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An Ont a r i o PC Ca uc us Whi t e Pa pe r
Se pt e mbe r 2012
The Ontario PC Caucus is focused on action to create jobs and grow the economy, but Ontario
also needs to make difficult, fundamental reforms to improve the performance of our public sec-
tor. Nowhere is that more apparent than in health care, where we are still failing to meet patients
needs despite a substantial increase in spending that has gone on for almost a decade. A better
system that puts patients, not bureaucrats, at the centre of decision-making is part of our plan
for a more prosperous Ontario.
Ask people in Ontario whats wrong with health care and they will tell you that too often they have
to fight like hell to get anything done. Its difficult to get a doctor, emergency room wait times are
too long, they cant get a long-term care bed for their elderly parent or there just isnt enough
home care available.
Ask experts on health care policy, and they point to a reason why we see those kinds of results.
What we call a health care system in Ontario really isnt a system at all. Its a complicated series
of loosely connected sectors with bureaucracies running other bureaucracies, and no one can
really get a handle on how to make it all work together in a coordinated way for the benefit of
patients. We spend lots of money, but we dont always spend it in the right ways.
Ask people in government about these same problems, and they will talk optimistically about
restraining the growth in health care spending while making the system even better. Great goal,
but there is no plan. Worse, there is no willingness to make the tough decisions that such a plan
would require.
Instead, the government tells us that the solution is to fine tune its Local Health Integration Net-
works, an expensive layer of bureaucracy that has had six years to integrate health care and has
precious little to show for it. The LHINs are part of a system built to fail, a system that lacks fo-
cus, priorities and clear lines of accountability. Patients suffer long waits for service while millions
of dollars are wasted on bureaucracy.
The combination of tweaks and wishful thinking the government proposes is like using 2x4s to
shore up a crumbling foundation. It might work in the short term, but it wont fix the underly-
ing problem. We believe that the foundation has to be rebuilt before we will have a system that
works better for patients. That means making some tough decisions that will change the balance
of power in Ontario health care, tilting it away from government and bureaucracies and towards
patients and the front-line professionals who understand patients needs best.
We suggest a new and completely different approach. Instead of complex layers of bureaucratic
and political supervision of health care, we propose to let our existing local health care admin-
istrators and front-line health workers lead the system. Local health care professionals know
whats best for patients.
We need to remember that the goal of the health system is providing health care, not creating
well-paid managerial jobs. We need a system that is centred on patients, a system that treats
them like human beings, not like OHIP numbers or an inconvenient drain on the budget.
Leader of the Official Opposition
Our plan will embed a Triple Aim approach as defined by the Institute for Healthcare Improve-
ment that will enhance patient quality and satisfaction, improve the health of the population and
reduce the per capita cost of health care.
The change we propose is long overdue. The last time Ontario made fundamental changes to
health care structure was in the late 1990s, when I was parliamentary assistant to the minister of
health. Since then, weve made the system more complex when it cries out for more simplicity.
In this paper, we describe how that new structure will work. There is more to come from us on
health care, which we will present in a forthcoming Paths to Prosperity white paper. But we be-
lieve the important first step is to rebuild the systems foundation.
Last year, Ontario spent $47.3 billion on health care, a gure that has been rising around six per cent a year
under the current government. Thats just not sustainable. The current government knows that, but it has no
credible plan to x the problem. Instead, it simply imagines that it can x the problem by tinkering with its Lo-
cal Health Integration Networks. Thats like imagining that a gas guzzler will magically become a Prius sim-
ply by wishful thinking.
Numerous studies show that European countries that spend the same percentage of GDP as we do on
health care produce better service for patients. We need to get more value for the billions of dollars we
spend. The way to do that is to improve the efciency of the sector through integration. That will produce a
better result for patients and taxpayers.
We know Ontario patients deserve better. That is why the Ontario PC Caucus has put a bold new idea on
the table with our third Paths to Prosperity white paper. Were proposing rebuilding the foundation of our
health system not just tinkering around the edges. We believe this approach will improve patient care and
provide more value for each dollar invested.
