I’m not a fan of hyperbole. So, take me at my word when I say that we are going through unprecedented health care transformation in Ontario. What is this transformation all about? What’s the view through the lens of child health? And what should you be paying attention to?
Why is the government transforming health care?
I remember when my kids were little and their fever always spiked in the late evening when the doctor’s office was closed, so we’d trundle off to the emergency room. There are other times you have a quick question about your health, but instead of being able to send an email or have a five-minute call, it can take weeks for an appointment. If you are the parent of a child with a chronic condition or serious medical disorder, you likely have binders of records you cart around to hospitals and specialists because you don’t have confidence that anyone but you can pull it all together and keep track.
That’s what we mean when we say Ontario’s system is highly fragmented. Parts of the system don’t connect easily for people and families. Seamless digital access to health records is uncommon. Often people wait too long for services that they need or get “stuck” in hospitals because other parts of the system (e.g. long-term care) aren’t available when they need them.
And while Ontario has some of the lowest number of hospital beds per person (while sustaining some of the best health care outcomes, amazingly talented clinicians, groundbreaking research and best educational institutions globally), health care is still costing us all a lot—and because we pay for most of it through our taxes, we care about keeping costs at a minimum.
We all want pretty reasonable things: improved patient experience, improved overall health, and keeping costs at a minimum. Health care as an industry has also woken up to the fact that better patient care experiences, enhanced wellness, and less burnout for physicians, nurses, personal support workers, therapists and other health care providers has an inevitable positive impact on patient care.
So, in short, better health, better experience of giving and receiving care and the provincial budget are all key drivers of the reforms.
What is the government doing?
The first element is the invitation to create Ontario Health Teams. This would include all the service providers and partners required for optimal health of the people within a particular geography. The mix would include primary care (physicians, nurse practitioners), home nursing and other home supports, hospitals, school health, children’s treatment centres, transportation, emergency responders and public health.
The other element of the transformation is something called Ontario Health. It brings under one “roof” (a single board of directors) a number of health funding, coordinating, standards and quality setting organizations (e.g. local health integration networks, Cancer Care Ontario, Health Quality Ontario and others).
How is the government doing this?
The short answer is: fast! Many have described the process of self-assessment for Ontario Health Teams as a “low rules environment”. The government indicated that it might approve three to five health teams in the first round, within only a few months, and received well in excess of 150 applications.
What is the view from “the kids table” on this health transformation?
Kids aren’t little adults. The way we care for children needs to be designed around their wellness needs. They experience a variety of unique health conditions and their health exists within the ecosystem of their family, school and community. Families are also the most unpaid caregiving workforce in children’s health care.
Most children don’t receive their health care in specialty children’s hospitals. Their care happens at the family doctor, at the local community hospital, in school, through public health. For 85% of children who are mostly well, their health services experience will be routine and infrequent.
Moreover, the investment in children’s health will reap a long-term return on population health. For example, treating chronic conditions early can prevent a greater need down the road. An even better example is prevention—keeping children from getting sick in the first place.
Finally, because of the enormous progress of medical research and medical care, very ill children, premature babies, children with disabilities, medical complexity and rare disorders, are moving into adulthood with ensuing health and social service needs. Planning and making sure our “new” health system works for those children today, as youth, and into adulthood is something that must happen. But plans for children can be eclipsed because the demographics and chronic conditions of aging, surgical interventions like knee and hip replacements, or the insufficient numbers of long-term care beds are taking up most of the air time. Seniors vote and kids don’t.
What should you be paying attention to?
Across Ontario, family doctors are still often solo practitioners, leaving them and their patients vulnerable and frustrated. Highly integrated and high-functioning health systems include well-organized and integrated primary care. Pay attention to how and whether Ontario Health Teams are including and engaging primary care providers.
Another thing you may want to do is “follow the money”. You should care about the cost of the health system because, as taxpayers, you pay for it. You should care about how appropriately funded it is because you use it for yourself and your family. We know that the government will want to drive cost out of the health system, but if our system gets cheaper before it gets better (organized, integrated and more streamlined) then you should be worried.
And finally, keep in mind that sign you see when you drive in your neighbourhood:
“Slow down! Watch for children”
“Slow down! Watch for children” means that if the system we are creating doesn’t work well for the kids, it probably isn’t going to work for any of us in the long run.
Slow down. Watch for children. The future of health care is depending on you.
Based on remarks given at the 2019 Annual General Meeting of the Medico-Legal Society of Toronto.