For the second in my series on the Drummond Report, I get into the part the hits closest to home for me as a nurse, health care. The report mostly covers issues that many of us within the system have been talking about for years, so hopefully this part will get the full attention of decision-makers. However, before highlighting the key points that I agree with, I wanted to speak briefly to the LHINs.
LHINs came under fire during the last provincial election due to the costs of paying management level positions. However, it is important that we remember the history and the purpose of regionalizing health care. For years, if not decades, in London we have been complaining about a health system centralized in Toronto and not terribly responsive to our particular needs. The district health authorities seemed tokenistic and toothless. We wanted local decision-making for local health care. So, the LHINs are an answer to this, truly being able to manage our health care dollars locally. However, the biggest problem we have had since their inception is that LHINs have not had enough power to really work. Primary health care, public health, home health all fall outside their authority, and hospitals operate with independent boards. The Drummond Report gets to the heart of this matter, and says that a truly integrated, truly efficient system means that all pieces have to be folded into local decision-making. This is a positive direction.
Other than that, there are many recommendations that we have been saying for years:
- We must move away from an acute care heavy system and do as much as possible through primary care, home care, and outpatients.
- We must protect our drug costs from the impact of free trade agreements.
- We have to stop having the most expensive care providers doing care that others could do. This means more nurse practitioners, and many more nurses working at full scope of practice.
- We cost the most to the health care system in the last year of life. We need to ensure everyone has pre-planned for end-of-life care to avoid extremely expensive procedures and treatments that might not be wanted.
- Let’s hold off greatly increasing long-term care beds before we can better figure out our home care system.
- Physicians should be paid primarily through salary/capitation versus fee-for-service, and compensation could be frozen and still have Ontario physicians as the best paid in the country.
- Primary care physicians should all work within teams that are interdisciplinary.
- Health benefits should be linked to income, not age (ie. progressive not regressive).
- Electronic records…need I say more?
There are lots of suggestions here. However, I wouldn’t even describe this as ‘tough medicine’, I would describe it as good system management, that has strong fiscal benefits.