Health providers strongly support creating a clear strategy for improvement. They want and need to know
what is expected of them and how the systems pieces should t together to function more cohesively and
Ontario has some of the best health administrators and professionals in the world, but we dont make the
most of their talents because we require them to work in a system that is laden with bureaucracy and lacks
a coherent plan for success. Ontario spends too much money on health bureaucrats, money that should go
to patient care. Worse, our multiple health bureaucracies stand in the way of both innovation and real ac-
The solution lies in leadership and clarity of thinking from the provincial government and, most importantly,
timely and integrated services in our communities. We believe our proposed approach meets those objectives.
From my experience in the health care sector and as deputy health critic for the Ontario PC Caucus, I would
like to thank the health care experts who contributed months of work to this innovative new approach. We
also want to know what you think about our Paths to Prosperity: Patient-Centred Health Care discussion
paper. Please send me your feedback by contacting my ofce through email at bill.walker@pc.ola.org or
by phone at 416-325-6242 (Queens Park).
Ontario PC Deputy Critic for Health (Rural and Northern)
Bill Walker
A System Built to Fail
A New Foundation that Puts Patients First
Better Care for Patients
Patient-Centred Funding for Hospitals and Hubs
A New Role for the Ministry of Health and Long-Term Care
- 6 -
The health care system in Ontario
today is complex, inefficient and
difficult for patients to navigate. The
ideal system would operate more
like a smart phone, still complex, but
simple to use because the designers
have gotten the engineering right.
Any consumer knows that a badly
structured system of any sort
creates frustration, delays and poor
results. In health care, that means
higher costs, long waits for service
and health outcomes that are not as
good as they should be.
Patients are paying a price for a
poorly-built system, and so are
taxpayers. An OECD study estimates
that if Canadian health care was
as efficient as the best-performing
European systems, Canadians could
save as much as 2.5 per cent of
our GDP in health care costs. In
Ontario, this amounts to $13.4
billion according to economist
Don Drummonds recent report
on reforming the provinces public
services. Thats money that should
be going to patient care.
The governments own agency,
Health Quality Ontario, says people
are waiting too long for treatment in
emergency departments, for long-
term care and even to see their own
doctor. Despite spending over $2
billion, just over half of Ontarians
have electronic medical records that
cant link up with other providers.
To determine how to re-engineer
Ontarios health care system, its
necessary to look at the parts and
determine what is working and what
is not.
The first thing a reasonable person
would observe is that there is layer
upon layer of management in the
health care system. There are the
Local Health Integration Networks
(LHINs), the Community Care Access
Centres (CCACs), hospitals, as well
as the Ministry of Health.
Despite all these chiefs, it often
seems like no one is in charge. A lot
of people are working hard to make
this cumbersome system work, but
the real solution is to rebuild it with
fewer players, fewer layers, clearer
roles and real accountability. Thats
going to mean big change. Change
that will result in improved patient
care. Change that will result in
improved patient care and greater
financial accountability.
The Ontario PC Caucus has long
advocated the elimination of
the LHINs. Don Drummond also
concluded that the LHINs, as
presently constituted, werent up to
the job of integration that Ontario
health care so desperately needs.
We propose the elimination of two
layers of middle management the
LHINs and the CCACs. The case for
shutting them down and using this
money for patient care is strong.
Back in 2006, the provincial
government created the LHINs with
the idea that they could transform
the way our health care system is
managed. Unfortunately, the LHINs
werent equipped to do the job. They
have limited control over spending,
not much ability to influence the
way the sector works and are run by
boards of provincial appointees, not
the people who run health care on a
day-to-day basis.
Increasing Share of Program
Dollars Going Toward Health Care
Source: Ontario Ministry of Health
2012 2003 1993



We do not
directly provide
Source: LHIN Website, August 2012

That last point is a key one. LHIN

boards are stocked with people
who are beholden to the provincial
government. They dont do anything
that the province doesnt tell them to
do. They are assisted by managers

- 7 -
care, long-term care and home care
have either remained the same or
worsened under the LHINs.
