Looking for Solutions in Health Care for 2006 and Beyond

Our health care system needs to change to accommodate new demographics, new technologies and new pharmacologic advancement.

The roots of compassion and caring in health care should not change however, and it is with this in mind that the dialogue of change should be had surrounding health care.

How can we adapt to different needs that emerge as our population ages?

How can we  find sustainability in the midst of so many new advancements?

How can individuals become more empowered in serving their own health care needs?

What role does the individual have in enabling the  health care of others  beyond paying taxes?

Many questions like these need to be answered and if we are willing to look with open minds at the problems within our health care system, and beyond political posturing, then we can find new  solutions to take us further into this century. 





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Ontarians Should Be Very Wary of Bill 41- "The Patients First Act"

If ever there was a piece of legislation inappropriately named, it is Ontario Bill 41. If the Ontario Liberal government had more accurately named its legislation, “The Grow Bureaucracy and Invade Patient Privacy Act”, it would have garnered a lot more public and media attention. Even the Ontario Medical Association might have been forced to deal with it earlier instead of waiting until the legislation was under fire from front-line physicians.

Bill 41, cloaked in the reassuring sounding title of “The Patients First Act”, has passed second reading and is before a legislative committee. Premier Kathleen Wynne and Health Minister Eric Hoskins want to see it passed in the next four weeks.

Three things you should know about Bill 41:

1. Bill 41 gives the right to government to access your private medical records. The privacy of an individual’s medical record has traditionally been a source of reassurance and trust for patients during the medical process. For government to give itself the power to invade your privacy is as an affront to an individual’s right to have a confidential relationship with their doctor. Today, providers work in teams and more people do have access to a patient’s record now than ever before. But for government to insert itself between providers and patients has potential for negative consequences including further rationing of care and denial of government funded care-which is undoubtedly the rationale for this invasion of privacy.

2. Bill 41 will grow the bureaucracy adding more layers to the fourteen Local Health Integration Networks creating an additional eighty sub-LHINs to be filled with various personnel. Piling on more bureaucracy to the already inefficient LHINs is not the way to stretch our tax dollars to deliver more needed care. Since 2004, the growth in bureaucracy under the Ontario Liberal regime is staggering.  We have seen many layers of managers created to measure quality and wait times, while front line funding is being cut to offset the Ontario Liberals’ waste and mismanagement elsewhere.  The efficiency of the bureaucracy is not even measured. Ontarians will be paying for more managers, not more care.

3. Bill 41 empowers the Ontario Minister of Health with extraordinary levels of autonomy. This dictatorial positioning is of serious concern and raises many red flags. The legislation gives the government more power over patients and providers and it gives one individual, the Minister of Health, the power to do whatever is considered “in the public interest”. This is extraordinary power. Without ever consulting the public about its “interests”, doctors’ offices may be closed, providers may be limited in their ability to work based on geography, and various groups that exist to deliver care will cease to have a voice. Doctors and health care providers will be forced to comply with government decisions and those decisions will not require engaging the public or the medical profession in the process.

Make no mistake. The Ontario Liberals’ Bill 41, "The Patients First Act", is not about putting patients first. It is about the invasion of patient privacy, injecting the government into health care at every turn with a bulging middle management bureaucracy, and expanding the power of the Minister of Health to limit access to care and to treatments.

The public should be very wary of Bill 41. The rights and power seized with this legislation should remain with the people and not be snatched by a government to grow its bureaucracy while rationing our care. Bill 41 entrenches a heavy-handed, top down health system that no longer guarantees the trust and privacy of the doctor-patient relationship. It is truly unconscionable--even for this Wynne Government and Health Minister Hoskins. 

Reader Comments (671)

Except that the loss of power long preceded the "equity" debates. I've been at this game for 25 years now and just saw the tail end in the nineties where physicians retained considerable power but the decline had begun and accelerated due to the demographic changes mentioned above.

