Dr. Bob Bell (GP, surgeon, former hospital CEO, and former deputy minister of health) echoes Care Watch’s concerns about the proposed Ontario health teams (OHTs), which will take over the delivery of Ontario’s health services. In a September 4^th opinion in the Toronto Star, Dr. Bell notes that the majority of proposed OHTs are hospital-led and, under the government’s “low rules environment”, no provision has been made to ensure resources for home care and community support services on a long-term basis. He notes that, “With the opportunity to realign budgets for provider organizations within a region, will hospitals be able to resist the temptation to consolidate regional budgets to gradually provide better hospital funding?” Given that, as Dr. Bell points out, hospitals also face underfunding, it will be very difficult for them to resist this temptation. This is of particular concern because “…85 per cent of home-care visits are provided to patients referred directly from the community with no hospital involvement”.  How will those visits be funded and protected? There is no clarity regarding the management of necessary home care and community support services. There is also no known provincial provision to ensure availability of the current $4 billion for home care/community support services.

Each OHT will create its own home care/community support service system. There is no clear provision for retaining current or improving standards respecting, for example, the range of services to be provided; levels of care; and PSW working conditions and compensation. There is no clear provision for consistency across teams.

Care Watch concurs with Dr. Bell – OHTs seem at risk of creating a fragmented, chaotic approach to provincial health services planning and delivery.

We need to ask:

• How will resources for home care and community support services be secured and protected from absorption into hospital services?
• How will people who need assistance get services if they are coming from the community rather than from a hospital?
• What home care and community support services will be available to all Ontarians who need such services?
• What level of care standards will be guaranteed?
• What working conditions for PSW and other community workers will apply?