Despite spending $1 billion on an
Aging at Home program, a Toronto
Star investigation found the strategy
failed seniors by not providing the
care they needed to remain in their
The LHINs have failed miserably at
their most basic task, integrating
our system. Drummond noted that
despite the title, the LHINs do not
integrate key parts of the health
Premiers Ofce
The Layers of Ontarios
Health System
Minister of Health
Ministry of Health
Health Quality Ontario
eHealth Ontario, Cancer
Care Ontario, etc.
Regulatory Colleges
Community Providers
Despite the
title, the LHINs
do not integrate
key parts of the
Source: Drummond Report,
February 2012, Pg. 172

The LHINs are not really local, they

havent integrated health care and
Network in their title remains only
a concept. Put simply, LHINs just
dont work.
The situation with the Community
Care Access Centres has received
less attention, but isnt much more
Nearly one in ten patients is readmitted
to Ontario hospitals through
emergency departments within
seven days of being discharged,
according to the Canadian Institute
who often lack the experience or
skills to qualify for the sophisticated
leadership jobs in hospitals, where
they could have a real effect on
patient care.
The LHINs are condemned by their
own results, or lack of them.
The LHINs havent improved health
system performance. For instance,
the average LHIN failed to achieve
77 per cent of the governments
health care targets in 2010-11,
according to the LHINs own annual
reports. Province-wide, wait times
for services such as emergency
- 8 -
for Health Information. This is due in
part to a lack of quality community
care. Hospital readmissions cost
our system millions each year, use
much needed hospital beds and
are bad for patients. The CCACs
have failed in their role in preventing
The CCACs core job is managing
patients access to care in the home
care and long-term care sectors.
The goal is to make home care and
long-term care less confusing for
those who need help. Its a useful
goal, but the CCACs are doing a
poor job.
No one sees the big picture, which
is that helping people stay in their
homes is the best care for them, and
the cheapest for the system. When it
comes to long-term care, managing
the waiting line has become more
important than those the system is
there to serve. People are forced
into long-term care homes before
they need them because they fear
losing their spot in line.
The CCACs are failing at great cost.
They devote 30 per cent of their
budget, more than $500 million a
year, to administration and case
management, according to the
Auditor General. They simply arent
getting results.
A PC government established
the CCACs in 1996, and they
were an improvement on the old
system, which was fractured and
mostly municipally-run. They also
introduced some competition into the
sector, which the Liberals weakened
when they froze competitive bidding
in 2008. Unfortunately, over time,
the CCACs became top-heavy,
siphoning away valuable front-line
We agree with the Drummond
Commissions position that CCAC
functions should be absorbed by a
A failure of leadership at the highest levels within
the WWCCAC resulted in a degree of
organizational dysfunction.
Source: Corpus Sanchez, Ensuring Effectiveness & Accountability at the
Waterloo Wellington CCAC, June 2012

regional health authority.

Both the CCACs and the LHINs are
administrative bodies that dont
produce value for money in a health
care system that struggles to afford
real patients needs. Theyve got to
The Ontario PC Caucus believes its
time for a fundamental restructuring
of health care in Ontario, to create a
system that puts patients first and
stops wasting health dollars.
We dont think that a platform of
excellence can be established from
a foundation of weakness.
The reality is that LHINs dont
feature the capacity, leadership or
track record of performance that
other health care organizations in
Ontario do. Building off the LHIN
platform, as Drummond proposed
in his report, would institutionalize
weakness. We think it makes more
sense to rely on our strengths by
doing more with our existing high-
performing health organizations.
Thats why we are proposing specific
hospital boards, directly linked with
organized primary care physicians,
serve as a platform to take over
the job of coordinating the regional
integration of health care.
There are 10,000 seniors waiting
for home care and 20,000 seniors
waiting for a long-term care bed, a
problem the CCACs, the LHINs and
the health ministry have not been
able to tackle.
This reduces the CCACs to rationing
home care, delivering it only to
those who are absolutely desperate.
CCACs end up in the news because
they do things like telling a disabled
Ottawa senior they cant afford
to give him a weekly bath depsite
promises to do so, or telling a
105-year-old Toronto woman that
she will have to wait two years to get
long-term care.