But I'd agree the equity debates are part of the problem. Just have a look at the recent U of T medicine article with Decter and Martin pushing the equity of access. Unfortunately these 'equity of access' proponents fail to recognize that in most cases our biology is destiny and in the large majority of cases counseling someone about weight loss is not going to prevent the eventual knee replacement. It might delay the replacement but in general once obese always obese.

I always remember one of my first days working in a native health clinic in northern Ontario where I entered the building and saw one of the staff in tears. I asked her what was wrong and she told me that she was a dietician who was from the community and had gone to university in the hopes of returning to lower the rate of diabetes and its complications in the community.

On that particular day she told me she had been at the "dream job" for five years and saw a full day of clients and nothing had changed in those clients in five years despite free intensive dietary counselling. I asked her what she planned to do and she said leave the community permanently and go back to law school. I fully expect to see her at one of the upcoming pipeline protests where her efforts likely will make a difference. Trying to change genetics and behavior is next to impossible.

Regarding equity of access:
"These conflicts aren’t mutually exclusive but in fact are productive tensions that can result in fundamental change, Martin says. But finding a path that takes into account these seemingly divergent views needs a conversation about values. For example, if we truly value equity in Canada, we can’t focus solely on personalized medicine at the expense of population health. We need both. But what does that mean for doctors? “It might mean not being able to do every single thing for every patient every time, in order to have adequate resources to help most of the people most of the time,” she says. It could involve counselling a patient with a sore knee about losing weight and exercising instead of automatically ordering an MRI, at a cost of $1,000 to the system."

From article "Inertia Creeps"
December 11, 2016 | Unregistered CommenterCanary in a Coal Mine
And if the patient ignores your counselling, and returns 10 lbs. heavier, can you then use resources to get the 82 year old on a 2 year wait list their surgery.

The issue of "equity of access" must be link to "equity of responsibility". That is not blame,that is,as a functioning member of society, you have an obligation not to unnecessarily draw resources.

But we set up "social fairness" rules that defeat the propose of moving societies ahead. Tobacco is our best example. We can't remove the product, so we pay, globally to educate not to use, tax it heavily to cover its cost, yet turnaround and subsidy tobacco use for the underprivileged. Perhaps, as we pay for all the injustice to the indigenous, we mandate they tax tobacco at the national rate? It is the inconsistency that is breaking us.
December 11, 2016 | Unregistered CommenterMovingforwardOntario
The government and the profession campaign against tobacco smoking....and then promptly turn around and open the doors to marijuana can expect adverts with MDs smoking pot just as MDs were once seen in cigarette ads...then , one day, there will be a government and medical professional campaign against marijuana usage...with the government opening the door to...?
December 11, 2016 | Unregistered CommenterAndris.
There have been stages of decline that reflectt doctors activity and lack there of. Let' s look just for a moment at our nonallopathic confreres.

Homeopathy and other "trades" were put forth for regulation by then Minister
Smitherman reflecting the interests and desires of the citizens of the

It is now enshrined in regulation as the civic right of citizens to
undertake a holistic belief system that is attractively safe, easy,
superficially consultative and caring. Were the same said of allopathic medicine , would we be where we are now?

You have seen the enemy, it is us.
December 11, 2016 | Unregistered Commentereklimek
Here you go Andris. Don't smoke pot until you're thirty.
December 11, 2016 | Unregistered CommenterCanary in a Coal Mine
We have already seen an explosion of teens smoking pot this year as if it is already legal. The schools remain willfully blind unless there is dealing or a disturbance.

We have three early twenty year old males that we inject with anti-psychotics who all developed their psychosis during high school with heavy daily pot smoking.

The cost to society of a tripling in the number of cases of schizophrenia would be huge if these numbers bear out after legalization. Trudeau is making a mistake but there is such a financial incentive now to legalize that it seems to be a forgone conclusion.

"Also, many of the people who have these disorders are supported by disability income, public health insurance, state mental health systems provide housing for them, and other opportunities. When you add it all up, some have calculated numbers as high as $200 billion a year in the U.S. that goes toward supporting and caring for people with psychotic disorders. So a meaningful reduction in those numbers by prevention of cannabis use in teenagers would still actually have a significant impact on society."
December 11, 2016 | Unregistered CommenterCanary in a Coal Mine
One can liberalize the ability to use,in one's life, marginal things. It is when those things, have adverse issues,and resurface in the public system for support,where the collisions occur.

