The darling of Ontario's health-care system has long been the agency that oversees cancer care.

Admired by health leaders around the world, Cancer Care Ontario (CCO) is considered the pinnacle of success in establishing standards, tracking and publicly reporting outcomes, multi-year planning, developing information systems, consulting patients and advising governments and practitioners.

It oversees $1.9 billion in funding and touches the lives of more than 90,000 new patients annually. And it's about to vanish as an independent agency.

CCO, along with the Trillium Gift of Life Network and four other agencies, is being dissolved and absorbed into the province's new health-care super agency, Ontario Health.

So far, 205 back-office jobs have been eliminated at CCO. A bus that brought cancer screening and support for smoking cessation to vulnerable Hamilton, Niagara and Burlington neighbourhoods has lost its funding. And a partnership that ensures Ontarians have access to consistent high-quality colonoscopy, mammography and pathology services is ending.

The Quality Management Partnership with the College of Physicians and Surgeons, started in 2013 because of past patient safety incidents and regional variations in quality of care. It is being replaced with a new model that the government says will be similar but will be for the entire health-care system.

The changes are part of a massive overhaul of the health-care system in Ontario that came into effect June 6 under the Connecting Care Act. An investigation by The St. Catharines Standard and The Hamilton Spectator provides the most comprehensive coverage to date of the restructuring considered the biggest change since Medicare.

The restructuring puts Ontario Health in charge of the entire health-care system — from hospitals to community care to organ donation to cancer care. It will oversee dozens of regional groups, called Ontario Health Teams, made up primarily of health and social service organizations working together to integrate services locally and help area residents navigate the system.

Supporters of the super agency say a single, streamlined system will make for a cheaper, more effective health-care system. When rolling out the plan in February, Health Minister Christine Elliott said Ontario Health would take the best lessons learned from CCO and share them across the system, such as developing a comprehensive chronic disease management strategy.

"There are certain things that we are doing well, and you don't need to throw the baby out with the bath water," said Linda Haslam-Stroud, former longtime president of the Ontario Nurses Association. | Submitted photo

"Imagine if we could replicate those achievements to correct the inequities that have led to the development of such a world-class cancer system while leaving our mental health and addictions sector with little to no infrastructure at all," she said at the announcement Feb. 26.

But what if the opposite happens and CCO is weakened instead, asks Marvin Ryder, former board chair of Hamilton Health Sciences.

"The fear of course is that you take the good agencies and make them less effective, and you don't ever actually fix the agencies that need to be fixed," he said.

Ryder believes too much is at stake to risk the world-respected cancer system CCO has built since it was created by the NDP government in 1995.

"If it's not broke, why are you trying to fix it?" he said. "Cancer Care Ontario is really the envy of the world and same thing with the Trillium Network. There are many jurisdictions in the world that look at those two things and say, 'They are amazing, they are working really well, and why would ever think of tinkering with them?'"

A prominent Ontario nurse says the government needs to identify actual problems in the health-care system and focus on fixing those.

"There are certain things that we are doing well, and you don't need to throw the baby out with the bath water," said Linda Haslam-Stroud, former longtime president of the Ontario Nurses Association.

CCO will get lost within the super agency, says former Liberal deputy minister of health Dr. Bob Bell. The strength of CCO is found in its relative independence and singular focus, which allows it to adapt to evolving science quickly, he says. A super agency will have too many masters and move too slowly as a result, he said.

The former Liberal deputy minister of health Dr. Bob Bell said "cancer care is going to be buried in the decision-making matrix." | Supplied photo

"The CEO of the super agency will be giving direction to the director of cancer care but will also have concerns about ambulance response times and other issues," Bell said. "Cancer care is going to be buried in the decision-making matrix. And that worries me for cancer patients, not right now but in two to three years. Will we have the same ability to offer frontier cancer care in Ontario? I think definitely not."

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Others believe bringing those agencies into the fold will allow their methods to be used throughout the system to bring the same kind of success to other sectors.

"We have to learn from the great strengths of Trillium Gift of Life and Cancer Care Ontario," said Dr. Tom Stewart, CEO of St. Joseph's Healthcare and Niagara Health. "Hopefully, by doing this, it will allow the spread of good ideas faster."

The plan is for the super agency to break down the barriers between the 20 organizations that currently act alone.

"Bringing together a number of agencies that have been separate makes a lot of sense," said Eric Vandewall, CEO of Joseph Brant Hospital in Burlington. "There's the opportunity to see transfer of ideas and successes among these agencies ... versus disparate silos."

The result will be higher co-ordination, common goals and one set of measures to evaluate the health-care system, predicts Doris Grinspun, CEO of the Registered Nurses Association of Ontario.

"Bringing them under one umbrella can only do good," she says.

Which side of the argument is right will all come down to how Ontario Health is implemented, says Rob MacIsaac, president and CEO of Hamilton Health Sciences.

"That will be about the government needing to execute really well on this plan," he said. "If you could take those same principles and the same horsepower and apply it to other chronic diseases ... I think that is a very important opportunity for people in the province."

But he adds, "I think it's really important that the good work of Cancer Care Ontario not get lost."

It's significant because expanding CCOs leadership, oversight and accountability to other parts of the system could substantially improve care. But it could all too easily go the other way.

"Why would you endanger the cancer-care system in Ontario at all?" asked Natalie Mehra, executive director of The Ontario Health Coalition. "It's very risky."

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