Commission on the Reform of Ontario's Public Services

Executive Summary
The LHINs should optimize human resources capacity by shifting services to lower-cost
caregivers where feasible and encouraging full scope of practice — a net shift in
responsibilities from physicians to nurses and others in health teams, including physician
assistants. The LHINs should use funding as a lever to ensure that nurses, nurse practitioners,
personal support workers and other staff members can apply their full range of skills.
Out-of-hospital services — for outpatients as an example — should fall to others, such as
the CCACs and private health care operators, which have demonstrated that they can do this
sort of work for much less than hospitals. The LHINs should also resist the temptation to build
many more long-term care facilities until the government can assess if more can be done
for an aging population by further emphasizing the use of home-based care, supported by
community services. Home-based care is less expensive and should generate greater
population satisfaction.
Funding: The government should give LHINs the authority, accountabilities and resources
necessary to oversee health within their regions, including allocating budgets, holding
stakeholders accountable and setting incentive systems. The LHINs should deal with all
aspects of the health system’s performance, including primary care (physicians), acute care
(hospitals), community care and long-term care. This would include setting budgets and
compensation for all players. Compensation for senior executives should be tied to health
outcomes, not the number of interventions performed.
Case Management: There is a lack of smooth and consistent patient case management.
“Clerical system navigators” who co-ordinate appointments and help patients with forms and
paperwork, a role developed in some parts of Ontario, should be used across the entire
system. “Quarterbacks” can help FHTs and specialized clinics track patients as they move
through the integrated health system. Complex care patients should be managed through
interprofessional, team-based approaches to maximize co-ordination with FHTs and other
community care providers. Chronic issues should be handled by community and home-based
care to the fullest extent possible.
Revamped LHINs would need solid governance and structures. A key element of governance,
if they are to co-ordinate the system, is appropriate representation. Their need for more
resources would entail a significant transfer of employees from the MOHLTC. Government
needs to stand by the LHINs’ decisions, even if they close a facility.
Decisions regarding medical procedures covered under OHIP are now part of the
compensation package negotiated by the government and the Ontario Medical Association
(OMA). Doctors should be consulted, but no more.
23