We should examine the energy dilemma which is mounting. When need energy,but must recognize the negatives that affect us all. Should we all pay the cost on a equitable distributive model (equal tax based on actual use), or continue on with "social fairness" - the weaker get relief.

Health is a mess - energy is worse, and affect us all, unlike health.
December 11, 2016 | Unregistered CommenterMovingforwardOntario
Health affects us all--perhaps not at the same time physically but economically it does, perhaps not overtly at first.
December 11, 2016 | Unregistered CommenterMerrilee Fullerton

Health directly affects about 10% of the population each year.

Energy directly affects 100% each year.

That is one reason central is shock this year. No one of the energy consultants told central. Health just bothers 10% of the population,each year. Energy gets all of us us all the time.

Central is in panic over energy. It is struggling to figure out,how to tax consumption more, when you are consuming less.

Each month,each household is being advised what they are costing the system.

Can you imagine what would happen if each month,each household was presented its health consumption bill?
December 11, 2016 | Unregistered CommenterMovingforwardOntario

Again,I must thank you for operating an open,ad reasonable, site.

I note the Hansard site regrading the OMA involvement with Bill 41, in Ontario, is now a "hot site"in Ontario. First referenced on your site.

Did or did not, the OMA,following all its confirmed multiple meetings, state, "we do not, and will not, support this legislation?". Not tough documentation.
December 11, 2016 | Unregistered CommenterMovingforwardOntario

If you look at the comment section of Shawn Whatley's recent blog post above you will see why it is a "hot site".

I'm sure there are a lot of visits from the OMA executive to Hansard tonight.

To the OMA executive: Did the OMA or its proxies support Bill 41,..Yes or No?
December 11, 2016 | Unregistered CommenterCanary in a Coal Mine
Regarding health affecting only 10% of the population at any given time....It simply depends on what is selected as a measurement. The health premium just gets buried...doesn't it.
Huge human cost of addiction and loss of productivity.
Health and it's costs have an affect on all of us.
December 11, 2016 | Unregistered CommenterMerrilee Fullerton

That was read into Hansard for a political reason. To focus the MDs against the OMA,not against Bill 41. Recognize a political tactic for what it is.

The political issue is,Bill 41. If one wnats it off the books, that must be done before June 2018.

Although central will try to focus all blame on Bill 41,on the OMA, central passed the bill. Although the OMA clearly has issues, don't waste all your time on internal self destruction,which is what central is trying to get you to do.

Since this is a bill passed along party lines, comply with that. All MDs in ridings which supported the bill, should provide their hours starting in January with their closures starting with one session in January,with an increase in closure for each subsequent month. Bill 41 would be removed by October 2017. (10 sessions a week).

Focus on the Bill, not the OMA.
December 12, 2016 | Unregistered CommenterMovingforwardOntario
We want to focus on the Bill...but the distrust of the OMA is palpable...and the OMA wants to lead the assault on Bill 41..many, if not most, would not follow the organization to the outhouse let alone a battle.
December 12, 2016 | Unregistered CommenterAndris.
That is why politics is tough. Have to set priorities, and put others on the back burner.

Do remember lots outside the OMA support Bill 41.
December 12, 2016 | Unregistered CommenterMovingforwardOntario

It is time to play the long gone and the number one priority is to fix the OMA and regain the trust of the membership. As things stand now we don't know who they represent,.....kind of like the new Republican party and their potential ties to the Russians.

I doubt those dates were read into the Hansard for the reasons you state above but rather for the reasons you stated previously which were to establish the OMA's support should the bill's implementation run into trouble before the election. No one would have noticed those remarks had they not been posted on this forum.

This is definitely not about destroying the OMA it is about routing out those that are more interested in putting the corporate OMA and MOH's interests ahead of the membership's interests. The duplicity of these people knows no bounds and they certainly don't represent the interests of the majority of fee for service physicians on the front lines.

