Transcript: Debating Ontario's Health-Care Overhaul | Mar 25, 2019

Steve sits in the studio. He's slim, clean-shaven, in his fifties, with short curly brown hair. He's wearing a gray suit, blue shirt, and spotted blue tie.

A caption on screen reads "Debating Ontario's Health care overhaul. @spaikin, @theagenda."

Steve says THE ONTARIO GOVERNMENT
RECENTLY UNVEILED SOME MAJOR
CHANGES TO THE WAY HEALTH CARE
WILL BE DELIVERED IN THIS
PROVINCE.
STAKEHOLDER GROUPS HAVE
RESPONDED PRETTY MUCH AS
EXPECTED.
BUT WHAT HASN'T BEEN EXPECTED IS
A PUBLIC DISAGREEMENT BY TWO
PEOPLE WHOM TRADITION HOLDS TEND
TO KEEP THEIR ADVICE PRIVATE.
NOT THIS TIME.
BOTH DR. BOB BELL AND
MICHAEL DECTER ARE FORMER DEPUTY
MINISTERS OF HEALTH FOR THE
PROVINCE OF ONTARIO, AND THEY
SEE THE NEW RESTRUCTURING VERY
DIFFERENTLY.
SO WE THOUGHT WE'D INVITE THEM
HERE TO FIND OUT WHY.
AND HERE ARE:
FORMER ORTHOPAEDIC SURGEON,
DR. BOB BELL...

Bob is in his late fifties, clean-shaven, with side-parted blond hair. He's wearing glasses, a gray suit, blue shirt, and navy tie.

Steve continues AND MICHAEL DECTER, WHO IS CURRENTLY A MEMBER OF THE
PREMIER'S COUNCIL ON IMPROVING
HEALTHCARE AND ENDING HALLWAY MEDICINE.

Michael is in his sixties, clean-shaven, with short white hair. He's wearing a black pinstripe suit, blue shirt, and checked burgundy tie.

Steve continues DEPUTIES, GOOD TO HAVE YOU HERE, OR FORMER DEPUTIES, I GUESS I SHOULD SAY.
OFF THE TOP HERE GIVE ME 45
SECONDS OR SO TO OUTLINE WHAT
THE NEW CHANGES ARE INTENDED TO
DO AND TO BE, AND THEN WE'LL
PICK UP ON SOME OF YOUR COMMENTS
AFTER THAT.
SHELDON, IF YOU WOULD?
THE GRAPHICS.
HERE WE GO.

A slate appears on screen, with the title "Ontario Health."

Steve reads data from the slate and says
THE GOVERNMENT HAS JUST UNVEILED
A NEW PROVINCIAL ORGANIZATION
CALLED ONTARIO HEALTH, THAT'S
GOING TO CONSOLIDATE 20 HEALTH
CARE AGENCIES THAT CURRENTLY
EXIST ALL UNDER ONE ROOF, THAT'S
LIKE CANCER CARE ONTARIO AND
E-HEALTH, ETC. ALL UNDER ONE
ROOF.
AND HOSPITALS, DOCTORS, HOME
CARE ORGANIZATIONS AND SO ON
WILL FUNCTION, AS THE GOVERNMENT
SAYS, AS ONE SEAMLESS
CARE-GIVING TEAM.
THE GOVERNMENT EXPECTS TO HAVE
30 TO 50 OF THESE HEALTH TEAMS
RESPONSIBLE FOR 300,000 PATIENTS
IN PLACE OVER THE NEXT THREE
YEARS.
THE ONTARIO HEALTH TEAMS ARE
ALSO EXPECTED TO USE DIGITAL
TECHNOLOGY SO PATIENTS CAN HAVE
ACCESS TO THEIR RECORDS, AND THE
SYSTEM WILL BE ABLE TO FOLLOW
THE PATIENT JOURNEY, AGAIN THIS
WORD, SEAMLESSLY.
PATIENTS MIGHT ALSO, IN FUTURE,
BE ABLE TO BOOK THEIR
APPOINTMENTS ONLINE.
AND THERE IS A NEW COMMITMENT TO
VIRTUAL CARE.
SO YOU MAY NOT HAVE TO
PHYSICALLY VISIT YOUR DOCTOR TO
RECEIVE CARE.
YOU MIGHT BE ASSESSED, FOR
EXAMPLE, BY A VIDEO INTERFACE,
WHERE APPROPRIATE.
AND THE GOVERNMENT INSISTS THAT
ANY SAVINGS REALIZED FROM THIS
MORE EFFICIENT ADMINISTRATION OF
THE HEALTH CARE SYSTEM WILL BE
INVESTED BACK INTO THE SYSTEM.
LET'S START WITH THIS.
CAN I GET EACH OF YOU TO GIVE ME
YOUR SORT OF OVERARCHING, FOR
LACK OF A BETTER EXPRESSION,
ELEVATOR PITCH SUMMATION OF WHAT
YOU THINK THIS DOES, POSITIVELY
OR NEGATIVELY?
DR. BELL, START US OFF.

The caption changes to "Bob Bell. Former Deputy Minister of Health."

Bob says THANKS, STEVE.
WELL, THIS IS GOING TO HAPPEN.
SO NO POINT IN SAYING IT'S THE
WRONG THING TO DO.
AND LET'S FACE IT.
OUR HEALTH SYSTEM IS FLEXIBLE,
THE PROVIDERS IN OUR HEALTH
SYSTEM ARE THE WORLD'S BEST.
IT WILL SUCCEED, NO MATTER WHAT
THE ORGANIZATION.
HOWEVER, I THINK THE OPPORTUNITY
TO MOVE ONTARIO HEALTH FORWARD
VERY MUCH DEPENDS ON THE
IMPLEMENTATION OF THIS PLAN.

Steve says DEVIL'S IN THE DETAILS.

The caption changes to "Bob Bell, @drbobbell."
Then, it changes again to "A plan to restructure."

