Russ Ford's Blog

Transform This



I spent a considerable amount of time this week meeting with CHC colleagues from around the province.  Much of our conversation centered on the so called "transformation agenda".

If you do not know what that is, do not worry you have been living in a cave.  Unless you work in government or  receive government funding, you won't know.  There has been  no transparency or public consultation.

It is however something you should know about as it has the potential to fundamentally change  how you receive government services.  Briefly, the intent is to make government services operate as a "system".  The whole apparently is viewed as less than the sum  of the parts.

That is a broad concept to be sure, but there is a belief that services could not only be provided better but also cheaper if they were reorganized.  Health is one example.  If we could get health care providers working better together, we could achieve better  outcomes at less cost.

While those goals are certainly laudatory, let me suggest that creating a "system" is neither as cost effective or as rational a process  as one may think.
It also goes directly counter to the rationale  to bring in local health planning bodies or LHINs.  Regional planning bodies should be about responding to local needs, system transformation is about central control

Despite the arrival of the LHINs which was supposed to decentralize health policy, the bureaucracy has grown substantially at head office or Queen's Park  since their inception.  Ted Ball a former Assistant Deputy Minister in Health and one of the top minds we have in health planning , recently wrote t that the ministry has grown from five ADMs before we had LHINs, to 13 ADMs, two Associate Deputies and a Deputy Minister today.

What we also learned this week is  to expect  is a sizeable increase in our IT costs because we have moved to a common platform in order to facilitate our participation in this new system.  Have we had any guarantees that this increased level of funding will be covered?  No, and unless it is we will have to cut services.

Services will be cut to people so we can  better count the people that we do serve unless our budget  concerns are addressed  without an increase to our base operating costs.

But the bigger question is whether or not we can actually create a new system.  No matter what you think, we have a system now.  It was not drawn up by a team of MBAs but we do have something that at some  level works. So how do we move from one to the other?

More importantly how to we move without the power to move.  System transformation  has to a large degree been lead, to quote an infamous American president, "by a coalition of the willing."  Providers who see the merit of the transformation agenda and want to make it work.  LAMP is among those providers.

But health is invested with a lot of special interests which make the idea of a common sand box hard if not impossible to implement unless the rules change.  Family physicians are key to the success of this agenda yet there is nothing that compels them to participate.  They can simply take a pass and there is nothing that can be done about it.

The government has tried to create an environment of physician participation by providing financial incentives  but again there is  more cost.

They also do not have the power to regulate you and I. We have the right to seek whatever care we want from wherever we want.  That is a problem for system planners.  In the Toronto Central LHIN more than half of  the users of  health care resources in Toronto are not from Toronto.

The reason for that is obvious.  If we had to build a system  today we would have not  built University Ave.  We would not have located so many services in downtown Toronto . We  would have dispersed them around the GTA.  But we can't move those institutions which  means the "system" will never be as it is depicted on the planning table.

Community based services like LAMP could become community based in name only under this reorganization.  Organizations like LAMP are about  responding to local  issues and allowing local people to have a voice in how we operate.  That is what community based really means  It's not just a geographical description.

You cannot have both a strong centralized system  and one that responds to local needs. It is an inherent conflict.

Perhaps the best example of that lies with the City of Toronto.  On one hand there seems to be a strong move to centralization, the one size fits all approach, yet on the either hand the city has been engaging in consultations about  ensuring we have strong neighbourhoods.  You cannot have both or if you can I have yet to see it work in any part of the world.

LAMP of course supports the notion associated with creating strong neighbourhoods.  We also support the concept that health is more than the absence of disease.

Yet when we look at the direction of health care in this province it is very downstream  thinking.  The focus now is on reducing the amount of time  people spend  in the emergency rooms of hospitals.  Nothing wrong with that direction, but it does not address the root causes of health care consumption which we all know to be poverty.

In short, you can  tinker but you will never address the rising costs of health care and the overall health status of the population unless you address the number one cause- poverty.

So the future of the  health care  transformation agenda is unclear. While its implications are great, few know about this and that is a problem.  It is your tax dollars  and you at least need to understand how  it is being spent.

Health is however not the only Ministry undergoing transformation.  It seems to be at work in just about every ministry.  For example, for about 30 years LAMP has had a lawyer one afternoon a week to provide free summary legal advice to people who cannot afford a lawyer.

That service was recently cancelled by Legal Aid Ontario who told me that it did not fit with their "transformation agenda"

So the residents of the lakeshore are no longer getting access to this service but at least I can say to them, "But you took one for the system."
 
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End notes: I have been  having software issues for the past couple of week s and therefore have not been able to attach "LAMP News and Views."   If you want info on LAMP just go to the web site at www.lampchc.org
There will be no blog ext week.  I am going on vacation

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