- 9 -
In streamlining the health care
system, we asked, how do patients
really use health care?
For example, consider the situation
of a typical older person with chronic
illness. She might require home
care through the CCAC, primary
care from her physician or help at
the hospital. In reality, there is a
close connection among all these
needs, but they are met by separate
systems, with the LHINs as the weak
glue that tries to hold them together.
Its up to patients to understand how
all this works and try to connect the
pieces. We dont think thats the
right approach.
We also observed that the provinces
14 LHINs cover large territories that
dont always reflect how and where
people live and seek care. We believe
some of the geographic zones the
LHINs represent are simply too large
to be considered local. Similarly,
the Ministry of Health is too far
removed from patients and whats
happening day-to-day to really
understand local needs.
Our solution is to have 30 to 40
existing hospital corporations,
based on regional health care
characteristics, serve as a platform
to take over the functions of the
LHINs and CCACs. The health
experts we consulted thought this
was the appropriate number of
hubs to service a province with
Ontarios patient needs. Unlike
the LHINs, which were prescribed
at Queens Park, specific hub
proposals would be developed by
communities themselves to address
local characteristics. These health
hubs build off the best parts of our
existing infrastructure. We believe
the care needs of Ontarians will be
better served by this decentralized
and delayered system with
smaller, regional hubs that follow
natural referral patterns, that are
more connected to patients, that
are well regarded by the community
and that are run by health leaders
with a track record of success.
The health hub is a simple concept.
Hubs take over the LHINs job of
local health care planning, funding
and performance. They also take
on the CCACs job of connecting
people with government funded
home and community care and
long-term care. Most importantly,
they will be required to integrate
acute care with primary care, home
and community care and long-term
care into a seamless partnership.
Health hubs will provide the
administrative expertise that this new
system requires. They have strong
performance and accountability
mechanisms already in place.
Ontario has the most efficient
hospitals in Canada, according to
the Canadian Institute for Health
Information. They have a long history
of success and are a visible centre
of care in the community. Patient-
centred funding will make them even
In our proposed model, the people
who actually manage and deliver
your health care today would run the
system without costly and extraneous
bureaucratic organizations that
impede innovation. Decisions will be
able to be made in a timely manner
and without bureaucratic processes,
ensuring patient care is always the
Local health care shouldnt be run by
people appointed by the provincial
Hospital Corporation
Informal Coordination
Formal Integration
Health Hub Model
Home and
Community Care
Primary Care
Family Doctors, Nurses
Public Health,
Mental Health, EMS
Eliminate two layers of middle management the 14 LHINs and the 14 CCACs and
use this money for home care and other frontline patient care instead.
Build off of the existing high performing health infrastructure in 30 to 40 Ontario
hospitals to create health hubs. Hubs will organize, plan and commission services
for the patients in their respective regions.
Require the health hubs to integrate into a seamless partnership, acute care with
primary care, home and community care and long-term care.
Require each hub to establish a permanent, physician-led Primary Care Committee
to integrate primary care physicians into local health care planning and to scrutinize
their ongoing performance.
Investigate options of coordinating municipally-run public health units and
emergency medical services with the hubs.
- 10 -
cabinet, as is the case with the
LHINs. The health hubs will have
local, volunteer board members
chosen based on their unique skillset.
These people will bring professional
expertise and knowledge of their
own communities, making them
well positioned to manage the new
For physicians, it will mean a stronger,
more hands-on role in planning primary
care, as well as new accountability for
producing results. This will be driven
through physician-led Primary Care
Committees. These permanent hub
xtures will have formal authority for
integrating primary care physicians
into local health care planning and
scrutinizing their ongoing performance
in quality of care, patient experience
and other metrics.
Because our patient-centred care
approach will call on communities
to develop a proposal to establish
health hubs, rural and Northern health
needs will be given a renewed focus
as communities will design their health
hubs to serve their unique populations.
This means, for example, that a health
hub in Central Ontario will look different
and service different population needs
than would a health hub in downtown
Toronto. The design of these hubs is
nimble enough to adapt to geography
and circumstance. Rural and Northern
health needs must be prioritized in the
design of hubs, and we will look to
leading best practices in all jurisdictions.