We need to 'drain the OMA swamp' and then we can deal with Bill 41 and the consequences hopefully well before the next election date.
December 12, 2016 | Unregistered CommenterCanary in a Coal Mine
Clearly interesting times for the MDs in Ontario.

I doubt it works out well.
December 12, 2016 | Unregistered CommenterMovingforwardOntario
Sorry that should have been "long game".

Mfo what has not worked out well is our current and past OMA representation so we have little to lose by routing the OMA of its MOH sycophants. The swamp must be drained and yes while there are physicians who do support Bill 41 they are the minority.

We know from the auditor general's report that only 45% of family physicians in the province are part of FHNOTs or on salary/AFPs and a good number of these docs are against Bill 41. Almost all of the non-academic specialists are against the bill.

When the members of an organization have nothing to lose that is when the leadership (both the current OMA and MOH) should be fearful. We are at that point and it is time to make things right. With an OMA responsive to its membership good things will happen in Ontario both for physicians and patients.

Yes very interesting times but this kind of disruption of the status quo is now happening all around us.
December 12, 2016 | Unregistered CommenterCanary in a Coal Mine
It clearly will require clear strong leadership to lead the herd of cats.
December 12, 2016 | Unregistered CommenterMovingforwardOntario
Other provincial physician's organizations have managed to represent their membership's interests and not allowed the MOH to corrupt its leadership. We hope to do the same.
December 12, 2016 | Unregistered CommenterCanary in a Coal Mine

Do sort through the agendas of central, to so clearly read into the record of Hansard that information about the OMA. It was a good tactic to further marginalize the MDs. It does two things: clearly impacts the OMA and involvement with Bill 41, but also creates further strains amongst the various MD factions. Both,help central, and assure Bill 41 will stand.

With Bill 41, the funding can be better controlled, and reduced for the physicians. The feds will be involved.

Hansard apparently had more visits than usual over the weekend.
December 12, 2016 | Unregistered CommenterMovingforwardOntario
The nice thing about reading into Hansard is parliamentary privilege. It makes them accountable to the speaker should the actions be called into question. My suspcion is that viewing the cited meetings as support or consultation may be interpretation. Not being present at such meetings one would need the meetings records to judge. The troubling notion here would be if the substance of the Hansard were publicly acknowledged without refutation.
December 12, 2016 | Unregistered Commentereklimek


Nice thing is,those concerned can request recorded documents,to confirm the veracity of statements.

No innuendo, just evidence based. The OMA either cleraly supported,or central manipulated.

Someone needs to figure it out.

Funny how the media isn't investigating this issue of conflict in facts.
December 12, 2016 | Unregistered CommenterMovingforwardOntario
The OMA has been 'gaslighting' the membership for years.
December 12, 2016 | Unregistered CommenterCanary in Coal Mine
Shades of Interhealth Canada:

Someone should ask Minister Philpott. Nursing unions will be bothered.
December 13, 2016 | Unregistered CommenterMerrilee Fullerton
Joke of the day.

"Ontario is proposing a new 10-year federal funding plan that would see Ottawa’s health transfers to the provinces rise by 5.2 per cent a year."
December 13, 2016 | Unregistered CommenterCanary in a Coal Mine

The carbon tax fund has new resources in it. A 7% increase in health is tolerable given the local,provincial, and federal tax increases.
December 13, 2016 | Unregistered CommenterMovingforwardOntario
With a 5.2% request for health, and a GDP running under 2%, clearly program costs are exceeding capacity.

1. Taxes, fees, licenses costs all are going up.
2. We haven't "bent the curve". Mandated entitlements are overwhelming the system.
December 14, 2016 | Unregistered CommenterMovingforwardOntario
Ah yes, divide and conquer. Make one group envious of another. Watch as infighting and internal focus detracts from seeing the bigger picture. OMA, if you fall for this, you are truly self-serving.
December 14, 2016 | Unregistered CommenterMerrilee Fullerton
Law of unintended consequences has begun.

