Cuts to front line care in hospital and community health services and the growth of costly middle management in the regional Local Health Integration Networks (LHINs) and Ministry offices in Toronto are part of the negative legacy of the McGuinty- Wynne years. The Liberals’ sorry mismanagement of health care in Ontario must be stopped.
Front line care lags while middle-management growth surges
Under the current Ontario Liberal government, we have witnessed a stranglehold on front-line care and patient services. Hospital budgets have essentially been frozen for over eight years, cuts to patient services have become the norm, nurses have been laid off across the province, and patients have been denied life-saving care.
During this same time, health care bureaucracy has expanded at an amazing rate spawning new health networks, and even more agencies to measure and monitor while patients wait. These sub-layers of management are now bulging, supposedly ensuring greater efficiency; when, in fact, middle-management and bureaucracy are creating more obstacles to care.
If you manage to get the care you need, then you are well-served. But it is for all the patients and families who are not able to access the care they need when they need it that we should be concerned.
People who make the health care system function, whether on the front lines or in the bureaucracy, are not to blame. It is the current government’s agenda that has resulted in the bloating of bureaucracy under the guise of “system transformation”. This has siphoned tax dollars away from front-line patient care towards their middle management.
An ever-growing bureaucracy now at 13,000
Health Minister Eric Hoskins is reported to have claimed that there are 3,053 health ministry staff but counting employees from agencies and partners of the Ministry of Health and Long-Term Care the tally is over 13,000. While the Wynne government has been growing the bureaucracy, front line workers including nurses are losing their jobs and patients spend days in the ER waiting for a hospital bed.
Instead of considering how to lighten the bureaucratic load on taxpayers, the Wynne government continues to heap on more legislation contributing to the growing layers of management. There is new legislation that will have the Ontario Liberals adding approximately 80 sub-LHINs to the already inefficient 14 LHINs across Ontario. Despite rolling the Community Care Action Centres into these LHINs, there will be additional red tape and regulations to overcome before any care providing can occur.
Even more problematic is that the accountability has become blurred. Which level of bureaucracy does the patient hold accountable when the care is inaccessible or substandard? In Ontario, there is a Patient Ombudsman but we seldom hear from this office.
The most basic care for many of our most vulnerable citizens is lacking while more management is encouraged without accountability to Ontarians. Addressing the rate of increase in bureaucracy would help to provide more patients with the care they need. It is worth noting that one health-sector public administration employee in Canada serves approximately 1,415 Canadians. In Germany, the ratio is one to 15,545—greater than a tenfold difference.
A health system that has lost its focus on the patient
The argument is routinely made that if we could measure, monitor, and manage more, that the health care system would be more efficient yet there is no evidence that the health care system overall is becoming more efficient despite these efforts. Increased costs in one area often result in decreased spending in another area of the system or vice versa. Costs associated with the growing bureaucracy have simply been offset by limiting patient services. This is not the way to move forward in delivering more care to more people.
Our health care system has become so complex and bureaucratic that patients are resorting to paying consultants to help navigate their meetings with agencies, book tests, and co-ordinate medical care. Privately paid patient advocates, also called “care managers”, are a sign of the difficulties patients and their families face as they attempt to access the care they need.
It is ironic that in efforts to create efficiencies, the Ontario government has created a rigid bureaucratic system that is unable to adapt to changing patient need making it more difficult for patients to access care. Waiting is waste.
It’s critical for the government to reprioritize its health care agenda
Ontarians need to hold the Liberal government accountable for the rapid rise in bureaucracy. Unnecessary micromanagement of health care is costing enormous amounts of tax dollars and results in underfunding of patient services including mental health, home care, and long-term care. The priority should be patients, not a bureaucratic-heavy health care system that cannot respond to evolving patient needs.
There is a great deal that must be addressed in Ontario’s health care system. The first will be to re-prioritize the focus on front-line care and to reassess the need for the layers of middle management in the LHINs and at the Toronto ministry offices.
READ MORE: Dr. Merrilee Fullerton on health care in Ontario