Command and Control and Bill 41

It’s clear that Bill 41 is what it’s come to for Ontario Liberals. I thought I would read through the Bill and try to come up with some insights into it that could be published at all rationally but, really, I’m just not good at working these things out. If you have a look at the text of Bill 41, you’ll see that it seeks to amend a number of other acts. Just to give you an idea of how sweeping the Act is, here is the list of Acts that will be amended if Bill 41 passes:

  • Local Health Integrations Networks Act.
  • Broader Public Sector Accountability Act
  • Commitment to the Future of Medicare Act
  • Community Care Access Corporations Act
  • Electronic Cigarettes Act
  • Employment Standards Act
  • Excellent Care for All Act
  • Health Insurance Act
  • Health Protection and Promotion Act
  • Ministry of Health and Long-Term Care Act
  • Ombudsman Act
  • Personal Health Information Protection Act
  • Poverty Reduction Act
  • Private Hospitals Act
  • Public Hospitals Act
  • Public Sector Labour Relations Transitions Act
  • Retirement Homes Act
  • Smoke-Free Ontario Act

To completely determine the full impact, one would have to see what the recommended changes mean in total and I do not have the patience to methodically figure out what all is being tinkered with in Bill 41.  A quick glance reveals the Government’s intention to close down Community Care Access Centres (CCACs) in favour of the Local Health Integration Networks (LHINs), a move that has many wondering how effective that will be at providing care. The further addition to LHINs of smaller administrative units (the so-called “Sub-LHINs”) is also evident, a measure that has front line care providers wondering once again how more administration favours patient-care. Other measures are the beginning of health care system changes, and, of course many are concerned that their impact will not be as positive as anticipated. Complex, extensive changes are being proposed for health care in Ontario. It doesn’t take any special skills to work out that Minister Hoskins is trying to shift a lot of legislation to bring health care more and more under his control.

He is seeking to affect Local Health Integration Networks, Public Health, Public and Private Hospitals, Doctors’ Practices. He’s even seeking changes in areas where he already has significant control such as the Nurse-Practitioner-Led clinics and with the Medical Officers of Health.

When I set out to consider Bill 41 for myself, I remembered that all this tinkering had something to do with Patients First: A Proposal to Strengthen Patient-Centred Healthcare in Ontario, a report released late last year that sought to address the need for better integration of Ontario’s healthcare system.

As a hospital-based psychiatrist who treats only adolescents and young adults, better integration sounds like a good idea and, in that context, I would love to have an opportunity to consider how integration might benefit my patients. Would it give a young man with Schizophrenia access to a Psychiatrist and Family Doctor in the town where he’ll attend university? What about access to care for street-involved youth? My colleagues and I have lots of ideas about how this might work. When I read the Patients First Discussion paper and Bill 41, I can see the parallels and how the Government is trying to do with legislation what would more effectively be done by discussion before implementation.

I know that the Ontario Medical Association and doctors in general have many concerns about Bill 41, but so did hospitals as evidenced by this report on the Bill when it was Bill 210 before the legislature was prorogued. While generally supportive, even Ontario’s nurses expressed concerns about the loss of nursing jobs because of the closing down of CCACs.

But it seems that the Ministry of Health and Long-Term Care is really only willing to discuss the situation on their terms. Because of this, it is left to doctors, nurses, and hospitals to write reports, appear before parliamentary committees, visit Members of Provincial Parliament and resort to social media in order to discuss legislation that will affect healthcare profoundly for years to come.

Goodness knows, change is absolutely necessary in the health care system in Ontario. Without all the Command-and-Control, Ontario doctors and nurses and hospitals are working toward better integration. But it seems as though our pace or our proposed direction are not good enough or fast enough, or something, for Minister Hoskins. So this is what it’s come to. There is no need to analyze Bill 41 extensively. The government will tell you what to do.

 

One thought on “Command and Control and Bill 41

  1. I think it is important to note that the majority of changes to the other pieces of legislation is just a matter of removing the reference to ‘CCAC’ and replacing it with ‘LHIN’.

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