An increase in the number of beds in the health system in Ontario alone will not solve the problem of overcrowding in the hospital, a report said that will shape the reforms of Prime Minister Doug Ford.
The report, officially released Thursday, came from the Prime Minister's Council on improving health care and closing medicine on the corridor, a panel of eleven senior administrators led by a close Ford ally.
The council has the mandate to advise Ford and Christine Elliott, the minister of health in Ontario, to reduce waiting times in the hospital, completing the so-called "medicine on the corridor" and making long-term structural changes in the system.
The report, published on Thursday morning, also says that too many patients go to hospital emergency rooms for conditions that can be treated elsewhere.
While the report says that the province "can not have an adequate number of hospitals or beds for long-term care to meet the health needs of the population," it does not advocate an increase in the number of beds.
"Simply adding more hospitals or beds for long-term care of the system will not solve the health care problem in the Ontario Corridor," a 32-page document said.
She says hospitals do not use existing beds as efficiently as possible and describe "insufficient capacity" in home care and mental health in the community as a key factor.
"There are people in the province who spend time in hospital beds because they can not access other options for health care," the report said.
"Going to a emergency health care department that can be provided somewhere else happens often in Ontario, sometimes because it is the only health facility open 24/7."
While the Council determines what looks at the causes of overcrowding in the hospital, it does not yet provide specific recommendations for change. They should come to their next report, which is due in spring.
It is a safe bet on Ford's government to take its advice. The council is headed by Dr. Ruben Devlin, longtime executive director at Humber River Hospital, former chairman of the Progressive Conservative Party in Ontario and Ford's trusted partner. He was appointed as the day the Ford government took power last June.
"He brings some very useful insights," Elliot told a press conference Wednesday.
The report says the lack of community-based mental health services is partly to blame for pressure on hospitals
"The Council is concerned that patients are unable to access mental health services and addictions when they need it most," the report said.
"Long waiting time for treatment in the community means that sometimes the patient's condition worsens while sitting in the queue, giving them no other option but to seek care through the emergency department."
Devlin has already publicly given strong indications of where he goes with his recommendations for reform.
"We know there are problems with the health system, but how can we fix it?" Devlin told the attendees at Algonquin College in a speech in late November. "People say," You can not make the system better, improve quality and save money. "That's not true."
The biggest immediate challenge facing the Devlin group – and the Ford government – is overcrowding at the hospital.
Employment rates are unsustainable, Devlin said in her speech in November. He pointed to the Ministry of Health's projections for the capacity of the hospitals, which points to the need for the province to have 8,000 hospital beds by 2028, but only 1,700 people are planning.
"Will we build 6,300 hospital beds, with associated capital costs and operating costs, or will we provide different health care?" Devlin asked.
"We need to look at where patients can be treated. If we decide to solve some of the problems of medicine in the corridor, how can we make patients go to their primary care areas rather than appear in the emergency department?"
Devlin also doubts whether it would be wise to provide 41,000 additional places for long-term care, which require projects from the Ministry of Health to meet demand.
"Will we really institutionalize our older citizens?" said Devlin in November, describing long-term care homes as a final option. "We want to provide care for people in the community, at home and wherever they can receive it, outside the institutions."
Devlin wants to redesign service delivery to be committed to the patient and family
"We get a lot of feedback that the navigation of the system is tough," he said. "If we need to go to a family member in long-term care, it's hard. If I need to take my beloved one through cancer care, it's hard."
Devlin has a vision of what she calls "Team Ontario" for the health system. "No matter where you are, we will take care of you. One number to call, one website, someone who moves through the system and will improve for you. In my mind, we have to be here today."
The use of technology to improve the system is another key topic in Devlin's approach. He predicts hospital emergency departments to be able to obtain the entire medical history of the new patient by transferring their Ontario Health Insurance Card (OHIP).
He paints a provincial command center for digital health, and highlights the possibilities for virtual care, such as the patient to check his or her blood pressure at home, and the result is transmitted online to his doctor.
Some health management organizations (HMOs) in the United States provide more than half of their care practically, Devlin told Algonquin College audiences.
Devlin wants "the health ministry and organizational structure that is nimble and effective". He said he would seek "little organizational change".
He made the statement before CBC News that, according to several sources, the Ford government intends to dissolve the Local Health Network Integration Network (LHINs).
He said he renewed his team's challenge this way: "What is the future of health care? How will we transfer healthcare for 20 and 30 years from now?"
At a press conference Wednesday, Ford said his government is focusing on hearing from doctors, nurses and other healthcare professionals at the forefront.
"We are looking for their ideas, and our job is to look at those ideas and then to realize those ideas," Ford said during a statement to the Center for Addiction and Mental Health in Toronto.
"Nothing is worse than a bunch of politicians who tell people of first place, whether it is education, whether it's health care, how to do their job when doing it day and day out."