Ontario’s ambitious Patients First legislation met with hope and skepticism - Healthy Debate
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Ontario’s ambitious Patients First legislation met with hope and skepticism

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  • Susan Rocco says:

    As a PSW worker and contracted community caregiver for 33 years, I have never witnessed a team effort on any of these organizations , stating or practising a “Let’s all get together and make this work ” attitude. What I predict here, is the Psw ‘s will be handed the short end if the stick. overpaid management and useless technology need to go. Caregiving is a. Opassionate , patience and hands-on me skill. Bureaucracy onky serves to spoils the dish!!!!!

  • Franklin Warsh says:

    Patients First should have been renamed “No Bureaucrat Left Behind”. How much is going to be spent developing, implementing, and staffing these beefed-up LHINs and sub-LHINs before a single patient is seen, all in the name of “integration”? There is next-to-no evidence that the government engaged in serious thought or consultation about the feasibility or need for the Patients First initiative. Dr. Price himself labeled his report a “discussion paper”, and it’s being foisted on the entire health care system as a fait accompli, rather than the half-baked monstrosity it’s likely to turn into.

    How can you possibly force the various players to integrate when the LHINs have no authority over hospital Boards, nor medication purchasing, nor physician remuneration? And having public health dollars flow through the LHINs? When the Ministry already has to approve health unit budgets, and has accountability agreements in place with each health unit? It’s a pointless solution in search of a problem.

    Dr. Bell himself declared that the first people the LHINs will look to for help in managing home care are the people that turned the CCACs into a shambles. That’s smart governance?

    There appears to be limitless faith in administrators, with no direct experience in patient care, to be able to successfully reinvent a health care system without the levers to do so. Conversely, the doctors? The government’s free to trash them in the press.

    Instead of spending hundreds of millions to coordinate an underfunded system, why not just fund the system? Build the LTC capacity, build the hospices, expand home care…there are 1000s of things the government could do that would be more effective and easier to implement than Patients First.

  • Adrianna Tetley says:

    As I wrote in a recent blog post (https://www.aohc.org/blog/Join-our-online-call), to achieve meaningful health system transformation we need to shift the conversation. It can’t just be about doctors and hospitals. We need to focus on people and communities. We also need to focus on health promotion so Ontario does a much better job preventing avoidable visits to doctors’ offices and hospitals. Our ultimate goal must be to keep people well. To this end, the re-introduced Patients First Act needs to ensure the LHIN mandate is expanded to include an object that addresses health promotion. There must be no ambiguity on this point. As AOHC and OPHA stated in a joint letter to Minister Hoskins (https://www.aohc.org/sites/default/files/documents/Letter-Minister-Health-Promotion-LHINs-Sept-27-2016.pdf): while health promotion forms an important part of Public Health’s mandate, it must also be conducted in primary care settings. If you have any doubt just check out this story from the North Simcoe Muskoka Health Link (http://www.chigamik.ca/news-media/articles/report-shows-proof-that-addressing-social-isolation-and-poverty-can-improve-outcomes-and-reduce-health-system-costs/) that shows how health promotion activities in primary care organizations, like Chigamik CHC, are significantly reducing emergency department and hospital visits. This adds to the growing body of evidence that Ontario needs to embrace a much broader vision of health and re-orient health services as was envisioned in the Ottawa Charter of Health Promotion thirty years ago.

  • Angie Heydon says:

    André Picard wrote an excellent article on “How stewardship might heal our health care woes”. To me, this is where the Patients First Act is trying to take Ontario. It’s requires a focus on the health of populations, and mechanisms to enable patients and their health care providers connect to the care that will best help them, in a way that makes optimal use of the resources the public makes possible through their taxes.

    Picard refers to writings by Dr. Carl Nohr, outgoing president of the Alberta Medical Association, stating, “effective stewardship has two dimensions: fiscal efficiency and quality care, and the two are intimately linked. Stewardship is not about stripping power and responsibility away from physicians, it is about expecting them to exercise their powers and responsibilities differently (and be compensated appropriately for it).

    Agreeing with Dr. Cargill – yes, the province must repair its tattered relationship with its physicians. In the meantime however, we must also must move forward to put in place the mechanisms for more effective planning, coordination and integration of care for people and communities. This is why the Patients First Act must proceed.

    (Picard’s article is at http://www.theglobeandmail.com/opinion/how-stewardship-might-heal-our-health-care-woes/article32063889/ )

  • Darren Cargill says:

    “There’s not a lot of happy people who are ready to say, ‘Let’s all get together and make this work”

    Sadly, this is true. The antagonistic and vitriolic health care environment created by this government is likely to see this effort fail, or fall well short of its intended goals.

    Rather than engaging physicians, the government has taken the tact to dictate terms and demand compliance. This simply leads to more stand offs and even more demands.

    It is within the government’s power to see the spirit of this Bill succeed by withdrawing it and beginning the process of rebuilding a tattered relationship between itself and Ontario’s doctors.

    • Tracey Smith says:

      The Patient’s First Act is yet another expensive attempt at primary care transformation.

      We have been undergoing Primary Care transformation in Ontario for over 15 years. Iteration after iteration and we are no farther ahead. In fact, we are farther behind because taxpayers money continues to be wasted on these “transformational experiments”.

      How much money has Bob Bell wasted on The Patient’s First Act so far? And it hasn’t even been introduced at Queen’s Park yet. He is going around holding catered conference after catered conference at the LHIN level “selling” this Bill all on our dime. And what do we get for it? More bureaucracy and the same patient outcomes.

      Where is the accountability of Government? Let’s do a cost-benefit analysis on the Ministry of Health including Eric Hoskins and Bob Bell.

      • Angie Heydon says:

        We now have data that shows in Ontario what Barbara Starfield’s research demonstrated internationally – higher primary care quality is associated with lower total health system cost. Over the past 11 years, investments in interprofessional models of primary care delivery are associated with improvement in quality of care and outcomes. It appears Ontario’s efforts in primary care have begun to bear fruit. For some examples of evidence please go to :
        http://www.afhto.ca/wp-content/uploads/Handout-Quality-Cost-for-D2D-4.pdf
        http://cmajopen.ca/content/4/2/E271.full
        http://www.cmaj.ca/content/early/2015/09/21/cmaj.150579

        The next step is to introduce mechanisms that put a stronger focus on the health of populations, and therefore foster greater stewardship and coordination of care – please see my comments below on this topic.

      • Gary says:

        All the articles in the world won’t help you see just how much work the LHINs do. The sheer amount of data they deal with and how it has been used to improve so many facets of the health care system is remarkable. Could they be better? Most definitely. The reality of our health care system is that we have governments who are looking at a lack of dollars – patients who are looking at a lack of care – doctors that aren’t used to being told what to do – – and many little off-shoots trying to mesh them all. It is IMPOSSIBLE to please everyone and it will be that way forever.

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Wendy Glauser

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Wendy is a freelance health and science journalist and a former staff reporter with Healthy Debate

Mike Tierney

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Mike is the Vice President of Clinical Programs at Ottawa Hospital.

Debra Bournes

Contributor

Dr. Debra Bournes is the Chief Nursing Executive and Vice-President of Clinical Programs at The Ottawa Hospital.

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