Bob says DEVIL'S IN THE DETAILS, AND I
THINK THERE ARE CERTAIN PROBLEMS
THAT ARE STARTING RIGHT FROM THE
BEGINNING.
A LEVEL OF PERHAPS DEVIOUSNESS
AROUND HOW THIS IS GOING TO
BEGIN.
THE COUNCIL THAT MICHAEL SITS ON
PROVIDES GREAT SERVICE TO...
PRODUCED ITS FIRST REPORT AND
THEY'RE GOING TO PRODUCE A
SECOND REPORT WITH OPTIONS FOR
CONSULTATION.
WE THEN DISCOVERED AT THE SAME
TIME AS THIS REPORT WAS BEING
WRITTEN, LEGISLATION WAS BEING
PREPARED THAT HAD THE FULLY
BAKED PLAN.
AND IF IMPLEMENTATION IS GOING
TO BE SUCCESSFUL, THERE HAS TO
BE A SENSE OF TRUST.
THERE'S ALSO A SENSE THAT THIS
IS SOMEWHAT VINDICTIVE.
WE JUST LEARNED LAST WEEK THAT
OUR LHIN BOARDS WERE TERMINATED.
THEIR ORDERS IN COUNCIL WERE
FINISHED.
THEY WERE TOLD BY e-mail THAT
THEIR SERVICE WAS FINISHED.

Steve says THOSE ARE THE LOCAL
HEALTH INTEGRATION UNITS.

Bob says THE LOCAL HEALTH INTEGRATION
BOARDS THAT HAD WORKED HARD OVER
THE LAST FEW YEARS TO BRING A
LOCAL CONTEXT TO THE ONTARIO
HEALTH CARE SYSTEM.
THEY WERE READY TO BRIEF THE NEW
ONTARIO HEALTH BOARD.
THEY KNEW THEY WERE GOING TO BE
FINISHING THEIR SERVICE.
THEY WANTED TO HAVE CONTACT TO
TALK ABOUT WHAT THE PROBLEMS
WERE IN THUNDER BAY AND WATERLOO
WELLINGTON.
THEY WERE DISMISSED.
IT FELT VINDICTIVE.

Steve says THAT'S A GOOD START.
I'M NOT USED TO HEARING DEPUTY
MINISTERS SAY DEVIOUS ABOUT
HEALTH CARE PLANS.
WHAT SAY YOU?

The caption changes to "Michael Decter. Former Deputy Minister of Health. @mdecter64."

Michael says NEITHER AM I.
AND I FRANKLY FIND THAT THE
RHETORIC IS INAPPROPRIATE.
YOU KNOW, WE BOTH SERVED AS
PUBLIC SERVANTS.
I SERVED A LONG TIME AGO.
I'VE WORKED FOR I THINK EVERY
GOVERNMENT SINCE I SERVED AS
DEPUTY MINISTER OF HEALTH.
AND THAT'S NOT VOCABULARY I
WOULD CHOOSE.
YOU KNOW, I HAVE A BIT OF A
PROBLEM BECAUSE, YOU KNOW, I
CAN'T TELL WHETHER DR. BELL IS,
YOU KNOW, A FORMER PUBLIC
SERVANT OR WHETHER HE'S TAKEN ON
AN ADVOCACY ROLE OR A POLITICAL
ROLE.
BUT LET ME LEAVE THAT ASIDE AND
COME BACK TO THE BASIC QUESTION
HERE, WHICH IS: IS IT A GOOD
IDEA TO HAVE THIS AGENCY?
AND HERE I SHOULD SAY, I CAN'T
SPEAK AS A MEMBER OF THE
PREMIER'S COUNCIL.
ONLY DR. DEVLIN SPEAKS ON BEHALF
OF THE COUNCIL.
WE DID ONE REPORT, WHICH POINTED
OUT SOME VERY SIGNIFICANT
PROBLEMS IN THE SYSTEM.
THEY'RE PROBLEMS THAT HAVE BEEN
THERE.
THEY'RE NOT UNKNOWN TO ANYBODY.
HALLWAY MEDICINE HAS BEEN A
RECURRING ISSUE.
IT'S REAL.
1200 PEOPLE PROBABLY LAST NIGHT
SPENT THEIR NIGHT ON A GURNEY IN
AN EMERGENCY ROOM OR A HALLWAY
IN ONTARIO.
HANDOFFS HAVE BEEN TROUBLED IN
THE SYSTEM BETWEEN HOSPITAL AND
HOME, BETWEEN HOME AND HOSPITAL,
SO PEOPLE GET STUCK.
THEY DON'T GET THE CARE THEY
NEED.
BUT I WANT TO SAY THAT THE
ONTARIO HEALTH, ONE OF THE MOST
ENCOURAGING THINGS I'VE HEARD IS
THAT THE FIRST AGENCY THAT'S
GOING TO BE INTEGRATED IS GOING
TO BE CANCER CARE ONTARIO,
BECAUSE I THINK CANCER CARE
ONTARIO ACTUALLY HAS THE DNA
THAT COULD MAKE THIS THING
REALLY SUCCEED.
AND I GIVE DR. BELL CREDIT, YOU
KNOW, IT WAS ON HIS WATCH THAT
CANCER CARE ONTARIO EXPANDED
BEYOND CANCER.
SO IT'S BEEN VERY EFFECTIVE WITH
CANCER.
BUT IT TOOK ON RENAL AND, YOU
KNOW, WE GET VERY GOOD MARKS
NATIONALLY ON CANCER CARE BEING
ORGANIZED.
WE GET TERRIBLE MARKS ON
DIABETES, FOR EXAMPLE.
LIKE, WE RANK PROBABLY ONE OR
TWO ON CANCER WITH B.C.
WE'RE BOTH PRETTY GOOD.
BUT WHEN YOU GET TO DIABETES,
WE'RE WAY DOWN THE LIST.
SO THE LEARNING FROM CANCER CARE
ONTARIO, IF THAT BECOMES THE DNA
OF ONTARIO HEALTH, THE HOPE IS
THAT THIS WILL MAKE THE WHOLE
SYSTEM BETTER, RATHER THAN
MAKING CANCER CARE WORSE, WHICH
IS A LEGITIMATE FEAR TO HAVE.

Steve says LET'S PLUCK APART
NOW... WE'RE GOING TO DIVE
DEEPER ON THESE THINGS YOU
BROUGHT UP.
I SHOULD GIVE YOU AN
OPPORTUNITY, FIRST OF ALL, TO
HAVE YOU COMMENT ON HIS
SUGGESTION THAT YOU'VE MOVED
FROM ADVISOR TO ADVOCATE TO
QUASI POLITICIAN HERE.
I MEAN, THE WORD HE USED WAS
"POLITICAL" IN THE COMMENTS
YOU'RE MAKING THESE DAYS.

