Minister David Caplan answers questions at the Kergin Lecture
David Caplan
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Ontario Minister of Health
David Caplan opened his Kergin
Lecture at University Rounds
with a story about the minister
who asked his speechwriter
for a 20-minute talk. When he
spoke, it was a disaster. It took
over an hour. Half the audience
fell asleep while the other half
walked out. When he got back
to the office and chastised his
staff for the failure, the speechwriter said, "I did the best
I could. I gave you a good 20-minute speech and two
back-up copies." Minister Caplan then gave an excellent
20-minute talk and took 40 minutes of questions.
He told us that though the economy has forced constraints
on healthcare investment, we are still hiring
9,000 more nurses, deploying more family healthcare
teams, continuing to invest in hospital infrastructure,
reduce wait times in emergency rooms and develop creative
solutions to connect unlinked Ontarians to primary
care. He recounted that investment in hospitals has been
increased from $11 billion to $14 billion and that health
spending is up 35% during the present administration.
The ministry plans to focus the Wait Times Strategy on
general surgery, orthopaedics and ophthalmology and
look for solutions across the entire health care system to
provide greater safety. Alan Hudson will take the lead in
electronic health and Michael Baker will lead the safety
program. Minister Caplan finds the Ministry of Health
an exciting change from his previous portfolio of provincial
infrastructure where he made substantial contributions.
He feels that healthcare is "part of the identity
of Canada"; he follows in the footsteps of his mother
Elinor Caplan who also served as Minister of Health.
Following her advice to focus on a few key areas, he
will emphasize prevention and management of chronic
disease, improvements in mental health and addiction
and conversion to electronic health records. He closed
by promising not to "soar to mediocrity", but to improve
healthcare by listening to people like this audience, in the
spirit of Dr. Kergin.
A well-orchestrated question session followed, reflecting
thoughtful preplanning to cover all the subjects
important to our department. Dean Cathy Whiteside
acknowledged the importance of family doctors and
pointed with pride to the statistic that almost half the
family doctors in Ontario trained at the University of
Toronto. She asked what will be done about specialists,
including generalists within the specialties, like general
surgeons. Minister Caplan pointed to the important
role of Joshua Tepper, Assistant Deputy Minister,
Health Human Resources Strategy, whose responsibility
includes training institutions to help attract people into
healthcare through "Workforce Ontario". The ratio of
retired to workers has shifted from 1:8 to the current
level of 1:5. It will soon become 1:3 and there will be
an increased need for personnel trained in healthcare.
Michael Jewett asked about support of research. "There
is a Ministry of Research and Innovation to help build
made-in-Ontario solutions through basic research as
well as systems research. Our mandate before the switch
to LHINs was operational; today it is more strategic."
Hans Kreder, Chair of Orthopaedic Surgery, asked about
the ministry's vision for long-term financial stability of
healthcare in contrast to cyclic targeted funding programs
such as the wait time initiative. He emphasized
that some LHINs may end up absorbing the worst
problems from the rest of the province. Minister
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Caplan responded that quality measures and outcomes, such
as patient satisfaction, provider satisfaction and clinical
results will be used to distribute resources. He predicts
that healthcare will increase the shift from a department
store model to focussed centres, for example for cardiac,
orthopaedic or cancer care. Hugh Scully underlined the
problem of matching the funding to the costs of patient
care. He emphasized that 30-60% of the patients in the
Toronto Central LHIN come from outside our LHIN.
Caplan acknowledged the problem of managing funding
more precisely. He felt that we will someday have
a formula that lands some place between the global
budget for hospitals and the fee-for-service budget for
physicians. He and Brian Goldman, Sandra Rotman
Chair in Health Sector Strategy at the Rotman School of
Management recently visited Harvard Business School's
famed Professor Michael Porter for advice about funding.
Acknowledging that we do not have this problem
well worked out, he isplanning to bring Michael Porter
up to assist in the analysis of this problem. Robin
Richards raised the Alternate Level Care (ALC) problem,
recounting his experience with two patients who needed
repair of ankle fractures the preceding night, "I did the
one who was an in-patient because he would become an
ALC patient blocking the availability of beds to other
patients needing admission. The out-patient had to be
deferred." In answer, the minister told us that 20,000
beds had been added in the previous administration,
and 7,000 during the current administration. With each
addition of beds and each increase in expenditure, the
number of ALC patients increased. "We have better
drugs and better treatment and they all increase demand
on the healthcare system. We need to drive care back out
into the community, and to work on prevention and the
development of transitional beds that will allow management
of patients until they can be moved into long
term care." He told us that Timmins is working on a
"wrap-around" patient care program to put care around
the home rather than around a hospital bed. Resident
Danny Penello asked about funding for MBA training
of residents, a costly but much-needed investment.
The minister plans to emphasize funding for leadership
courses for physicians, emphasizing that healthcare must
be run by physicians. "We'll continue to support the
leadership course," he said, referring to the Ministry
of Health and Long Term Care's Health Leadership
program. (http://webcontent.rotman.utoronto.ca/open/ health_leadership/program.asp)
In answer to Dimitri Anastakis' concerns about the
unstandardized financial reporting across jurisdictions
throughout the province, the minister told us that they
have asked KPMG to do an effectiveness analysis across
the LHINs. In general, the LHINs system is doing better
with managing the financial aspects of healthcare
than the ministry had in the past, and there is more to
come from this analysis. Tirone David pointed out that
the expectation for healthcare services has increased in
Canada far above the more realistic attitudes among the
public in France and the United Kingdom. He asked
whether we shouldn't "teach doctors to bring the bar
down - life is finite". Minister Caplan said that at every
meeting he attends with healthcare leaders, we are envied
for our system. "People certainly need to take care of
themselves and to improve their overall wellness, nevertheless,
as an Ontarian I expect excellence in diagnosis
and treatment and I see it throughout the system."
M.M.
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