Last week, NDP leader Andrea Horwath revealed leaked draft legislation that she said suggested the government was planning to privatize health care in this province. As I noted then, the text of the bill didn’t substantiate her claims. But on Monday, the New Democrats shared a new batch of documents — ones that seem to show that the government has already taken steps to prepare for major structural changes to Ontario’s health-care sector.

Health and Long-term Care Minister Christine Elliott emphasized last week that the leaked draft legislation was just that — a draft — but the documents released by the official Opposition on Monday indicate that the process of developing a new structure for the health-care system began late last year and is already reasonably far along: the province has, for example, already named three of the directors who would sit on the board of the “superagency” that would oversee the new system.

As health and long-term care constitutes by far the largest single ministry budget (MOHLTC spends more annually than some provinces), any major changes could have huge ripple effects throughout the government.

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Here are some of the major questions the NDP-obtained documents raise about the future of health care in the province.

Oversight and accountability

According to the draft legislation the NDP released last week, the new “superagency” would be answerable to the auditor general, which would have the same rights and powers to investigate it that the office currently has in regard to other Crown agencies. But the superagency would also oversee potentially dozens of smaller groups (referred to in the briefing documents as “MyCare Groups”), which would actually be responsible for delivering care. The documents don’t make clear whether those groups would also fall under the auditor general’s purview.

The Tories are also proposing to appoint a Patient Ombudsman to advocate for patients within the health-care system. Critics, including former ombudsman André Marin, raised serious concerns about the position when the Liberals created it: the ombudsman is formally an employee of the government (unlike the Auditor General, who is appointed by the legislature and has a degree of independence). According to this government’s draft legislation, the patient ombudsman would be an employee of the superagency itself. This wouldn’t solve the conflict — can the ombudsman really investigate their employer? — and may even make it worse.

Risks to patient care

The government’s own documents about its proposed changes mention the potential for labour disruptions and “risks” to health-care services. This isn’t necessarily alarming — the provincial bureaucracy is trained to identify any “risks,” however minor, that may arise through changes to public policy. But, as the briefing notes indicate, the collective-bargaining agreement with the Ontario Nurses’ Association expires in March of this year, and that poses a problem for the government: Would the Tories be able to negotiate a drama-free contract with nurses while upending the health-care system? Even powerful ministries have only so much time in a day.

There is a real possibility that, even if the government’s intentions are sound, changes to the health-care system could result in significant service disruptions in hospitals and long-term care facilities. When then-premier Kathleen Wynne made changes to the rules governing daycare and recreational programming, families of young children were left scrambling — the Tories are currently trying to clean up the mess. A carelessly drafted regulation or piece of legislation could have major implications for patient care across the province.

Secrecy doesn’t make for good government

Horwath has referred to the government’s public consultations on health care as a “sham” — and it’s true that if the documents her party provided are credible, then the government has already begun building the superagency (naming directors, notifying the directors of existing agencies that their remaining time is limited) and looking for office space.

Elliott, for her part, denied at a press conference on Monday that the process had advanced as far as the documents would seem to suggest, saying that she hadn’t seen the specific pages in question and that there were multiple aspects of the plan that will still need final approval from cabinet. She emphasized that the documents released by the NDP had come from within the non-partisan public service and not from partisan staff.

A note on “privatization”

The documents released Monday do, to some extent, buttress the NDP’s concerns about privatization. One — titled “Outsourcing/Transfer to the BPS” — lists government functions that could be outsourced. (BPS is government-speak for the “broader public sector,” a catch-all term for agencies and Crown corporations, as well as municipalities and school boards.) However, it’s unclear whether outsourcing necessarily means privatization.

Elliott, speaking to reporters at Queen’s Park on Monday, disavowed any intentions to privatize and specifically denied any intention to outsource any of the functions listed in the documents.

Although she declined to comment on what matters have gone through the cabinet approvals process, Elliott later stated in an email that “we can confirm a number of the sections Andrea Horwath specifically highlighted … are not under consideration by the Minister of Health and are not proceeding under our government’s watch — including the outsourcing of inspections, laboratories, licencing, devices, and Ornge.”

The premier’s office did confirm on Monday that the public servant who leaked the documents to the NDP had been fired and that the Ontario Provincial Police had been “notified” of the incident.