The caption changes to "Connect with us: Twitter: @theagenda; Facebook, agendaconnect@tvo.org, Instagram."

Bob says YOU KNOW,
MICHAEL IS ABSOLUTELY WRONG.
I AM NOT POLITICAL.
I AM SIMPLY A HEALTH CARE GUY.
I SPENT FOUR YEARS AS THE DEPUTY
MINISTER, BUT I SPENT 44 YEARS
WORKING IN THE ONTARIO HEALTH
SYSTEM.
I CARE ABOUT THIS TRANSFORMATION
DEEPLY.
THIS IS THE BIGGEST CHANGE TO
HEALTH CARE THAT'S OCCURRED IN
THE LAST 50 YEARS.
IF IT'S GOING TO WORK, IT HAS TO
BE DONE RIGHT.
THE IMPLEMENTATION HAS TO BE
APPROPRIATE.
THERE HAS TO BE TRUST.
WHAT WE'RE HEARING IS WHAT'S
GOING TO HAPPEN.
WHY I SAY "DEVIOUS" IS BECAUSE I
DON'T THINK THAT'S WHAT'S
HAPPENED TO THIS POINT.
THERE'S AN OPPORTUNITY TO
CORRECT THAT, TO MAKE IT MORE
OPEN AND TRANSPARENT, AND I'M
ENCOURAGING THE GOVERNMENT
THROUGH MY CONVERSATION TO
ACTUALLY DO THAT.

Steve says HOW COULD IT BE MORE
TRANSPARENT THAN IT IS RIGHT NOW?

Bob says WELL, FOR EXAMPLE, MICHAEL'S
TALKED ABOUT CANCER CARE ONTARIO
TAKING A LEADERSHIP ROLE.
I THINK THAT'S CRUCIAL.
I THINK WE NEED TO HAVE A STRONG
CANCER CARE LEADER THAT ACTUALLY
HAS AN ELEMENT OF ONTARIO HEALTH
THAT'S INDEPENDENTLY LED,
FOCUSED ON CANCER, FOCUSED ON
RENAL, THAT WE DON'T SEE A
DECAPITATION OF CANCER CARE
ONTARIO.
WE'VE HEARD THE PREMIER SAY THAT
A NUMBER OF LEADERS OF THE LOCAL
HEALTH INTEGRATION NETWORKS AND
THE OTHER AGENCIES INVOLVED IN
THIS INTEGRATION ARE GOING TO BE
FIRED.
THAT'S NOT THE WAY TO START
LEADERSHIP OF CANCER CARE
ONTARIO, BRINGING ONTARIO HEALTH
ALONG THROUGH AN IMPLEMENTATION
THAT MAKES USE OF CANCER CARE
ONTARIO'S EXPERIENCE.

Steve says DOES HE HAVE A POINT HERE?

Michael says WELL, I
MEAN, THERE ARE 20 CROWN
CORPORATIONS THAT ARE BEING
MERGED INTO THIS AGENCY.
THEY'RE NOT GOING TO NEED 20
VICE PRESIDENTS OF FINANCE.
THEY'RE NOT GOING TO NEED 20
HEADS OF I.T.
YOU KNOW, I THINK THE PREMIER'S
SUGGESTION THAT PEOPLE WOULDN'T
LOSE THEIR JOBS WAS NOT,
FRANKLY, EXTENDED TO THE
EXECUTIVE LEVEL.
IT NEVER HAS BEEN.
YOU KNOW, PEOPLE SERVE IN
HIGH-PAYING BIG JOBS, YOU KNOW,
WITH THE RISK THAT IF THINGS GET
REORGANIZED, WHETHER HOSPITALS
GET MERGED, JOBS DISAPPEAR.
BUT THE WHOLE PUSH, AND IT
BEGINS BEFORE THIS GOVERNMENT
AND IT BEGINS IN COMMUNITIES,
HAS BEEN TO GET MORE MONEY FOR
THE FRONT LINE, TO GET MORE
MONEY FOR THE ACTUAL DELIVERY OF
CARE.

Steve says AND THAT'S WHAT THIS
IS ABOUT.

Michael says THIS IS ONE OF THE PUSHES.
AND, LOOK, IT TOOK A LONG TIME
FOR ALL THESE ORGANIZATIONS TO
GET SET UP.
I THINK EVERY ONE, WHEN IT WAS
SET UP, HAD A PURPOSE.
BUT I DON'T THINK ANYONE WOULD
HAVE SAID, LET'S CREATE ALL OF
THESE THINGS SEPARATELY WITH
THEIR OWN INFRASTRUCTURE, WITH
THEIR OWN MANAGEMENT TEAM.
I MEAN, IT'S A LOT OF EXECUTIVES.

Steve says LET ME FOLLOW UP ON
THAT BECAUSE... BECAUSE ONE OF
THE CRITICISMS I'VE HEARD IS
THAT IF YOU HAVE A CANCER CARE
ONTARIO... LET'S SAY YOU'RE
WATCHING THIS RIGHT NOW AND
YOU'RE DEALING WITH CANCER.
UNDER CANCER CARE ONTARIO AS A
STANDALONE ORGANIZATION, THE
ARGUMENT GOES, IT WAS ABLE TO
FOCUS MORE LASER-LIKE ON
WHATEVER ISSUES YOU WERE DEALING
WITH, WHEREAS AS ONE
ORGANIZATION OUT OF 20 IN A
BIGGER SUPER AGENCY, IT MAY HAVE
MORE DIFFICULTY DOING THAT.
THAT'S THE SUGGESTION.