So all these specialists are being hit with clawbacks and reduced OR time which affects the bottom line. Many have let staff go in order to reduce overhead.

The latest trick and it is great for patients is new multi-disciplinary clinics are popping up like weeds in our neighbourhood with all the specialties available for referrals under one roof. Think of them as specialist WICs except you do need a referral.

I'd say at least six have opened in the last six months with great names like "One hour clinic" indicating time from referral to appointment or the "10 to 10 clinic" for hours of operation. They likely have one secretary, a cheap space to lease, and only a desk. Most of these new clinics have at least a dozen specialists listed under the one location, but many also retain their private offices alongside these drive-through clinics. It's an easy way to ramp up volume again especially since the patient demand is clearly there.

So wait lists are actually declining as we get speed consults available same day 12 hours a day.

So much for bending that curve.
December 14, 2016 | Unregistered CommenterCanary in a Coal Mine
From an online source:
"Ontario government offers three-year fee deal to doctors
December 14, 2016by The Canadian Press and staff on
Categories: News
TORONTO | Ontario is looking to target high-billing specialists as it proposes a new three-year budget for physician services that would also see more money for family doctors.

The OMA said they were presented with the offer just one hour before the Minister of Health presented it publicly. In a statement, the OMA called the government’s actions “disrespectful and unacceptable.”

Doctors voted overwhelmingly earlier this year to reject a tentative agreement and have said they won’t return to negotiations unless the government puts binding arbitration in place—something the government won’t agree to.

Physicians play a vital role in the lives of Ontario patients and I know very well how hard they work to deliver the highest quality care to their patients every day
But the current plan for physician services spending expires March 31, so the government has handed the Ontario Medical Association a proposal for an interim plan.

It would cut any physician billings over $1 million by 10%, and any billings over $2 million by 20%.

The proposal would also cut the amount doctors could bill for certain procedures and tests that can be performed more quickly due to technological improvements.

Family doctors would be given an additional 1.4% per year—$185 million—as compensation for specifying evening and weekend hours they must work.

Ontario would also allow 40 doctors per month to join the family health team model, after restricting it last year to 20 per month.

The changes would boost the physician services budget from $11.7 billion to $12.6 billion in 2019/20.

As part of the proposal, the government has said that no further unilateral, across-the-board actions related to physician compensation would be undertaken.

“Physicians play a vital role in the lives of Ontario patients and I know very well how hard they work to deliver the highest quality care to their patients every day,” Health Minister Dr. Eric Hoskins said in a public statement. “Ontarians need investment in their health care system now so that they can get access to the care they need, when they need it.”"
December 14, 2016 | Unregistered CommenterMerrilee Fullerton
And the OMA's response:

Dear Colleagues:

This morning Minister Hoskins released through the media a three-year proposal to the OMA.

The Ministry statement is available here.

Your OMA Board of Directors, together with negotiations advisors Howard Goldblatt and Steven Barrett, are currently reviewing the proposal and we will provide an analysis to you after careful review.

The Board today unanimously passed the following motion:

“That the OMA expresses its outrage with today’s action by the MOHLTC that is disrespectful of, and totally unacceptable to, the physicians of Ontario.”

Our public statement in response to the Ministry’s announcement is here.

I want to be clear:
• The OMA has had no input or consultation to this proposal.
• The Ministry’s actions today mark further evidence of government disrespect toward the medical profession.
• This proposal appears to be a re-tabling of the tentative PSA, which was rejected overwhelmingly by members just months ago.
• The OMA will strongly oppose any further unilateral actions by government against our members.
• Members have clearly stated that a binding dispute resolution mechanism is essential. The Ministry proposal is silent on this critical component.
While we are deeply disappointed with the Minister’s approach, rest assured that your Board and advisors will undertake a measured review of the proposal, and we will provide a comprehensive analysis for you, and make all information available online as quickly as possible.

With thanks for all you do,
December 14, 2016 | Unregistered CommenterCanary in a Coal Mine
Hoskins knew that his proposal would be rejected by both the OMA and the membership as a why did he do it just prior to Christmas?

