Thursday, September 22, 2011

Ontario Health Care is a Mess. What Will the Parties Do? Tinker.

Health care is in a mess, though perhaps getting better while at the same time getting worse.

LHINs – or Local Health Integration Networks – are the Liberals’ health care delivery model, bureaucratic style. LHINs have led to some dreadful medicine. Only a bureaucrat with little personal health care experience and no imagination would think putting labour and delivery in one building and the crash unit if something goes wrong and the mother starts to die in another building. Yup, when a life is on the line in a hospital-type setting, the best thing is to waste time crossing roads. Figures that George Smitherman dreamt up these LHINs. At least he’s gone and is not rerunning for the Liberals in Ontario.

He also oversaw the eHealth scandal, you know, that government program that was supposed to computerize medical records and instead spent dollars on perks and incompetence. Since Smitherman left, the Liberal government has claimed that they are making eHealth work, that they have cleaned it up and are putting it into action. So this is how the action works on the ground from my experience: my GP jots down notes on his tablet computer and also gets my test results directly from the lab onto it. But there’s only one lab that apparently will send the results or will work with whichever system he’s using. Ergo, I have no choice in which lab I can go to for my blood tests. My specialists take down notes the old-fashioned way: pen and paper. I recently met one specialist who did type them on his laptop. Progress! None talk to each other. None share information with each other except through me. That means I have learnt to demand copies of my test results and to ask them to write my GP (which should be de facto) so that I can take the results to my GP, who is supposed to co-ordinate my care. Fat chance. But a couple of the specialists I’ve seen won’t even photocopy the test results for me because they seem to think I have no right to see or will misuse my own information. Give me a break. I don’t know when the Ontario government intends to put medical information on secure cards, but given the state of the doctors’ offices in university-affiliated hospitals, it doesn’t matter anyway. These guys wouldn’t know what to do with them…except my GP. My GP is unusual though.

Premier Dalton McGuinty boasts in his Liberal party’s TV ads about reducing surgery wait times. Well, that is true -- and is not. It all depends on the surgery. Sexy surgery like knees get done quicker these days. Icky surgery like bowel reductions, ostomies, and the like are now so far into the future, the patient might as well stab themselves and be done with it. Basically, it looks like the government robbed the people with devastating bowel diseases to pay for surgery for people with bad knees. Not that bad knees aren’t hell, but you’re not likely to die of them. The government funds all surgeries so poorly that many surgeons don’t get enough OR time to keep their skills as sharp as we’d want them to be. This situation has been around for at least two decades, although apparently it’s worse now. I remember how strange it was to talk a doctor in the 1990s about how she got only one operating day a month. It made me wonder how she could keep in practice. Today she’s allotted less time.

CCACsCommunity Care Access Centres – deliver home health care, that is, they assess and then provide the kind of therapists, nurses, and home medical support that patients living in the community need. I was told that because I was injured in a car crash I could not receive help from CCACs, and it was only after all the insurance games were over that I became acquainted with them back in 2009. I learnt that where you live determines the kind of community care you receive, that people with brain injuries receive two assessments unlike everyone else who receives one, that people with cancer get case managers whereas people with brain injuries do not, that though you may qualify for help from a social worker you will receive maximum three visits only no matter how complicated your problem is, the same is true for other therapists, that people after knee surgeries are allowed to receive actual hands-on physiotherapy but those of us with brain injuries and chronic physical problems are not, that those with brain injuries can only receive exercise advice from a physiotherapist (no physio!), and that unless you’re deranged and about to kill yourself with knife in hand, you pretty much won’t receive psychiatric help no matter how otherwise desperate you are. And all this is pretty recent because the Liberal government drastically cut the budget for CCACs, I was told when it was explained to me why I couldn’t receive the help I was assessed as needing.

These are just a few of the problems with our health care.

The question is what will the parties do about them?

The Ontario Liberals’ website records that in February they still thought LHINs a good thing:

“LHIN’s: What the Experts are Saying

February 18, 2011

With Tim Hudak roaming the province criticizing Local Health Integration Networks (LHINs), let’s take a look at what the people who work with them every day have to say:

•   "With the support of the South East LHIN, Kingston General Hospital has reduced the number of patients waiting for alternate levels of care (long-term care, rehabilitation or complex continuing care). This means more patients are receiving the right care, in the right place at the right time and KGH can focus on complex-acute and specialty care." -Karen Smith, Lead Public Affairs Specialist, Kingston General Hospital

•   “Regional collaboration and planning is absolutely crucial if we want a true continuum of care – where health providers all work as partners to fully meet each patient’s needs efficiently and without delay. The Central LHIN has provided a venue where different healthcare organizations – acute care hospitals, rehabilitation hospitals, community care agencies and other providers – can come together to look at our community’s overall needs….This type of collaboration would have been impossible without the Central LHIN’s focus on facilitating discussions amongst the diverse providers of care, and enabling decision making that focuses on the specific realities of our local area, as well as the needs of patients at all stages of recovery.” -Malcolm Moffat, President and Chief Executive Officer, St. John’s Rehab Hospital