Michael says WELL, LET ME PUSH BACK VERY
HARD ON THAT BECAUSE CANCER CARE
ONTARIO, WHICH DIVESTED ITS
ACTUAL DELIVERY OF CARE AND
BECAME A STANDARDS AND A
LEADERSHIP ORGANIZATION IN TERMS
OF THE QUALITY OF CARE AND
INNOVATION, ALL OF THAT WAS
REALLY IMPORTANT.
BUT YOU CAN'T HAVE A HIGH
QUALITY CANCER SYSTEM INSIDE OF
A NOT-HIGH-QUALITY HEALTH CARE
SYSTEM.
AND THE DILEMMA IS, PEOPLE DON'T
GET UP IN THE MORNING AND
SAY, "I'VE GOT CANCER.
LET ME GO TO THE CANCER CENTRE."
THE ONLY WAY THEY GET THERE IS
THROUGH THE REST OF THE SYSTEM.
AND IF YOU'VE GOT VERY SLOW
REFERRALS, IF YOU'VE GOT LONG
WAIT TIMES FOR DIAGNOSIS, IF
YOU'VE GOT PEOPLE PARKED IN
EMERGENCY ROOMS FOR HOURS AND
HOURS WHO GET DISCOURAGED AND GO
AWAY, THEN YOU'RE NOT GETTING TO
THE CANCER SYSTEM...

Steve says HE SEEMS TO BE
SAYING YOUR HEALTH CARE SYSTEM
IS NOT AS GOOD AS YOU THINK IT IS.

Bob says WELL,
CERTAINLY IT IS NOT MY HEALTH
CARE SYSTEM...

Steve says YOU WERE RESPONSIBLE
FOR IT FOR A WHILE.

The caption changes to "Watch us anytime: tvo.org, Twitter: @theagenda, Facebook Live."

Bob says I WAS.
HOWEVER, YOU DON'T IMPROVE THE
HEALTH CARE SYSTEM BY REDUCING
THE LEADERSHIP AND THE FOCUS ON
CANCER CARE WITHIN THOSE PARTS
OF THE SYSTEM THAT ARE DEALING
WITH CANCER.
YOU WANT TO TAKE THE ELEMENTS OF
THE CANCER SYSTEM, I THINK
YOU'RE TALKING ABOUT, MICHAEL,
THE INTEGRATION, THE FOCUS ON
QUALITY, WHAT CANCER CARE IS
KNOWN FOR, AND SPREAD THOSE
CHARACTERISTICS ACROSS THE REST
OF THE SYSTEM.
I UTTERLY AGREE.
BUT YOU DON'T DO THAT... AND I'M
GOING TO COME BACK TO THE
IMPLEMENTATION... YOU DON'T DO
THAT BY NOT TALKING TO THE CHAIR
OF CANCER CARE ONTARIO DURING
THE COURSE OF THE DEVELOPMENT OF
THIS PLAN, BY NOT TALKING TO THE
CEO, NOT GETTING ADVICE OF THE
EXPERTS WHO DEVELOPED THE CANCER
SYSTEM, AND THEN SIMPLY
ELIMINATING THE BOARD.
WE NEED TO TAKE THOSE
CHARACTERISTICS AND SPREAD THEM
BROADER.
NO QUESTION.

Michael says WELL, I
SPENT A VERY INTERESTING HOUR
WITH THE CEO OF CANCER CARE
ONTARIO, MICHAEL SHEERER, TWO
WEEKS AGO.
HE FELT THAT HE WAS ACTUALLY
BEING CONSULTED AND INVOLVED IN
THE CHANGE.
I THINK THE BOARD DECISION... I
DON'T KNOW HOW YOU DEAL WITH
THAT.
I DON'T KNOW HOW YOU DEAL WITH
20 BOARDS THAT ARE GOING, YOU
KNOW, I DON'T KNOW THAT THAT'S
EVER BEEN SOMETHING THAT
GOVERNMENTS HAVE BEEN VERY GOOD
AT.
WHEN GOVERNMENTS CHANGE THINGS,
THEY DO IT BY LEGISLATION, AND
LEGISLATION HAS DATES IN IT AND
THERE HAS TO BE CONTINUITY...

Steve says CAN WE JUST DO A
BOTTOM LINE EXAMPLE HERE?
LET'S JUST TAKE... LET'S TAKE A
BOTTOM LINE EXAMPLE OF SOMEBODY
WHO IS IN HOSPITAL, HAS A
PROCEDURE DONE, NEEDS FOLLOW-UP
CARE AT HOME.
GOES HOME, HAS TO SOMEHOW
CONNECT WITH A HOME CARE AGENCY
IN ORDER TO HAVE THAT FOLLOW-UP
CARE.
FROM WHAT WE HAVE HEARD FROM
MANY CRITICS, DR. BELL, THAT
PATIENT, THAT PATIENT JOURNEY
HAS NOT BEEN AS SEAMLESS AS IT
SHOULD BE, AND THAT TRYING TO
GET THAT FOLLOW-UP CARE AT HOME,
TRYING TO MAKE IT ALL WORK, IS
TOO DIFFICULT AND NOT SEAMLESS.
IS THAT AN ACCURATE CRITICISM?

Bob says YOU KNOW, I
THINK THE HOME CARE SYSTEM FOR
POST-DISCHARGE PATIENTS NEEDS TO
IMPROVE, THERE'S NO QUESTION.
I THINK IT HAS IMPROVED.
THE INTEGRATED COORDINATED CARE
THAT WAS BROUGHT INTO OUR SYSTEM
BY ST. JOSEPH'S HOSPITAL THREE
OR FOUR WEEKS... THREE OR FOUR
YEARS AGO, NOW BEEN SPREAD TO
TRILLIUM, TO NORTH YORK GENERAL
AND OTHER PLACES, WHERE THE
COORDINATION BEGINS IN THE
HOSPITAL LONG BEFORE THE PATIENT
IS DISCHARGED AND PERHAPS BEFORE
THE PATIENT IS EVEN ADMITTED TO
HOSPITAL, WHERE THERE'S ONE
NUMBER TO CALL AFTER DISCHARGE.
WE KNOW HOW TO DO THAT BETTER.
WE NEED TO SCALE AND SPREAD
THAT.
WE CAN DO BETTER.
THERE'S NO QUESTION.
BUT MAKING THAT HAPPEN, FOR
EXAMPLE, WITHIN PATIENTS WHO ARE
IN... NOT HOSPITAL BUT IN
COMMUNITY, WHO DON'T HAVE THE
CONNECTION TO HOSPITAL, THAT'S A
TOUGHER CHALLENGE, AND THAT'S
SOMETHING WHERE OUR CARE
COORDINATION STAFF IN THE
LHINs HAVE EXPERIENCE WITH
IDENTIFYING PATIENTS IN
COMMUNITY.
THAT NEEDS TO BE TRANSFERRED TO
THE NEW ORGANIZATIONAL
STRUCTURE.
THAT'S A CRITICAL PART OF THE
SUCCESS OF ONTARIO HEALTH, IS TO
UNDERSTAND HOW COMMUNITY HOME
CARE WILL DEVELOP.
AND RIGHT NOW IT'S HARD TO SEE
WHERE THOSE FORMERLY LHIN
GOVERNMENT RESOURCES ARE
ACTUALLY GOING TO BE ORGANIZED
WITHIN ONTARIO HEALTH.

