Don’t panic over Ontario’s looming health care overhaul, former top bureaucrat says

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A prominent member of Premier Doug Ford’s health advisory council is urging Ontarians not to panic over a looming overhaul of the health-care system, saying “relax” until the plan is made public.

The advice from Michael Decter, deputy health minister in former premier Bob Rae’s NDP government of the early 1990s, comes amid conflicting versions of the shape a “transformation” acknowledged by Health Minister Christine Elliott will take following the leak of confidential draft legislation.

While New Democrat Leader Andrea Horwath, whose office has received other leaked documents related to the creation of a new health-care “super agency” with powers to increase privatization of medical services, Elliott flatly denies the charge and has insisted nothing is “finalized.”

“People should just relax a little bit and not see this as the start of a war,” Decter said Wednesday, noting he was speaking for himself and not for the council headed by Dr. Rueben Devlin.

“Nothing really moves that fast in health care.”

A “status report” from the second week in January warns of several risks, including moving home care from existing Local Health Integration Networks to new integrated care models could lead to “service disruption” during the transition period and “potential labour disruption” by care co-ordinators who are members of the Ontario Nursing Association, whose labour contracts expire in March.

“Ford and his government have been doing all this behind closed doors, in secret,” Horwath said in a statement.

Elliott’s office said earlier this week that “much of the material released by the NDP has ever even crossed the minister’s desk, let alone made it to the cabinet table.”

However, the super agency has been incorporated as the Health Program Initiative, as indicated in the documents released by Horwath, according to a search of public records.

Decter, who has advised governments of all three stripes on health-care matters over the last three decades, said health is a massive ministry and that opposition parties need to be cautious when receiving leaked papers.

“I’m sure all of the documents are real but when the minister says I never saw those ones I tend to believe her. I had a minister that used to say that to me fairly often: ‘where the heck did this come from?’”

In regard to the leak, an unnamed civil servant was fired Monday by acting secretary of cabinet Steven Davidson for breaking the oath of confidentiality, with the Ontario Provincial Police anti-rackets squad now considering whether to investigate. Horwath’s office said it has not been contacted by the OPP.

In the meantime, the bargaining agent representing civil service managers and professional staff is representing the worker in a grievance, as is “routine” in cases of dismissal.

“We have no comment on the concern expressed by some that the person dismissed is not the person who leaked material to the NDP,” the Association of Management, Administrative and Professional Crown Employees of Ontario.

Horwath and others including former deputy health minister Dr. Bob Bell, who served under the most recent Liberal government, have raised concerns that the world-renowned Cancer Care Ontario would be subsumed into the super agency and lose effectiveness.

But Decter said this could be a way to use the cancer agency’s expertise and model to improve mental health and other forms of care.

“Rather than seeing it as cancer loses, maybe you see it as mental health learns from cancer how you run something province-wide and measure quality,” he added, noting Cancer Care Ontario is already helping improve kidney dialysis.

Rob Ferguson is a Toronto-based reporter covering Ontario politics. Follow him on Twitter: @robferguson1

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Ford government autism program overhaul met with outrage by some parents who fear kids will lose out

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Parents of children with autism will be given the power to choose what services they want — but there will be a total family budget of $140,000 and high-earners will no longer be eligible.

In an announcement Wednesday in Toronto, Lisa MacLeod, the minister of children, community and social services, also said the government is doubling funding for diagnostic hubs and planning to clear the 23,000-child wait-list within the next 18 months.

Waiting for a diagnosis — which currently can take more than two years — can “throw a family into crisis,” said MacLeod.

“This is the best approach and the most fair approach to make sure every single child” is well-served,” she added.

The amount of funding will depend on the length of time a child will be in the program, and support will be targeted to lower- and middle-income families. Families with annual incomes above $250,000 will no longer be eligible for funding, MacLeod said.

“It ignores the fact that there are some kids on the severe end of the spectrum requiring tons of support and time and those on the mild end” who don’t, said Kirby-McIntosh.

