9/11/12

PCs swear they'll get restructuring right this time

The new Progressive Conservative policy paper, Paths to Prosperity: Patient-Centred Healthcare, isn't just another far right rant like we've heard from Tim Hudak in recent weeks. It does make a few reasonable points:

· The Local Health Integration Networks (LHINs) lack expertise and provide little value
· The health care ‘system’ isn’t so much a system as a loosely connected bunch of sectors.
· We need better integration of health care services
· More leadership expertise resides at the hospitals than the LHINs
· LHIN leaders are beholden to the cabinet
· The LHINs cover too big an area and there is little local control 

But there are other, bigger problems with the PC paper.

Health care restructuring is the central theme of the paper: As is often the case with prospective governments, they see the solution in extensive high level restructuring of health care.

The paper proposes the elimination of LHINs and Community Care Access Centres (CCACs) and the creation of 30-40 health care ‘hubs’ based in hospitals. The hospital hubs would have full responsibility for disbursing the local area’s funding , and would have the ability to move money from one sort of provider to another.

This is bound to create uncertainty and insecurity in the health care workforce - perhaps a positive for the PCs, but hardly a plus for health care.  If the last round of PC health care restructuring during the Mike Harris era is any indication, the restructuring will also soak up up millions of hours of health care time and billions in health care dollars.

The PCs nevertheless persist in claiming that, this time, they are going to save money.

But the main "money-saving" suggestion they make -- to turn the work of the LHINs and the CCACs over to the hospital "hubs" and thereby save hundreds of millions of dollars -- is laughable. Unless they intend to simply ask hospital staff to fund and restructure health care on their lunch breaks, oversee home care case management on their weekends, and work on placing patients in LTC facilities in their evenings, they are simply going to have to increase resources at the hospital hubs to do the work formerly done by CCACs and LHINs.

Or leave gapping holes in health care.

One of the gapping holes would be case management of home care --  perhaps the service done by the LHINS and CCACs with the least obvious need.  But without it the for-profit providers that the PCs and the Liberals have imposed on home care would be free to do pretty much whatever they like with the money given to them, as there would be no public oversight.  The  giant corporations that back the PCs may like the sounds of this, but it would be a ridiculous way to run home care and spend public money.  (Case management, however, could be reduced or redirected if work was publicly delivered rather than contracted out, but there is no hint of that in the PC paper -- of course.)

Even the PC math doesn't pass the sniff test.  The PCs want to cut 2,000 jobs and save $800 million. Somehow they are going to save $400,000 for every job they cut:  i.e. about five times more than the wage and benefit bill they claim they will cut.  That's a neat trick. 

Ironically, despite having so much faith in another round of restructuring, the PCs propose abolishing one of the main types of organizations created during the restructuring of the Mike Harris PC government – the CCACs.

The proposals also open up an obvious political flaw for the PCs: while 30 or 40 hospitals would become ‘hubs’ with control over funding, the other 120 hospitals would not be hubs and would have to go cap in hand to the hub for every penny of funding. Smaller communities with smaller hospitals (where the PCs have their main base of support) would be especially likely to see their services deemed expendable. 

Putting smaller, rural  hospitals on the second tier is not going to go down well with older, rural voters.  Yet, they are the core PC voters.  So the political calculus for the PCs is dodgy.

Health care restructuring during the Harris era meant shutting down or merging hospitals in many communities. It was much hated in local communities and it's  fair to say small communities were especially hard hit by those reforms. The small hospitals that did manage to survive restructuring were often incorporated into larger multi-site hospital corporations -- and they have been losing services ever since as hospital corporations respond to funding cuts by centralizing services in the largest communities.  

Likewise, the non-hospital health care providers are probably going to be very concerned that the hospitals will hold the purse strings. The PCs make a few nice sounding noises on this, but I doubt that is going to be enough to comfort those providers. The bosses at those organizations will not be pleased at the implicit suggestion that they have less leadership expertise than the hospitals.

I’d also like to see the battle in Toronto among the big hospitals about who will get ‘hub’ status. That would be quite entertaining (although perhaps not so good for health care).

 All in all, the plan is going to be hard for the PCs to implement, if they are ever elected.

The PCs also want quicker implementation of the fee-for-service funding (i.e. what they call "patient-centred funding") for hospital services. The Liberals are already rushing this out the door  - but the PCs say they want it to happen even more quickly. As with the Liberal proposal, this increases the possibility of contracting out and privatizing hospital work. Indeed, the PCs are a bit more frank about this than the Liberals, as you might expect. 

Despite the suggestion of more local control, fee-for-service funding will greatly reduce local control over hospital services. Toronto will decide how many surgeries get done in every town.

The PCs suggest a second paper on health will come out later.  Perhaps the PC health critic, Christine Elliott, who didn't even get to put her name on this paper, will have some role in unveiling that paper.

Today, as the PCs pounded away at the CCACs, the Liberal health minister is reported to have told the Joint Provincial Nursing Committee that she will make the moratorium on CCAC-led competitive bidding for home care permanent.   The rumours that the Liberals will wind up the CCACs also continue. 

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