Steve says THAT EXAMPLE I JUST
GAVE, ARE THEY LIKELY TO DO
BETTER UNDER THE FORMER SYSTEM
OR NEWER SYSTEM?

Michael says TIME WILL
TELL AS IT DOES WITH THESE
THINGS.
THE HOPE THAT MANY OF US HAVE
HAD FOR A LONG TIME AND WE'LL
ACTUALLY GET THE INTEGRATED
HEALTH DELIVERY ORGANIZATIONS.
THERE HAVE BEEN A FEW KIND OF
ATTEMPTS OR EFFORTS OR THINGS
THAT ARE A LITTLE MORE
INTEGRATED.
THERE ARE CERTAINLY PARTS OF THE
PROVINCE WHERE IT WOULD BE
EASIER TO DO.
YOU LOOK AT A HAMILTON AND
YOU'VE GOT ST. JOE'S, YOU HAVE A
BIG FAMILY HEALTH TEAM WITH WELL
OVER A HUNDRED DOCTORS, SO THERE
ARE FEWER PIECES TO PUT
TOGETHER.
BUT WHAT'S WORKED ELSEWHERE IN
THE WORLD... U.K., U.S., THE
LEADING HEALTH SYSTEMS... YOU'RE
NOT A PATIENT OF A HOSPITAL AND
THEN A PATIENT OF A HOME CARE
ORGANIZATION AND THEN A PATIENT
OF A REHAB FACILITY.
YOU'RE A PATIENT OF ONE
ORGANIZATION.
AND SO THEY OWN YOUR CARE ALL
THE WAY THROUGH.
YOU KNOW, WE'VE MADE SOME
EFFORTS, BUT YOU STILL, IN A LOT
OF THE PROVINCE, HAVE PATIENTS
WHO HAVE A DISCHARGE PLAN DONE
BY THE DISCHARGE PLANNER IN THE
HOSPITAL.
THEN THEY'RE DISCHARGED.
THEN THEY HAVE TO HAVE AN
ASSESSMENT BY THE CCAC, WHICH
CAN TAKE TIME TO ARRANGE...

Steve says COMMUNITY CARE
ACCESS CENTRE.

Michael says NOW TUCKED UNDER THE LHIN BUT STILL A FUNCTION.
IF THEY'RE GOING HOME, THEN
THERE'S A HUGE FIGHT OVER HOW
MANY HOURS THEY'RE GETTING, AND
THE NUMBER IS OFTEN TWO HOURS.
THAT SEEMS TO BE KIND OF... THE
KIND OF WHAT YOU'RE GOING TO GET
UNLESS YOU'VE GOT SOME REALLY
HEAVIER NEEDS.
BUT THAT PROCESS IS ADVERSARIAL.
THE FAMILY, THE PATIENT FIGHT...
THE WORD I ALWAYS HEAR IS WE'VE
BEEN FIGHTING WITH THE CCAC TO
GET CARE, BECAUSE THEY DON'T
HAVE ENOUGH MONEY TO PAY FOR THE
CARE THAT PEOPLE WANT.
NOW, DO THEY HAVE ENOUGH MONEY
TO CARE FOR THE CARE THEY NEED?

Steve says HIS EYEBROWS WENT UP
WHEN YOU SAID FIGHT.

Michael says THAT'S THE PHRASE I ALWAYS HERE.
THE HOPE WOULD BE, AND THEN IF
THEY'RE GOING INTO ANOTHER
INSTITUTION LIKE A REHAB CENTRE,
THERE'S A THIRD ASSESSMENT
BECAUSE THE RECEIVING
INSTITUTION HAS TO ASSESS.
THE HOPE WOULD BE, YOU'VE GOT AN
INTEGRATED TEAM, THE ONTARIO
HEALTH TEAM, RESPONSIBLE FOR
300,000 PEOPLE, THAT WHEN
SOMEONE MOVES FROM ONE PART OF
THAT ENTITY TO ANOTHER, THAT
THERE WOULD BE ONE PLAN FOR
THEIR CARE RATHER THAN TWO OR
THREE ASSESSMENTS.

The caption changes to "Subscribe to The Agenda Podcast: tvo.org/theagenda."

Steve says DR. BELL, COME BACK.

Bob says SO, YOU KNOW,
THERE'S A BIT OF MAGIC THINKING
IN THAT, MICHAEL, AND THAT IS
THAT WE CURRENTLY HAVE A LHIN
SYSTEM WHERE CARE IS ORGANIZED
AROUND YOUR POSTAL CODE.
WE HAVE CARE COORDINATORS WHO
WORK FOR THE LHIN WHO ARE
RESPONSIBLE FOR PATIENTS LIVING
IN THOSE AREAS.
WE'RE NOW GOING TO STOP THAT
SYSTEM AND WE'RE GOING TO MOVE
TO A NEW SYSTEM WITH 30 TO 50
ONTARIO HEALTH TEAMS YET TO BE
DEVELOPED, YET TO BE IDENTIFIED.
I THINK THAT THIS CONCEPT THAT
WE'RE GOING TO HAVE A
DEVELOPMENTAL PLAN WITH 30 TO 50
PROPOSALS COMING FORWARD, THAT
IS GOING TO SUDDENLY INTEGRATE
CARE, NOT AROUND WHERE THE
PATIENT LIVES BUT AROUND WHERE
THE PROVIDERS ARE.
THAT'S WORRISOME.

Michael says I DON'T SEE
IT THAT WAY AT ALL AND IT ISN'T
ALL CLEAR YET.

Bob says IT'S NOT.