We want to be clear that this does not
amount to letting hospitals make all the
decisions. This will be a partnership
among equals. It is also about putting
the patient rst and making better use
of existing sites, not closing them down.
Today in Ontario, public health and
ambulance and paramedic services
remain under the control of municipalities
and outside the main health care
system. The hubs will ensure that local
health systems are coordinating with
these municipal services.
- 11 -
What does this mean for patients?
Lets go back to the smart phone
analogy. We know that most people
dont care about the mechanics of
the health care system. Like smart
phone users, their main concern is
getting the service they need, when
they need it.
That requires a system that can
respond quickly and appropriately to
your requirements. Our health hub
plan makes that easier by having
primary care, home care, long-
term care and acute hospital care
all operating on the same platform.
Putting all those services under one
administration and making proper
use of electronic health records
will make it easier for all the health
professionals that serve you to
work together to make timely and
appropriate decisions about your
We see big gains from the integration
of primary and acute care with the
other two large parts of the health
care system, home and long-term
care. This will lead to more rational
decisions about how money is
spent, what volume of services are
available and more timely care.
Heres a concrete example. Today,
one in six Ontario hospital beds
are filled by people who dont really
need the level of care hospitals
provide. They are stuck in hospitals
when they dont need to be.
Were told the system cant afford
the cheaper home or long-term care,
so people get the most expensive
care in the system instead. This
is because of the lack of planning
and coordination. This one problem
alone costs Ontario $400 million
a year according to the Ontario
Hospital Association.
This is one of the problems the new
system is designed to fix. It puts all
the local health care money in one
pot, under the control of one board.
If home care is cheaper and better
for you as a patient, the board will
provide that care. Under the new
system, it is in the hubs interest to
do so.
With far fewer patients who really
need an alternate level of care stuck
in the hospital, more beds will be
available for those who really need
them. This will lessen emergency
room backups and make more beds
available for surgeries, too.
Accelerate the implementation of patient-centred funding at Ontarios hospitals and
- 12 -
As part of our plan to put patients
first, we propose changing the way
hospitals and hubs are funded.
Ontario is moving far too slowly in
adopting patient-centered funding
a model that most developed
countries have been using for years.
There are two principles to patient-
centred funding. The first is making
sure health care dollars follow a
patient as they travel through the
health system. The second is making
sure that health funding reflects a
communitys health based needs.
Patient-centred funding doesnt
mean less money for hospitals and
hubs it simply means theyll get
the right amount of money. Heres
just one example.
Historically, Ontario hospitals have
received a lump sum of money for the
entire year. This had the unfortunate
consequence of turning patients into
a drain on hospital budgets. Under
this model, every time a patient
walked into a hospital for care,
the hospital had less money. The
province also uses the same funding
model for the CCACs.
Were proposing to reverse this.
Under the new system, hospitals
will get money for every service they
perform. This simple policy change
turns patients into valued customers,
not drains on hospital budgets. They
will be treated like human beings
and will get better customer service.
It creates the potential for healthy
competition between hospitals and
independent health facilities, such
as the Kensington Eye Institute. It
also reduces variations in rates now
being paid.
Hubs will be funded on a patient-
centred basis as well. Nearly all of the
money they get from the province will
be based on a communitys health
needs. Hubs will have total control
and responsibility for this funding.
For example, a hub might choose to
locate a nurse practitioner-led clinic
adjacent to a hospital emergency
room, so that people with less urgent
problems can be seen quickly. A
region with higher than average
rates of diabetes will be able to tailor
their services to local needs and be
compensated accordingly.

Reduce the size of the Ministry of Health. Make it responsible for provincial health
system planning, funding and quality control. Eliminate its role as micromanager of
the system. Make the Minister ultimately accountable for Ministry performance.
- 13 -
The health ministry will play an
important role in Ontarios revamped
health system, but that role will
be fact-based planning, not
bureaucratic micromanagement of
the system.
As it exists today, the ministry is an
organization that takes a long time
to produce very little. The ministrys
recent action plan on health care
took nine years to write, but it is only
14 pages long and doesnt address
vital issues such as how much home
care or chronic disease care we
will need in the future. That kind of
performance is unacceptable.
