Enacted earlier this year by the Ford government, the People’s Health Care Act started the most radical changes in the history of Ontario’s health system. The act eliminated Cancer Care Ontario, Trillium Gift of Life and 14 Local Health Integration Networks (LHINs) and created one Ontario Health agency to govern the province’s health system.

It also initiated the development of 50 to 70 Ontario Health Teams (OHTs). Reviewing the first proposals for OHTs offers an opportunity to evaluate the potential benefits and risks of the People’s Health Care Act.

One of the first applications for an OHT to be publicly posted comes from North Toronto.

The application engenders admiration for the teams developing the proposal. However, it also raises questions about whether the structural disruption created by the Peoples’ Health Act is necessary to improve Ontario health care, concern about community engagement in governance of OHTs and questions about the provincial resources needed for OHT success.

In proposing to improve care for their patients, the North Toronto OHT partners (which include hospitals, community service providers, home-care companies and primary care groups) reasonably decided to focus on improving integration of services for 10,000 seniors with complex health problems. This population has long been a focus for their teams within collaborative structures called Health Links. Health Links were established under the LHIN system more than five years ago with the goal of better integrating care for complex patients.

Under the prior system, North Toronto partners developed a variety of resources to support primary care providers in caring for these complex patients. These resources are well described in the application. The initiatives were established under the Toronto LHIN and will provide the foundation for improvement in the new OHT. The partners also suggest providing system navigators for the most complex seniors — an initiative that was often undertaken by Health Links.

All of these services and resources were developed long before the Peoples’ Health Act.

Is there a disadvantage to health service oversight under the Peoples’ Health Care Act compared to the model that the new act terminated? Under the prior model, regional health services were overseen by 14 regional LHIN boards. It is presently uncertain whether the ministry of health or Ontario Health will eventually be responsible for oversight of OHT’s. The complexity of monitoring more than 50 OHT’s from Queen’s Park will be demanding.

The governance of OHT’s will also be different from the prior system. The North Toronto application suggests that the partners’ current boards will gradually determine a governance mechanism for the OHT. Although the application describes the development of a Patient Family Advisory Committee for the OHT, there is no mention of the public contributing to OHT governance.

The prior LHIN boards were comprised of public appointees who were responsible for ensuring communities were engaged in governing regional health services. Some suggest that not all LHIN boards excelled at public engagement. Despite this possible performance deficiency in the old model, the lack of proposed community engagement in governance of more than 50 OHT’s is a problem in the People’s Health Care Act — unless the new Ontario Health agency takes responsibility for public discussions across the entire province.

The other reason for concern about the success of OHT’s is the long list of challenges that must be addressed by the province to support OHT’s.

The North Toronto OHT application addresses barriers and enablers for OHT success. The list includes the complexity of merging budgets across partner organizations, the challenge of determining which patients are attached to which OHT, the lack of a management team or resources for managing an OHT, the struggle to recruit physician human resources when the Ontario Medical Association and the government are locked into a binding arbitration framework that does not reference OHT’s, the difficulty of creating interoperable health records without a provincial health record accessible to all OHT members, the problem of reorganizing home-care without a provincial position on renewal of home-care contracts, integrating procurement and supply chains and dealing with hospital overcrowding within the partnership.

The members developing this application have generated important conversations across health system sectors. However, the complexity of implementing and governing the work suggested by the North Toronto OHT may be daunting under the Peoples’ Health Care Act.

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