Michael says AS I
UNDERSTAND IT, THE MINISTRY WILL
BE RECEIVING AND APPROVING THE
FIRST FIVE OF THESE
ORGANIZATIONS THIS SUMMER.
SO THEY'VE SET OUT WHAT NEEDS TO
BE... THEY WON'T APPROVE ONE
UNLESS IT'S GOT, AND I THINK
THERE'S A LIST OF SIX OR SEVEN
POSSIBLE SERVICES, SO CLEARLY
PRIMARY CARE, ACUTE CARE,
REHABILITATION, MENTAL HEALTH
SERVICES.
SO THEY'RE LOOKING FOR PEOPLE TO
COME FORWARD, BOTTOM UP, AND
SAY, HEY, IN HAMILTON, WE CAN
PUT THESE PIECES TOGETHER...

Steve says WHAT'S YOUR CONCERN...

Bob says HERE'S MY CONCERN.
MY CONCERN IS INNOVATION USUALLY
OCCURS ON A BASIS OF STABILITY.
LOOK AT THE IMPACT OF THAT
INNOVATION AND SCALE IT FURTHER.
WHAT WE'RE SAYING IS, THE
LHINs ARE GONE.
WE'VE SAID THE BOARDS AND
LHINs ARE GONE.
THE PREMIER SAID THE EXECUTIVES
FOR THE LHINs ARE NOT GOING TO
HAVE THEIR JOBS ANYMORE.
THAT BASIS STABILITY THAT
INNOVATION OCCURS ON, I'M
WORRIED ABOUT THAT, MICHAEL.
WE HAVE 800,000 FRAIL ONTARIANS
WHO EVERY YEAR RECEIVE HOME CARE
IN THE COMMUNITY.
I'M WORRIED ABOUT THE STABILITY
OF THEIR CARE WHILE WE INNOVATE.
THE INNOVATION IS GOOD.
DON'T GET ME WRONG.

Steve says CAN YOU SPEAK TO HIS
POINT ABOUT PEOPLE FEEL THEY
NEED TO FIGHT TO GET WHATEVER
ACCESS TO RESOURCES THEY NEED?

Michael says IT'S A BUREAUCRACY.
WHAT THAT IS IS A TOP-DOWN
BUREAUCRACY.
THE LHINs, THE CCACs.
IT'S NOT BOTTOM UP.
IT WOULD HAVE
BEEN BOTTOM UP IF THE ORIGINAL
VISION OF THE GOVERNMENT, WHICH
MINISTER SMITHERMAN BROUGHT IN,
HAD BEEN ADHERED TO.
BUT IT WASN'T.
THEY WERE CHANGED TO BE ARMS OF
THE GOVERNMENT WITH THEIR PEOPLE
APPOINTED BY THE GOVERNMENT.
AND WHEN THAT HAPPENED, THEY
BECAME A TOP-DOWN RESOURCE
MANAGER.
AND OF COURSE PEOPLE FIGHT WITH
THEM BECAUSE THEY RATION CARE.

Steve says OKAY.
SPEAK TO THAT.

Bob says THE CARE COORDINATORS WHO
WORK IN THE COMMUNITY WHO ASSESS
NEEDS IN HOME CARE HAVE A GREAT
DEAL OF DIFFICULTY FINDING
PATIENTS AND FAMILIES ENOUGH.
OF COURSE THEIR RESOURCES ARE
LIMITED.
WE HAVE 42 PERCENT OF OUR
PROVINCIAL DOLLARS BEING SPENT
ON HEALTH CARE.
THERE'S A LIMIT TO HOW MUCH HOME
CARE CAN BE PROVIDED.
IT'S THE JOB OF THE CARE
COORDINATORS, NOT ON A TOP-DOWN
BASIS, PEOPLE WHO ARE NURSES,
SOCIAL WORKERS IN THE COMMUNITY,
WHO ASSESS THE NEEDS THAT
PATIENTS HAVE, TO MAINTAIN A
SAFE, PRODUCTIVE LIFE IN THE
COMMUNITY.
PEOPLE AREN'T ALWAYS HAPPY.
BUT THAT NEEDS TO BE STABLE
WHILE WE LOOK AT NEW WAYS TO DO
THINGS.
ONTARIO HEALTH TEAMS ARE INDEED
A NEW WAY...

Steve says LET ME JUMP IN.
LET US HEAR FROM THE MINISTER OF
HEALTH WHO WAS IN ONE OF THOSE
TWO CHAIRS NOT LONG AGO.
THE QUESTION I HAD FOR HER, THIS
NEW SUPER AGENCY THAT'S GOING TO
BE IN CHARGE OF EVERYTHING,
ONTARIO HEALTH, WHOEVER HEADS
THAT THING, WE KNOW WHO IT IS
NOW, IS GOING TO BE A MAJOR
PLAYER IN HEALTH CARE IN THIS
PROVINCE, AND I WANTED TO KNOW
FROM THE MINISTER OF HEALTH
WHETHER OR NOT IT WAS GOING TO
BE KIND OF A FRIEND OF THE
PREMIER'S OR A FORMER DEFEATED
TORY CANDIDATE TAKING THAT JOB
OR WHETHER IT WILL BE SOMEBODY
OF MERIT AND SUBSTANCE.
HERE'S WHAT SHE HAD TO SAY ABOUT THAT.
SHELDON, THE CLIP, PLEASE.

A clip plays on screen with the caption "February 28, 2019. Christine Elliott."
In the clip, Minister Elliott sits in the studio with Steve and talks.
She's in her late fifties, with long blond hair.

She says WE ARE ASSURING THE PEOPLE OF
ONTARIO THAT THE PEOPLE WHO WILL
BE SITTING ON THIS AGENCY WILL
BE PEOPLE WHO HAVE THE KNOWLEDGE
AND THE EXPERTISE TO MAKE SURE
THAT THIS JOB IS DONE PROPERLY.

Steve says YOU MAKE THE BOARD
APPOINTMENTS, I PRESUME, RIGHT?

Elliott says ULTIMATELY I SIGN OFF ON THEM.
BUT I CAN TELL YOU I HAVE NOT
BEEN INVOLVED PERSONALLY IN THE
INTERVIEWS BECAUSE I THINK IT IS
REALLY IMPORTANT THAT THIS BE
DONE WITH THE ASSISTANCE OF THE
OUTSIDE PROVIDER AND THAT THE
CANDIDATES ARE CHOSEN BASED ON
THEIR MERIT.

The clip ends.
The caption changes to "Executives with Merit."