Under our health hub plan, a smaller,
streamlined ministry will shift to a
position of strategic advisor with
responsibility for provincial health
system priorities, regulation, funding
and performance measurement
through Health Quality Ontario. This
is significant work, but we dont
need hundreds of health bureaucrats
to do it.
The main challenge for the ministry
will be capacity planning, determining
the provinces future health needs.
The last such plan in Ontario was
created in 1998. Without a detailed
assessment of our needs and how to
meet them, the health care system is
on a journey without a map. This
broad guidance is the kind of role
that is appropriate for government.
The ministry will set the policy
structure for the hubs but they
will allow these regional health
organizations the freedom to design
programming to meet patient
needs. The ministry will ensure
accountability for quality either
directly or through Health Quality
Ontario, and financially through
With a $15 billion deficit, Ontario
cant afford to keep throwing money
at health care. We need to be smart-
er about how we spend what weve
got and to always put patients
needs first. Thats the context in
which we offer our ideas for restruc-
turing health care.
This paper doesnt attempt to ad-
dress all the challenges of the health
system, but we believe it will fix a
significant problem that is prevent-
ing the kind of health care improve-
ments that Ontario patients deserve
and need. This is not the only new
idea we will propose. We will ad-
dress other apsects of health care
improvement in a future Paths to
Prosperity discussion paper.
We believe that the introduction of
health hubs will lead to a nimbler
health care system that has clear
roles and accountability for all the
players. This will mean quicker deci-
sions and more money spent on pa-
tients. The multi-layered bureaucra-
cy that attempts to guide our health
care now will be slimmed down and
brought closer to patients. This
opens the door to innovation and
tailoring our health care to the needs
of our communities.
The new system will make the most
of the talents of the people who
actually deliver health care. Local
health care managers will be able to
make timely decisions without hav-
ing to get them approved by a LHIN
or the Ministry of Health.
The provincial government will re-
main ultimately accountable for
- 14 -
health care, but it will stop micro-
managing the delivery of it. Instead,
it will focus on policy and measuring
It is not our goal to deliver more
health care in hospitals. Thats cost-
ly and not medically necessary. The
new health hubs will have strong
budget incentives to deliver care in
the community thats appropriate
and cost effective.
In our proposal to restructure health
Please let us know what you think by
contacting us at:
519-371-2421 (Constituency)
416-325-6242 (Queens Park)
RM 410 Main Legislative Building
Queens Park, Toronto, ON
M7A 1A8
care, we rely on our core principles.
First, build on whats already work-
ing. Then, examine the plan to make
sure it has the absolute minimum
amount of bureaucracy. Finally, test
the plan to make sure it delivers
value for money. We are confident
that this proposal meets those three
Health care is the governments
most costly service and the one
most vital to the welfare of all On-
tarians. The problems that patients
have in accessing health care today
are not due to lack of money in the
system or shortfalls in our medical
professionals. The problems stem
from the way weve organized health
care. The so-called system is diffi-
cult to understand and the pieces
dont interact well enough. For pa-
tients sake, we simply have to do
better. With the bold new focus we
suggest, we will succeed.
Eliminate two layers of middle management the 14 LHINs and the 14 CCACs and
use this money for home care and frontline patient care instead.
Build off of the existing high performing health infrastructure in 30 to 40 Ontario
hospitals to create health hubs. Hubs will organize, plan and commission services
for the patients in their respective regions.
Require the health hubs to integrate into a seamless partnership, acute care with
primary care, home and community care and long-term care.
Require each hub to establish a permanent, physician-led Primary Care Committee
to integrate primary care physicians into local health care planning and to scrutinize
their ongoing performance.
Investigate options of coordinating municipally-run public health units and
emergency medical services with the hubs.
Accelerate the implementation of patient-centred funding at Ontarios hospitals and
Reduce the size of the Ministry of Health. Make it responsible for provincial health
system planning, funding and quality control. Eliminate its role as micromanager of
the system. Make the Minister ultimately accountable for Ministry performance.
- 15 -