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Minister David Caplan answers questions at the Kergin Lecture

David Caplan
David Caplan

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

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."


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