Steve says SO THERE'S THE
COMMITMENT THAT THIS IS NOT
GOING TO BE A SORT OF TYPICAL
POLITICAL APPOINTMENT.

Bob says THE CHAIR
MEMBERS ARE EXCELLENT PEOPLE.
VERY ENCOURAGING.

Steve says YOU'RE OKAY WITH ALL
OF THEM?

Bob says I ABSOLUTELY AM.

Steve says ARE YOU OKAY WITH
THE NEW PROCESS OF WHO THE CEO
IS, A VERY BIG PLAYER?

Michael says YOU WANT TO
SORT OF SEE WHO COMES UP.
THERE ARE, YOU KNOW, A
SIGNIFICANT NUMBER OF PEOPLE WHO
WOULD DO A TERRIFIC JOB IN THIS
PROVINCE.
WE ALL HAVE OUR SHORTLISTS AND
WE'LL ALL BE, I THINK, PLEASED
WHEN THAT APPOINTMENT IS MADE
AND IT REDUCES THE UNCERTAINTY,
YOU KNOW, AND TO BE FAIR, BOB, I
THINK SOME OF YOUR EARLY
COMMENTS ON ALL OF THIS, BECAUSE
THE LEGISLATION WAS LEAKED, IT
CREATED AN ATMOSPHERE WHERE
PEOPLE KNEW A BIG CHANGE WAS
COMING, BUT THEY DIDN'T KNOW WHO
THE CHARACTERS WOULD BE.
AND, YOU KNOW, THERE WAS FEAR.
THERE WAS CONCERN.
I THINK THE PREMIER'S COUNCIL,
WHEN DR. DEVLIN ASKED ME TO SIT
ON IT, I SAID, IS THIS AN EXPERT
PANEL OR IS THIS GOING TO BE
MORE A POLITICAL THING?
AND HE SAID, NO, EXPERT PANEL.
AND THAT'S WHAT IT IS.
IT'S PEOPLE WHO WOULD... YOU
KNOW, WHO HAVE WORKED FOR A
NUMBER OF DIFFERENT GOVERNMENTS,
AND I THINK THE BOARD IS... YOU
KNOW, THE APPOINTMENTS THAT ARE
MADE SO FAR ARE VERY STRONG,
PEOPLE WITH BOTH GOVERNANCE
EXPERIENCE AND, YOU KNOW, MAYBE
A LITTLE LESS HEALTH EXPERIENCE
THAN SOME OTHER BOARDS...

Bob says THE THING
THAT WORRIES ME THE MOST,
MICHAEL, IS THIS IS THE BIGGEST
CHANGE, I THINK YOU'D AGREE, THE
BIGGEST CHANGE TO MEDICARE SINCE
IT WAS INTRODUCED, 50 YEARS.
THIS IS AN ENORMOUS SYSTEM, A
60 BILLION PLUS dollar SYSTEM.
HOW DO YOU ACTUALLY HAVE PEOPLE
PROVIDING INTEGRATED CARE,
CHANGING THE RESOURCE ALLOCATION
THROUGH THE SYSTEM WHEN THERE IS
NO STRONG CHANGE MANAGEMENT
PLAN.
THERE'S NO LEADER.
THERE'S NO CEO APPOINTED AS OF
YET.
WE'RE TALKING ABOUT FIRING
PEOPLE BEFORE WE'VE TALKED ABOUT
APPOINTING THE LEADER TO THIS
SYSTEM.
YOU NEED TO CHANGE THE DIRECTION
THAT PEOPLE ARE GOING ACROSS
THIS PROVINCE OVER THE NEXT
THREE TO FOUR YEARS.
THERE'S NO STRONG CASE YET AS TO
HOW THAT IS HAPPENING, AND WE'RE
ALREADY SEVERAL MONTHS INTO IT.
CHANGE OCCURS WITH A STRONG
PROGRAM.
THIS IS HOW THINGS ARE GOING TO
HAPPEN.
WITH ORGANIZED ANTICIPATION OF
HOW CHANGE WILL OCCUR.

Michael says I GUESS I'M
GOING TO DISAGREE HERE BECAUSE,
ONE, THE LEGISLATION HAS BEEN
INTRODUCED, BUT IT HASN'T BEEN
PASSED.
SO THERE IS A REAL PROBLEM WITH
ACTING ON A LAW THAT...

Bob says THE BOARD HAS
BEEN APPOINTED.

Michael says THE BOARD
HAS BEEN APPOINTED.

Bob says IT HASN'T
BEEN PASSED.

Michael says I HEAR LOTS
OF INTEGRATION AND
CONVERSATIONS.
THE DEPUTY IS PLAYING A LEADING
ROLE IN THIS.
IT'S SOMEONE WE BOTH...

[INTERJECTIONS]

Michael continues HAVE GREAT RESPECT AND I
HAVE GREAT CONFIDENCE THEY WILL
GET THERE ON THE TRANSITION.
THEY ARE KEEPING THE HEADS OF
THE AGENCIES IN PLACE ON AN
INTERIM BASIS.
EXTENDING THEM.
SO THAT THERE'S STABILITY.
AND I BELIEVE THAT THIS WILL
EMERGE AND EMERGE REASONABLY
QUICKLY.
BUT THERE IS SOME URGENCY WITH
THIS.
IF ONTARIO WERE SITTING WITH A
BALANCED BUDGET AND A HEALTH
SYSTEM THAT EVERYBODY WAS HAPPY
WITH AND PEOPLE WERE GETTING THE
SERVICE THEY NEED, I WOULD SAY
TAKE A LONGER PERIOD OF TIME.
BUT WE ARE BORROWING 15, 14,
15 BILLION dollars A YEAR IN FINANCIAL
MARKETS TO PAY FOR EXPENDITURES
THAT REVENUES AREN'T SUPPORTING.
40 PERCENT OF THAT IS FOR
HEALTH.
SO WHEN YOU SAY TO PEOPLE, DO
YOU WANT US TO BORROW ANOTHER
6 BILLION dollars AND POUR THEM INTO
THE HEALTH SYSTEM?

Bob says WHAT I'M
SUGGESTING IS THAT THE PLAN
NEEDS TO BE A PLAN THAT'S
CONSISTENT.
YOU DON'T BRING A REPORT OUT IN
JANUARY AND SAY, WE'RE GOING TO
HAVE OPPORTUNITIES FOR
CONSULTATION AROUND VARIOUS
OPTIONS, AND THEN AT THE SAME
TIME, HAVE IT DISCOVERED THAT
THE LEGISLATION IS ALREADY
DEVELOPED.