Is he imposing it anyway?

This is a top down dictatorial health care can anticipate aspects of Bill 41 being announced from high ...Hoskins descending from Mount Sinai at regular intervals, much like Moses, clutching his tablets with the latest commandments towards which we are all supposed to prostrate ourselves.
December 14, 2016 | Unregistered CommenterAndris.
A budget needs to struck, to plan. It takes time to get through the system. This is the budget. The redistribution can be changed but those reduction are going occur. So if the feds go to 5.2%, and the OMA gets 2.5%, who gets the rest.
December 14, 2016 | Unregistered CommenterMovingforwardOntario
Does everybody now understand it's time for a full blown doctor's strike. Let's do it over the holidays so the legislature has to be recalled to legislate the docs back to work. This is fascism, folks, plan and simple. We need a healthcare Arab Spring to turf these losers.
December 14, 2016 | Unregistered CommenterStephen Skyvington
The political reality:

1. Central WILL create a budget.
2. The OMA has been given the budget numbers.
3. There can be a negotiation about how to redistribute within the budget.
4. Central has 2 cards in play,it owns. Bill 41, and budgets.
5.The OMA has lost control of Bill 41, and budgets.
6.The majority of the "non sick" public want to punish the MDs as "too rich".
7. Over 1/3 of the MDs support central creating a fixed budget.
8. The MDs need to have a "single" voice.
9. The OMA, or whatever single voice, needs to deal with two items,budget and Bill 41, at the same time.
10. The public will not tolerate small isolated actions.
11 If action is taken, it needs to be clear about the goals, and direction.
12. Announce the action publicly, and time frame.
13. Announce the endpoint. The public wants to know the end consequence, if nothing can be sorted out.
14. Do NOT underestimate how committed central is to "fixing" their "rich" doctors independence problem. This is solely an "ideological" issue. It has nothing to do with evidence, quality, access. It is solely an ideological struggle about "control".
December 14, 2016 | Unregistered CommenterMovingforwardOntario
The non deal will be imposed on April fools day 2017....when will Bill 41 be fully imposed by then?
December 14, 2016 | Unregistered CommenterAndris.
Is it inconsistent to have a deal negotiated when the basis for the Charter challenge is the request for binding arbitration due to inability to achieve a negotiated agreement?

The details of todays anouncement may be given to the press but some may find it discourteous that the affected are unaware of the same.

Not surprising that the same whipping boys are held up for discipline. But why funding increases for the most expensive form of care delivery? The AG suggested about 1/2 billion $ was given for care that was not provided. Worse when negation could have been contractually implemented, money was not refunded. No mention of this.
December 14, 2016 | Unregistered Commentereklimek this time, is more concerned about "budget-ability", "efficient" use is not a concern,at this time. First enslave,then determine the workload.
December 15, 2016 | Unregistered CommenterMovingforwardOntario
The proposed, soon to be imposed, minuscule fee increase is only for the FHT FPs....evidently there is to be one more push to get the despicable non FHNOT FPs into the FHTs before the lash comes out.

Full enslavement 1 April 2017.....then, as Mfo points out, how to determine and distribute their increased workload....their gruel will be very budgetable.
December 15, 2016 | Unregistered CommenterAndris.
It is my anecdotal experience that many FHT MDs are sticking with the Liberal mantra. They align in hopes of more income. The higher cost of the FHTs makes no sense and at some point the powers that be will cause their income to be adjusted. I wonder if the Liberal leaning MDs will feel betrayed. I suspect not. It is similar at the door where many self-described Liberals seem angry at what their government/party has done but powerless to leave it.
I do wonder.
December 15, 2016 | Unregistered CommenterMerrilee Fullerton
The Liberal government's recent increase for the FHT MDs was simply a way to appease them briefly. A group that is supportive of the Liberal agenda is not a group the Liberals would want to turn on them.

OMA? Are you out there?
December 15, 2016 | Unregistered CommenterMerrilee Fullerton
Anything to add?
December 15, 2016 | Unregistered CommenterMerrilee Fullerton

It is ideology hitting up against the reality of economics.