•   “…local involvement is reflected in local decision making which is something that was not experienced prior to the inception of the LHIN.” -Janet MacLeod, Clinical Manager Diabetes Care and Research Program, Hamilton Health Sciences Corporation

•   “The creation of the LHIN has brought about two major changes for us.  First, it is now much easier to talk and meet with someone to discuss any issue and find local solutions. Before, it was very difficult not only to talk with someone in Toronto, but to even know who was in charge of a specific file. Second, the existence of the LHIN has created a momentum for more cooperation and integration of services. Several initiatives are underway and others will be launched in the near future. I hope government resists the temptation to start playing with structures again, as this may set us back several years.” -Michel Bilodeau, President and CEO, CHEO

•   “The Toronto Central LHIN represents a movement of health care management from "directive" to "collaborative". As a frontline stakeholder, I have confidence the interest in our input is real, and that the "consultants" that drive change are the ones affected by it - us.” -Dr. Laurie Mazurik, MD, FRCPC, Emergency Medicine, Sunnybrook Health Sciences Centre”

The Liberals will obviously stay the course on surgeries, and as long as the media doesn’t pick up on how seriously ill people are dying because they need the “wrong” kind of surgery, nothing will change.

The Liberals will help seniors with more home health care and will train more nurses and health care professionals (whoever they are), but the disabled who need social workers or physio, well, we’re out of luck.

(If you have a large screen, you gotta check out the fancy link Read the Ontario Liberal Plan.)

The Ontario Progressive Conservatives under Tim Hudak will “introduce a series of patient- centred reforms that make the patient – not bureaucracies, not administrators – the focus of our health care system.” That sounds super. Uh, what does that mean exactly?

They will close LHINs and, I think, redirect the funds to the Ministry of Health, hospitals, and CCACs.

They talk about ER wait time guarantees, making the CEOs accountable if their hospitals miss their targets, but I saw nothing on surgery wait times.

As for home health care, they will “give home care users more dignity, more flexibility and more say in determining where they acquire these important services. They will be able to choose to stay with the provider they have now, or pick a new government funded home care provider who better meets their individual needs.” Being able to choose is wonderful, but choice is not my issue. The people who were sent to me have been very good and the one bean-head I got was quickly hauled back and replaced with someone with a brain and compassion. No, the problem we patients have is actually getting the service. I gather from this that the PCs don’t intend to restore funding, and the redirected funds from LHINs may be totally inadequate as they will also go to hospitals – those buck suckers of the health care system.

The Ontario NDP led by Andrea Horwath will scrap the LHINs and will “replace them with effective local decision-making,” whatever the latter part means.

They will cut ER, home care, and long term care wait times. Nothing on surgery wait times though.

As for home care:

“We will help those who need healthcare services at home by funding an additional one million hours of home care, over four years, and eliminating the waiting list for home care.

However, we won’t just throw money at the problem. Under the existing privatized home care model, as much as thirty percent of home care dollars are spent administering private contracts instead of providing care. That money needs to be invested in the women and men who do the work providing support to people in need, not on private health deals.”

As a recipient of the care of these women and (one man) who do the work, I object. These workers may be under contract with private health care companies but they go above and beyond what anyone can expect. No one at a hospital or outpatient institution goes out of their way like some of these workers have for me. And I know how much the bureaucrats are on their ass because my brain injury is supposed to be all better now, fully cured, back to normal in only a year and a bit. I also know that when you compare the financial expenditures of public care – hospitals – versus private – doctor-owned clinics – for the exact same procedure, hospitals spend scads more. The NDP will increase the budget by going all public, meaning fewer home care hours for us, the patients.

They plan to “conduct a comprehensive review of home care policy with a goal of creating a new publicly owned and accountable home care system that reduces management and administration costs by 20 percent.” Reducing admin costs will help.

They will provide home support to seniors but not to the disabled in order to prevent hospital visits.

I do like their promise to cap CEO salaries to twice that of the Premiers. Very much, I like.

So, in short, the politicians don’t really get it. Except for scrapping the LHINs, they’re going to tinker.

2 comments:

Anonymous said...

I wonder if you've ever spoken to anyone in rural Ontario about their opinion of the LHINs? I would much rather have my local healthcare needs decided by people who live and work in my area. Previously it was made by healthcare bureaucrats who live in downtown Toronto. I may not like Smitherman or McGuinty, but it is pretty tranparently partisan and ignorant to just regurgitate the Conservative sound bites without thinking for yourself. The LHINs are the best thing that has happened to Northern Ontario - too bad that facts don't matter to people like you, just political spin.

talk talk talk / Shireen said...

Anon: You feel better making wrong assumptions about me? Makes you feel your argument is stronger and is unbreakable because you wrote -- under the cover of anonymity -- not so nice things about me, using epithets like "ignorant"?

Anyone who has read my stuff knows I have a lot of inside knowledge of the medical system. I have no idea what Hudak's reasons are for not liking LHINs. But then I believe the NDP don't either. It's an easy ideological method to say if I don't like the LHINs, ergo I must be a Hudak acolyte. Of course, the corollary is that since you do, you must be a McGuinty acolyte and just as unthinking.

And like Hudak, your nastiness has overshadowed your arguments, which I would've cared about if you'd argued intelligently but don't because of the language you chose to use.