Anti-Social Changes to Health Care Legislation and RegulationsPublic health care advocates in Ontario point out that laws passed in 2019 and 2020 make significant changes to the way home and community care services are organized and delivered which are causing serious problems in caring for the sick and elderly. These changes have a number of consequences that are destructive to the public health care system including lack of standardization across the province, deregulation, fragmentation and loss of consistency in services, and increased privatization. For example, Ontario Health Teams (OHTs) and Health Service Providers (HSPs) contain both for-profit and not-for-profit organizations, including private home care agencies which creates a conflict of interest where organizations making decisions about service coordination and delivery are also bidding on contracts to deliver those services.
It follows and complements two pieces of legislation passed in 2019 which were part of major restructuring of the health care system to serve private interests. The People's Health Care Act, 2019 and the Connecting Care Act, 2019 (CCA) led to the creation of a new agency, Ontario Health, which is responsible for managing health care services throughout the province, including the elimination of the regional health authorities, Local Health Integration Networks (LHINs), as well as other organizations including Cancer Care Ontario and eHealth Ontario. The legislation also created a new model of care, OHTs, which the Ministry of Health describes as "a new way of organizing and delivering care that is more connected to patients in their local communities. Under Ontario Health Teams, health care providers (including hospitals, doctors and home and community care providers) work as one coordinated team -- no matter where they provide care... Ontario Health Teams are groups of providers and organizations that, at maturity, will be clinically and fiscally accountable for delivering a full and coordinated continuum of care to a defined population." The transition from LHINs to OHTs is in progress so health care services are currently being regionally managed by a mix of the two. The operation of Ontario Health is governed by a board of directors, many of whom are current or past executives of, for example, TD Bank, Invesco Canada, Brookfield Asset Management, GE Canada, the C.D. Howe Institute, and others.[1] Bill 175 repealed the Home and Community Services Act, 1994 and moved home and community care into the CCA, and makes OHTs and other HSPs responsible for the coordination and delivery of these services. Another result is that much of what was included in the previous legislation was moved to regulations and policies, including the definition of community care services, the settings of care, eligibility for services, an updated version of the Bill of Rights and requirements for handling complaints. Unlike changes to legislation, which require decisions of the legislature, changes to policies and regulations can be made by cabinet, without any public consultation or scrutiny. Giving ministries carte blanche to privatize on the basis of introducing regulations which go against the public interest is a form of legalizing impunity which health care workers do not accept. Note1. Ontario Health Board of Directors, Ontario Health website. (Photos: WF, OFL)
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Ontario Bill 175,
the Connecting People to Home and Community
Care Act, 2020 was introduced in the
Ontario legislature on February 25, 2020 and
received royal assent on July 8, 2020.