In good times, all is available as the economy booms. It hasn't boomed in a decade now, and there is little to support a provincial wide boom in the future. Areas of toronto and ottawa may do well, but in general, the province is running out of money for expanding social programs, and has a rise in those drawing their entitlements. It is unlikely that immigration can get us out of this. Affordable housing for immigrants is becoming an issue.
December 15, 2016 | Unregistered CommenterMovingforwardOntario
Seems like there might be a conflict of interest with Eric Hoskin's wife being part of an academic FHT and the MOH fee only being offered to this high cost minority of family physicians. Fifty-five percent of FPs are still on FFS in Ontario.

As Eklimek pointed out yesterday how is it that the practice model that has costed Ontario an extra 500 million dollars (half a billion dollars!) with no difference in outcomes and higher ER use is the one to get a proposed fee increase? The optics of Hoskin's wife being part of this minority group are not good for a COI..
December 15, 2016 | Unregistered CommenterCanary in a Coal Mine
Central has too many balls in the air: trying to negotiate a new F/P/T deal, Bill 41, physician relations, there are more.

I appreciate MfO's previous comment about Central not necessarily worrying about implementation...but they have waited until far too late in their current term. The window available to see any results is too small and I believe the public has had enough of Liberal change that acts as a smokescreen for underlying distress.

I would also be worried about the capacity of the organizations to which implementation is being handed. Soon the 14 LHINs will have to simultaneously grow internally. They will be adding anywhere from 8 - 10 fold of staff numbers and no doubt they will be scrutinized by many to demonstrate that there will be not one iota of additional administration added to their ranks. Indeed some may clamour for less.

Further, monumental home care demands will not abate anytime soon and the newly merged agencies will have no one to point accusatory fingers as some have in the past. There is an old and very wise Indigenous saying: Every time you point a finger in scorn—there are three remaining fingers pointing right back at you will definitely apply here.

And then there are the 70-80 new subLHINs - what to make of them. Each will be lead (as I understand it) by an executive lead and a medical lead. How many appropriate leaders do we have in the province who (a) are skilled enough to take on these roles; (b) understand that we are looking at the entire continuum of care and (c) willing to risk their hard-earned reputations?

On the executive side, I fear that a significant number will be very early careerists with a poor understanding of how things really work seeking title entitlement. On the clinical side, given the sorry state of government-physician relations, it is likely that we will continue to see the appointment of physician-leaders who are "attracted to the trough" [not my characterization but summarized by regular contributors to this blog]. Whether or not they are "in it" for the right reason(s) is beyond my puny mind.

But I digress...

Too many balls in the air. Something is going to give. And when it does all fingers will point to Central likely during the lead up to the next election.

All the opposition parties have to do is STFU. However history dictates that at least of them cannot.

Batten down the hatches - the next 18 months is going to be a wild ride.
December 15, 2016 | Unregistered CommenterExecutive Lead Blogger
Sorry - missed a word in the penultimate sentence:

All the opposition parties have to do is STFU. However history dictates that at least ONE of them cannot.
December 15, 2016 | Unregistered CommenterExecutive Lead Blogger
Thanks for the perspective ELB.
"Significant number will be very early careerists with a poor understanding of how things really work seeking title entitlement."
Quite likely.

As for shutting up, I tend to agree but also keep hearing at the door that people want to know more details on policy. As I tell them, if good policies are brought forward too early, the Liberals adopt them and present them as their own. If policies are brought forward that haven't been thoroughly vetted internally, they are picked apart and used as ammunition by both members of the same party and by others.

So, timing is everything. Great discipline is required. At the same time, voters want to seen authenticity and a willingness to engage. Tough balance but can be had. No room for self-indulgence.
December 15, 2016 | Unregistered CommenterMerrilee Fullerton
I like the image of the minister having difficulties juggling....all he requires is a well aimed kick in the appropriate place....and the various balls will fly in all directions.
December 15, 2016 | Unregistered CommenterAndris.

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