Duncan: Progress in health care a long time coming

Duncan: Progress in health care a long time coming

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The following is a column by Dwight Duncan, the former Ontario finance minister and current senior strategic adviser at McMillan LLP.

Health care has been a top political concern among Ontarians for more than a generation. Every major western democracy shares a similar experience.

Reflecting on the past quarter century, a tremendous amount of progress has been made in modernizing the delivery of health-care services across a range of disciplines and so-called “silos."

The politics around this have not been easy and governments of all political stripes have gotten a lot of things right and many things wrong. Again, a situation not exclusive to Ontario.

Health Minister Eric Hoskins introduced legislation last week that, among other things, brings Ontario’s Community Care Access Centres (CCACs) under the umbrella of the provinces’ Local Health Integration Networks (LHINs). Hoskins and his officials have taken great care in dealing with a particularly challenging issue.

The Patients First Act is neither revolutionary nor conventional: The bill brings to life changes that address shortcomings in the provision of home-care services in the province, with the ultimate aim of redirecting more dollars to to front-line patient services.

Aggregate estimates place the potential benefit at $50 million each year. This number does not take into account the cost avoidance associated with provision of quality home care. Remember the cost per patient day in home care is approximately $45, versus $450 in an acute-care hospital, and $170 in a long-term care facility.

The legislation was greeted by the usual assortment of preplanned spontaneous reaction and spin. Adjectives ranged from sweeping and visionary through to statements claiming that patients are going to suffer and they (the Liberals) have done nothing but destroy our health-care system.

Yawn. To paraphrase Kipling: triumph and disaster are both impostors.

Hoskin’s legislation is actually the culmination of efforts that go back informally more than a decade, and formally since the report of Dr. David Walker, which was received by the government back in 2011. Since then, just about everyone, from Don Drummond through to various media outlets, have had something to say about the subject.

The Auditor General, never one to miss a photo-opportunity, weighed in at the behest of the public accounts committee with a report that borrowed heavily on the work done by others, notably  Walker, senior public servants within the government, and the government’s own internal auditors. The work spent a good deal of time dealing with CEO compensation and the accounting for direct program expenses.

The Auditor General did, however, remind us that care standards, where they exist, are not uniformly applied across the province. Outcomes and patient satisfaction must be better measured to ensure proper accountability.

Given that approximately $2.5 billion or close to 5 per cent of total health-care spending is directed at a variety of home-care services, accountability has to be enhanced.

The Patients First Act has been well thought out, and is the next step in the evolution of the delivery of health care. Although a difficult transition lies ahead, the integration of the CCACs into the LHINs is another example of how the health system has responded in recent years to demands that it  be more efficient as the population ages, technology improves, and funding is more constrained.

This year, the first baby boomers turn 70 and the youngest among them are in their mid- to late-fifties. We have arrived at the time that, years ago, was predicted to be crushing on provincial budgets as a result of the explosion of health-care costs associated with this demographic tsunami.

Many of the more-dire predictions from those days have not come to pass. While health-care budgets have grown relative to total spending, the rate of growth has been constrained to manageable levels. This has not happened by chance. It is the culmination of work by many governments dating back to the Peterson era.

Still, the years ahead promise to be difficult. There remain serious challenges. Problems ranging from wait times through to compensation for health professionals and future federal health transfers loom large.

Ontarians have reason to be optimistic that the Ministry of Health and Long-Term Care, often a whipping-boy for politicians, can meet these challenges head on. Deputy health minister Bob Bell and his predecessor Saad Rafi deserve credit for organizing the ministry to effectively deliver transformation that is essential for improving health outcomes while meeting challenging fiscal realities.

Eric Hoskins, like his predecessor Deb Matthews, has shown himself to be one of the government’s most competent ministers. Smart and compassionate, he has demonstrated strength and intellectual rigour in dealing with the always challenging health portfolio. His style of leadership will help ensure that we can continue to count on our health system, with all of its flaws, to be there for us when we need it most.

Dwight Duncan
Senior Strategic Advisor, McMillan LLP

Dwight Duncan has been a senior strategic adviser to McMillan LLP, the Toronto-based business law firm, since March 2013. He advises the firm's clients on investing and operating in Canada and abroad. A long-time MPP from Windsor, Duncan became Ontario finance minister in 2005 and held the cabinet post until he left politics in 2013. Duncan was also minister of energy, revenue minister and deputy premier, among other posts in the McGuinty government.

Dwight Duncan

Dwight Duncan is former Minister of Finance for Ontario. He is now a senior strategic advisor at McMillan LLP.

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