Drummond Report: Chapter Five Analysis

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I’ve decided to post my partial analysis of the Drummond Report, which was commissioned by the federal government of Canada in 2012. In February of 2012, a document known as the Drummond Report was released into the public realm. Chapter 5 of the report detailed over 100 recommendations for sweeping changes across the health care sector. In particular, setting out terms for reorganizing the structure of our health care system and how health care services can be delivered more efficiently. Under this section of Overall System Planning, the report sets our 5 recommendations, while pointing out that although our health care system possesses some positive qualities, there is still room for improvement. Fragmentation of services within the health care system has been evident. Drummond notes that although Local Health Integration Network’s (LHINs) were initially given a specific set of responsibilities, it has now become apparent that they were not given the proper authority or resources to execute the vision for renewing our health care system. Therefore, the Drummond Report set out 5 recommendations under the category of Overall System Planning to continue the movement towards integrated regional health care delivery.

Recommendation 5-1, under the category of Overall System Planning, pointed to a need to develop and publish a comprehensive plan to address health care challenges over the next 20 years. It encouraged the use of set objectives and solutions built around nine principles ranging from the system being centered on the patient to the coordination and quality of services. In 2012, the Ontario Ministry of Health released the Action Plan for Health Care, which set out the government’s commitment the restructuring of a health care system that is patient centered. Since then, there has been some progression towards completing the recommendation with the release of Patients First: Action Plan for Health Care, a blueprint like document released by the Ontario Ministry of Health in 2014.  The document establishes a framework outlining the need to put patients at the center of the system by focusing on their needs first.  Objectives of the document include: improving access (ex. Faster access to the right care, faster access to specialists), connect services (ex. Delivery of coordinated and integrated care in the community), supporting people and patients (ex. Education, transparency), and protection of our universal public health care system (ex. Making evidence based decisions) (Ministry of Health and Long-Term Care (MOHLTC), 2014). So far, the reaction to the announcement has been positive, with the Ontario Association of Community Care Access Centers, Ontario Hospital’s Association and Registered Practical Nurses Association of Ontario (RPNAO) giving the report a stamp of their approval. Specifically, the RPNAO commends the decision to improve access to home care, in hopes that it will benefit those who need it most, as well as the removal of barriers for nurses to perform their duties and control costs in the system (ex. Prescribing assistive devices) (Registered Practical Nurses Association of Ontario, 2015).

Recommendation 5-2, relates to the evaluation of all proposals for changes that include efficiencies and cost savings relating to the vision and plan developed (Ministry of Finance, 2012). In regards to this portion of the recommendation, there does not seem to be a whole of a transparency into evaluations of all proposals by the Ministry of Health and Long Term Care (MOHLTC). Health Quality Ontario, an arms-length agency of the Ontario government, is a partner in helping to transform Ontario’s health care system to deliver better outcomes of care and cost-effectiveness. Hence, the organization researches and makes recommendations about the uptake, diffusion, and distribution, or removal of health interventions to the MOHLTC, policy-makers, and clinicians. One example included the evaluation of cost-effectiveness and budget impacts in regards to the interventions of chronic disease cohorts as part of the Optimizing Chronic Disease Management (Health Quality Ontario, 2013). Of the 70 potential cost-effective analyses, only 8 met the inclusion criteria set out by the organization. Hence, this is one recent example of the MOHLTC seeking to evaluate all proposals of change by ensuring cost-savings, and efficiencies to the vision were adhered to.

Next, recommendation 5-3 calls for the diversion of patients not requiring acute care in a hospital setting and moving those patients into a more appropriate and less expensive form of care to reduce exposure to new health risks. This recommendation has been addressed in Ontario’s Action Plan for Health Care, a document released by the MOHLTC in 2012. Particularly in the sense that one of the greatest challenges in our system are patients who are being cared for in a hospital setting, but could be cared for at home or in the community if the right supports are in the right place (MOHLTC, 2012). The report focused on 3 principles: support to become healthier, faster access and a stronger link to family health care, and “the right care, at the right time, in the right place”. Limited solutions were offered by the MOHLTC in Ontario’s Health Action Plan to address this recommendation for all forms of patients. Instead the MOHLTC sought to focus on seniors and chronic disease management, which relates to recommendation 5-4 of the Drummond Report. Of particular interest was the exclusion of those suffering from mental illness and addiction, a notable cost driver in our health care system, as Drummond points out. The Commission recommended that more Family Health Teams should be better equipped to more effectively serve this population. It seems that in recent publications the MOHLTC has sought to address prevention, and building a system that is responsive to children, youth, and their families through their mental health strategy released in November 2014. Hence this was addressed in Ontario’s Comprehensive Mental Health and Addictions Strategy, a ten-year comprehensive strategy. The strategy focuses on the promotion of programs in schools and workplaces, a heavy focus on virtual applications to access services, integrated coordination between Health Links and agencies under the Ministry of Children and Youth Services, and increased supportive housing to prevent homelessness (Ministry of Children and Youth Services, 2011). Similar to Ontario’s Health Action Plan, this report also seeks to provide “the right care, at the right time, in the right place”.

