Now Underway – Consultation on a Future Framework for Palliative Care in Canada

The federal government passed a private member’s bill (C-277), the Framework on Palliative Care in Canada Act, on December 12, 2017. As required by the Act, the federal government is consulting on the future of palliative care in Canada – specifically, in the context of the availability of physician-assisted death. The goal is to develop a framework for access to high quality palliative care in hospitals, home care, long-term care facilities and residential hospices.

According to is website, the federal government is now seeking input from health care professionals across Canada, health system experts, caregivers, people living with life-threatening illnesses, and interested Canadians about their long-term vision for palliative care in Canada, including access, education, support and training for caregivers. The consultation seeks ideas and experiences on the following topics:

  • Definition of palliative care
  • Advance care planning
  • Person and family-centred care
  • Challenges facing people living with life-threatening illness
  • Consistent access to palliative care
  • Special populations (i.e., Indigenous, infants, children and youth, homeless, rural and remote communities, LGBTQ2, people living with disabilities, immigrants and refugees, and others)
  • Health care provider education, training and supports
  • Caregiver training and supports
  • Community engagement
  • Bereavement

This is a great opportunity to have your organization’s voice heard and to give your administrators and health care staff a chance to contribute to the development of public policy.  The voices of health care providers, caregivers and their families are also an integral part of these consultations about the future of palliative care in Canada.

Submissions are due by July 13, 2018 and may be made in writing or on-line.  For help making a submission, please get in touch with me: spalter@ddohealthlaw.com. If you are interested in reading the Act, it is available here: http://www.parl.ca/DocumentViewer/en/42-1/bill/C-277/royal-assent

By December 11, 2018, the report of the federal Minister of Health that sets out the framework for palliative care must be presented to the House of Parliament and 10 days after that the report must be posted on Health Canada’s website.  Watch this blog to stay informed.

 

 

Transfer of CCACs to LHINs is complete

Bill 41, the Patients First Act, provided for the CCACs to be merged into the LHINs by Ministerial order.  That process is now complete.  The CCACs began transitioning on May 3rd with the North Simcoe Muskoka LHIN, and ended on June 21st with the Central East LHIN.

Below is the summary chart showing the transfer dates for the LHINs:

LHIN Transfer Date
NSM May 3, 2017
HNHB May 10, 2017
WW May 17, 2017
SE May 17, 2017
SW May 24, 2017
CHAM May 24, 2017
MH May 31, 2017
CW May 31, 2017
NE May 31, 2017
TC June 7, 2017
CENT June 7, 2017
ESC June 21, 2017
NW June 21, 2017
CE June 21, 2017

 

Ontario’s new Patient Ombudsman

Recently here at DDO we were discussing the role and powers of the Patient Ombudsman. The Patient Ombudsman has jurisdiction to resolve complaints about health service organizations such as public hospitals, long-term care facilities, and certain services provided by the LHINs.

The Patient Ombudsman is an office of last resort – so people having complaints must first explore resolution directly with their health service organization. When a complaint is filed, the Patient Ombudsman will ensure that no other body has jurisdiction over the complaint and, with patient consent, will try to facilitate resolution by contacting the health sector organization.

The Patient Ombudsman may investigate complaints where a facilitated resolution is unsuccessful. Health sector organizations such as hospitals and long-term care homes will be well placed to respond to inquiries from the Patient Ombudsman if their internal processes for addressing complaints are robust, thorough, and comprehensive.

For more information about the Patient Ombudsman, for help in crafting a robust complaint process, or for help in responding to an inquiry from the PO, please contact me at spalter@ddohealthlaw.com.

Health Sector Supply Chain Strategy – Expert Panel Report

In May of 2017, the Healthcare Sector Supply Chain Strategy Expert Panel (the “Panel“) released its report titled “Advancing Healthcare in Ontario: Optimizing the Healthcare Supply Chain – A New Model“. The Panel was established by the Government of Ontario in 2016 to review Ontario’s current healthcare procurement strategies and to recommend strategic changes.

The Panel envisions a new supply chain strategy being implemented in Ontario over a 3-year period and provides 12 recommendation for its creation and implementation. These are categorized using the five overarching themes below:

  1. Ontario should have an integrated healthcare supply chain.
  2. Buying decisions should be made with a focus on patients and clinical requirements.
  3. The new procurement strategy should enable value-based procurement and innovation.
  4. The strategy should include means of monitoring and improving on performance, value, quality and safety.
  5. How to transition to the new supply chain strategy.

We list below the recommendations that the Panel made to further these 5 overarching themes.