Steve says LET'S TRY ONE MORE
THING HERE.
WE HAVE TIME FOR ONE MORE
CONVERSATION, ONE MORE AREA OF
DISCUSSION, AND THAT IS, THE
GOVERNMENT HAS PROMISED THAT
WHENEVER PEOPLE LOSE THEIR JOBS,
YOU TALKED ABOUT THE 20 VPs
AND I.T. PEOPLE, MERGED INTO ONE
AGENCY, YOU DON'T NEED THAT
MANY.
HOW CONFIDENT ARE BOTH OF YOU
THAT THAT MONEY SAVED FROM THOSE
JOBS THAT ARE NO LONGER NEEDED
WILL ACTUALLY GO BACK INTO FRONT
LINE PATIENT CARE?
DR. BELL?

The caption changes to "Better care ahead."

Bob says THERE'S NOT A
HUGE AMOUNT OF MONEY SPENT IN
ADMINISTRATION IN THE HEALTH
CARE SYSTEM.
THAT'S SIMPLY A FACT.
EVERY PENNY SHOULD GO BACK INTO
HEALTH CARE DELIVERY.
UNFORTUNATELY, WHEN YOU LOOK AT
THE HISTORY OF CHANGE, WHEN YOU
LOOK AT THE SEVERANCE COSTS,
WHEN YOU LOOK AT THE COSTS OF
CONSULTANTS THAT ACTUALLY COME
AND ADVISE ON THIS, QUITE OFTEN
YOU DON'T SEE THIS HAPPEN.
I THINK THAT WE'RE GOING TO HOLD
THE GOVERNMENT TO TASK TO MAKE
SURE THAT HAPPENS.
THERE ARE LOTS OF METRICS THAT
WE CAN MEASURE TO SEE.
HOW MANY HOME CARE HOURS ARE
BEING ACCOMPLISHED.
HOW MANY PRIMARY CARE PHYSICIANS
ARE BEING HIRED.
HOW MANY NEW PRIMARY CARE GROUPS
ARE BEING FORMED IN THE
PROVINCE.
I THINK WE'RE ALL GOING TO BE
HOLDING THE GOVERNMENT TO TASK
ON THAT, AND I'M ENCOURAGED WE
WILL SEE INCREASED RESOURCES.
BUT, YOU KNOW, CHANGE IS HARD.
AND WE REALLY NEED A STRONG
CHANGE PLAN TO BE EVIDENT TO THE
PUBLIC, AND EVIDENT TO PEOPLE
WORKING IN HEALTH CARE.
HOW IS THIS GOING TO OCCUR?
THE BIGGEST CHANGE IN ONTARIO
HEALTH CARE.
WHAT'S THE PLAN TO MAKE IT
HAPPEN?

Steve says LAST WORD TO MICHAEL DECTER.

Michael says I THINK IT
IS A BIG CHANGE.
I THINK THAT IT'S OVERDUE.
AND I THINK WE DO HAVE TO BE
VIGILANT.
FOR EXAMPLE, THE PROVINCIAL
GOVERNMENT SIGNED ON WITH THE
FEDERAL GOVERNMENT TO RECEIVE
MONEY UNDER THE NEW ACCORD, AND
A LOT OF THAT MONEY IS TARGETED
FOR MENTAL HEALTH, WHICH IS AN
AREA OF ENORMOUS NEED.
IF I HAD TO SAY...

Bob says I AGREE.

Michael says CANCER
CARE IS REALLY WELL-ORGANIZED,
WHAT'S THE AREA THAT ISN'T?
IT'S BEEN MENTAL HEALTH FOR A LONG TIME.
I WANT TO BE SURE THAT WHEN THAT
MONEY FLOWS TO ONTARIO, THAT IT
FLOWS THROUGH TO MENTAL HEALTH.
AND THAT'S GOING TO BE A BIG
QUESTION, BECAUSE THERE ARE
PARTS OF THE SYSTEM THAT DO WORK
PRETTY WELL.
EMERGENCY CARE.
YOU GO TO AN EMERGENCY... YOU
MAY WAIT LONGER THAN YOU'D LIKE
TO BECAUSE THERE ARE PEOPLE THAT
PROBABLY SHOULDN'T BE THERE.
BUT THE CARE YOU GET IS HIGH
QUALITY.
BUT IF YOU'RE MENTALLY ILL AND
YOU GO, YOU'RE OFTEN SENT OFF,
MAYBE WITH A PRESCRIPTION, MAYBE
NOT, BUT YOU CAN WAIT SIX MONTHS
TO SEE... AND THAT'S WRONG.
AND EVERY OTHER SYSTEM THAT'S
FIXED THAT PROBLEM HAS MADE IT
EASY TO GET FROM, YOU KNOW, FROM
THE DIAGNOSIS TO SOME KIND OF
CARE QUICKLY.
I'LL BE LOOKING VERY CLOSELY AT
ALL OF IT...

Bob says WE BOTH WILL BE.
MENTAL ILLNESS... IT'S CRUCIAL.

Steve says MY HUNCH IS WE
SHOULD RECONVENE THIS GATHERING
IN A YEAR OR TWO AND SEE THE
CHANGES THAT HAVE...

Bob says SIX MONTHS.

Steve says SIX MONTHS?
ALL RIGHT.

Michael says ANY TIME
YOU'RE WILLING TO HAVE US BACK,
I'D BE PLEASED TO DO IT.

Michael and Bob shake hands amicably.

The caption changes to "Producer: Steve Paikin, @spaikin."

Steve says THAT WAS AN
UNUSUALLY CIVILIZED DISCUSSION
BETWEEN TWO PEOPLE WHO HAVE VERY
DIFFERING VIEWS ON THIS THING.
DR. BOB BELL, MICHAEL DECTER,
FORMER DEPUTY MINISTERS OF
HEALTH FOR THE PROVINCE OF
ONTARIO. THANKS FOR MAKING TIME
FOR US HERE AT TVO TONIGHT.

Bob says ANYTIME, STEVE.

Michael says THANKS, STEVE.

Watch: Debating Ontario's Health-Care Overhaul