena Jaczek state that it was a myth that the MOH had a bloated bureaucracy? Come to think of it, didn't the former deputy health minister, the aforementioned Bob Bell, write that this was a myth too? Oops.
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The next step was to hire Dr. Rueben Devlin to be the chair of the Premier's Council on Improving Health Care and Ending Hallway Medicine. I've had the opportunity to meet Dr. Devlin a couple of times. He's smart, down to earth and has a strong background himself in providing front-line patient care. More importantly, he has a proven track record in embracing change, and deploying technology effectively. He created the first fully digital hospital on the continent. He showed me how some things work at his hospital, and I confess, I was drooling over how advanced they were.
Yesterday, it was leaked to the media that the government is looking at dissolving the dreadful Local Health Integration Networks (LHINs). I've written about just incompetent LHINs were in 2016, so I personally am very glad to see them go. The money saved from these wasteful behemoths of bureaucracy can be divested directly into front-line care.
So, what's next? Having read through a bunch of information, I think we can expect the Premier's Council to do the following:
Implement an IT plan of some sort, that has teeth to it.
Ontario's health-care IT infrastructure was left in a complete mess by the previous Liberal government. It is ridiculous that a patient in the Georgian Bay region has their health care team securely emailing each other about their case, but that nobody else in the province can have this. The fact that we still use fax machines(!) leaves us squarely in the dark ages. The IT infrastructure already exists to modernize and streamline things. We just need somebody in charge to say "make it so."
A move to more community-based funding for health care.
My guess is that the Council will take another look at the Price-Baker report, which essentially presented a Canadian version of what's called an Accountable Care Organization. If done properly, and with strong physician leadership, these have been shown to provide higher quality health care, at lower costs. As much as it pains me to admit it, even with LHINs gone, there will still need to be some (limited) bureaucracy to ensure the system functions.
Hopefully, there will be an outreach to front-line health care providers in their communities.
Many of them know how the system is failing and have insight and ideas on how to fix things. Giving them a true voice is important.
Premier Ford has a big challenge ahead of him with health care. Our population is aging. Health care technology is improving at a rapid pace. Cost of care continues to rise. But to these old eyes at least, it seems he has taken some reasonable first steps into getting a handle on the problem. For the sake of all Ontarians, let's hope he succeeds.
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