Moving to an Integrated Ontario Healthcare Supply Chain

  1. A Single Integrated Structure: Organization Consolidation. The Panel recommends that Ontario create a single consolidated organization (“ServiceCo“) to manage Ontario’s healthcare supply chain. The Panel believes that “one crown agency or not-for-profit model is best positioned to deliver the opportunities outlined in this report”. The Panel envisions the assets of Ontario’s existing healthcare shared services organizations (“SSOs“) could be leveraged to support ServiceCo. The Panel imagines that the existing SSOs could be integrated, or their assets used, to create ServiceCo.
  2. ServiceCo’s Mandate, Scope & Scale. The Panel recommends that ServiceCo take responsibility for essentially all steps in the supply chain process for all non-payroll categories of healthcare spending.
  3. Toward Fuller Healthcare Participation. The Panel recommends that the following healthcare providers be mandated to participate in ServiceCo: (i) publicly-funded hospitals; (ii) LHINs and the home and community care services they manage; and (iii) LHIN-funded community agencies. The Panel also recommends that other healthcare partners be encouraged to seek the services of ServiceCo (such as non-profit and for-profit long-term care homes and Crown agencies.
  4. A Robust Financial and Business Model. The Panel recommends that ServiceCo’s revenues should  come from, amongst other sources, a mix of (i) the existing in-house budget of participating healthcare providers; (ii) the budgets of existing SSOs; and (iii) fees that will be established based on the total operating budgets of the publicly funded healthcare organizations to whom ServiceCo provides services.

Encouraging Patient and Clinical Focused Buying Decisions

  1. Strengthening Clinical Engagement. The Panel recommends that clinical and medical expert “advisory panels” be established to provide advice and recommendations to ServiceCo with respect to procurement approaches and evaluations so that consideration of innovative technologies, clinical approaches and patient outcomes become a more significant consideration in procurement processes.

Taking a New Approach to Procurement

  1. Building Capacity to Undertake Value-Based Procurement. The Panel has recommended that “value-based procurement” be a central principle for ServiceCo. The Panel believes a focus on value-based procurement will allow ServiceCo to carry on supply chain activities in a manner that will improve patient outcomes across the full continuum of care.
  2. Procuring Innovative Products and Solutions. The Panel believes that continuous innovation is critical for the improvement of Ontario’s healthcare system. Based on this belief, the Panel recommends that ServiceCo be provided with the expertise, infrastructure, and market relationships to identify and procure “new products and solutions rapidly and proactively”.
  3. Addressing the Regulatory Environment. To facilitate value-based procurement and the continuous implementation of innovative technologies, the Panel recommends that Ontario’s current procurement policy framework – including the Broader Public Sector Procurement Directive – be reviewed and updated as necessary. The Panel proposed that clear and consistent instructions on the application of the Directive could help avoid the “overly cautious behaviour” that was consistently reported to the Panel during its review of Ontario’s current supply chain model.

Performance, Value, Quality & Improved Safety

  1. Data Integration and Analysis, Performance, and Reporting Framework. The Panel recommends the development of a robust data collection and analysis capability for ServiceCo. It is hoped that such data collection and analyses will create business intelligence that would allow for accurate evaluation of key performance metrics and the development of value-based procurement.
  2. Mechanisms for Feedback, Engagement, and Inclusion. The Panel recommends the creation of feedback mechanisms for healthcare providers, patients, and vendors to provide feedback on the performance of ServiceCo, as well as the products, services and solutions that it procures.
  3. A Framework for Full Product Traceability. To improve both patient safety and business analytics, the Panel recommends that ServiceCo adopt a bar-coding standard that can provide full traceability of products to patients.

Moving Forward

  1. Transition to a New Model. The Panel recommends the appointment of a Transition Board with a mandate not to exceed 12 months. The Transition Board will, among other things, be asked to: establish ServiceCo; transition assets to ServiceCo; and develop a strategic business plan for ServiceCo. The Panel recommends that the assets and services of existing SSOs be managed by the Transition Board during the term of its mandate.

The Ministry of Health and Long-Term Care has stated on its website that:

Over the coming months, the government will review the panel’s recommendations, and engage section partners in a dialogue that considers building and modernizing our supply chain model in healthcare, leveraging the investments and advances already made.

Our Take on the Report

We work on a daily basis with many of the healthcare procurement SSOs across the Province. They have revolutionized procurement in Ontario healthcare, introducing rigour, specialization, and expertise to a back-office activity that was often poorly performed by hospitals less than a decade ago.

Yes, the pendulum has been swinging back and forth over the last decade. From sloppy and decentralized practices, the Supply Chain Guidelines and the replacement BPS Procurement Directive introduced rules – and rigidity – to the procurement process. Now that we have lived with the BPS Directive for several years, SSOs and hospitals are becoming more comfortable with the rules and are innovating to work within them.

There can always be more improvements in healthcare procurement. But the changes should be made in a way that hospitals can buy into and own the changes – and the resulting ServiceCo. SSOs are now governed by the hospitals that use their services. Stepping away from hands-on governance will be a challenge for hospitals. Any governance changes should be gradual, so that hospitals can build trust in ServiceCo, its board and its leaders.

We anticipate that change will come, but slower (and steadier) than the Panel recommends.

12