Recommendation 5-4 encourages the increased use of home-based care where appropriate, in order to reduce costs. Similar to the previous recommendation, home care was also addressed more specifically in the action plan. Home care has been a significant part of the plan, with the MOHLTC noting that changes in the structuring of the system are required to meet the needs of the current population (MOHLTC, 2012). Although our system still faces patients venturing to emergency rooms, many of who could be better cared for at home or community, the government does intend to take steps in restructuring the system, with a specific focus on seniors and chronic disease management. This would be seen as a positive step, as home care has often been noted as the much cheaper alternative in comparison to the traditional hospital model. Thus, a Senior’s Strategy has been devised which calls for an expansion of house calls, more access to home care through additional support from Personal Service Workers, and the use of care-coordinators who will work in collaboration with health care providers to ensure the right care is being administrated (MOHLTC, 2012). Hence, the new Patients First: Action Plan for Health Care plan sets out a more detailed plan on the types of services that those who need home care will be able to access, including personal support, assistive devices, and increased use of technologies such as tele-homecare (MOHLTC, 2014).

Lastly, recommendation 5-5 focuses on improving the coordination of patient care through the integration of all health services in a given region. It has been noted that a considerable amount of integration has occurred over the last few years across in the health care sector. The MOHLTC addressed the need for local integration reform when they released their Health Action Plan in 2012. Much of the integration that has been seen recently has sought to bring programs and organizations together in an attempt to enhance service delivery to those that need it.  One such example includes the Canadian Mental Health Association (CMHA) integrating some of its services (primary and mental health care) with the LHINs (Canadian Mental Health Association (CMHA), 2014). The mental health system in Ontario has often been fragmented and inaccessible to many Ontarians needing services in this area, integrating services within the LHINs is a positive step. While the CMHA has been supportive for the most part on the recommendations of integration, there have been concerns in regards to the process not involving patients and stakeholders (CMHA, 2014). The organization has also raised concerns in regards to the integration of services just based on a number value, raising concerns that patient’s needs were not always considered in the decision-making process of integrating services. Hence, the organization recommended their own set of steps to be considered when looking to merge and integrate organizations, also emphasizing the need to focus solely on the patient as the primary objective (CMHA, 2014).

As pointed out by the Drummond Report, “the system should be centered on the patient, not the institutions and practitioners in the health care system” (Ministry of Finance, 2012). The recommendations under the Overall System Planning category have seen some promising shifts towards trying to make the health care system more patient centered over the past few years. Particularly with the release of the “Ontario Health Action Plan” and more recently the “Patients First: Action Plan for Health Care” pertaining to the reconfiguration of the health care system. It will most likely be a few years until we see the impact the changes will have on the system, but the recommendations in this category have clearly been acknowledged by the MOHLTC and LHINs in terms of both system planning and integration of services.

Hopefully this gives a little bit of insight into how our healthcare system in Canada is progressing (or how its not) and for those motivated to make effective and efficient changes (like me!) an opportunity to see where improvements can be made.

Cheers,

M

Works Cited:

Canadian Mental Health Association. (2014). Local health system integration act review:     Canadian Mental Health Association, Ontario division. Retrieved from http://ontario.cmha.ca/files/2014/03/LHIN-Presentation-FINAL.pdf

Health Quality Ontario. (2013). Optimizing chronic disease management mega analysis:    economic evaluation. Retrieved from            http://www.hqontario.ca/Portals/0/Documents/eds/ohtas/full-report-ocdm-mega       analysis-economic-evaluation-130912-en.pdf

Ministry of Finance. (2012). The commission on ontario’s public services. Retrieved from            http://www.fin.gov.on.ca/en/reformcommission/chapters/report.pdf

Ministry of Children and Youth Services. (2011). Ontario’s comprehensive mental health  and      addictions strategy. Retrieved from            http://www.children.gov.on.ca/htdocs/English/topics/specialneeds/mentalhealth        strategy.aspx
Ministry of Health and Long-Term Care. (2012). Ontario’s action plan for health care                   Retrieved from            http://www.health.gov.on.ca/en/ms/ecfa/healthy_change/docs/rep_healthychange.pdf
Ministry of Health and Long-Term Care. (2015). Patients first: Action plan for health care Retrieved from            http://www.health.gov.on.ca/en/ms/ecfa/healthy_change/docs/rep_patientsfirst.pdf

Registered Practical Nurses Association of Ontario. (2015). RPNAO applauds government’s         commitment to put patients first. Retrieved from                        http://www.rpnao.org/news/general-news/rpnao-applauds-governments-commitment           put-patients-first