“I’m diabetic and so is my husband, but it doesn’t make sense to give us the same amount of insulin.”

She said she’s “terrified” about means testing. Just because families are making more than $250,000 “doesn’t mean they have $80,000 lying around in the couch cushions.”

She said she was “devastated” by the direction the government is headed.

In her announcement, MacLeod said the government is doubling funding for five diagnostic hubs to $5.5 million a year for the next two years to address the diagnosis waiting list of 2,400 children, who currently wait on average for 31 weeks.

“Today, almost three out of every four children who require autism supports continue to be stranded on wait-lists, due to the cynicism and incompetence of the previous government,” MacLeod told reporters at Holland Bloorview Kids Rehabilitation Hospital, one of diagnostic hubs.

“The parents of these children have told me they are feeling abandoned. We cannot, in good conscience, continue treating these parents and children like lower-class citizens, so we are introducing reforms to provide them with the fairness and equality they deserve.”

Parents of children with autism launched protests against the previous Liberal government in the spring of 2016 when it announced that kids over age 5 would be cut off from funding for intensive therapy.

The Liberals ultimately backed down and installed a new minister — Michael Coteau — to roll out a new program, which proved to be much more popular with parents.

Coteau announced more funding, a quicker start date, no age cut-offs, and a direct funding option to allow parents to either receive funding to pay for private therapy or use government-funded services.

Wednesday’s changes announced by the Progressive Conservative government include establishing a new agency to help families register for the program, assess their funding eligibility, distribute the money and help them choose which services to purchase.

Clinical supervisors will have to meet program qualifications by April 1, 2021 and the government will be publishing a list of verified service providers.

With files from The Canadian Press

Kristin Rushowy is a Toronto-based reporter covering Ontario politics. Follow her on Twitter: @krushowy

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Ford government to overhaul autism services, give cash directly to families

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The Ford government is planning to overhaul children’s autism services by taking money away from regional agencies and putting funding directly into the hands of families to choose the care they want, the Star has learned.

Major autism service providers have already been informed of the changes that will also address the massive wait-list of 23,000 children and target money and services to those under the age of 6, which research has shown to be the most crucial time for treatment.

Funding will not be cut, but redistributed, sources told the Star.

An announcement is expected in the coming days.

“I would applaud them — early intervention is really important,” said one service provider. “These kids get on a wait list, and they miss a key window.”

“Everyone in the sector would be happy to support something that improves the wait list,” the provider said. “But we are not sure how they are going to change the wait list.”

Senior government sources told the Star the Ministry of Children, Community and Social Services is going to focus on the wait lists — for diagnosis, funding and treatment — as well as providing more equitable services and better oversight of therapy providers.

“The scope of the problem we inherited — this was a significant problem,” said one source, noting three of four children are currently not receiving the autism supports they need, calling the wait lists “unconscionable.”

“Those are valuable days, weeks, months, and the one piece of science we know in this area … is that having behavioural intervention below the age of 6 is when you make the biggest impact and have the most likelihood to make a difference,” said the government source.

Many parents like the idea of choosing where the funding is spent, rather than having to deal with service providers who can be in a conflict-of-interest when they control the funding. The current system is a mix of the two, with agencies controlling the wait lists and who gets the money.

But rumours the Ford government is planning to move back to funding based on age have struck fear in both clinicians and families, said Tracie Lindblad, clinical director at Monarch House, an Oakville clinic that offers services for children with developmental disabilities, including applied behaviour analysis (ABA) therapy for kids with autism.

Lindblad says Monarch House, which also has clinics in Waterloo and Ottawa, as well as British Columbia and Saskatchewan, has experience working with families in B.C. where the government imposes arbitrary funding caps based on a child’s age. And, she says, the approach is failing.

(In B.C., children under 6 diagnosed with autism spectrum disorder receive $22,000 a year for autism services while those between the ages of 6 and 18 get $5,000, regardless of their needs.)

“We know it’s not working there. Why would the Ford government want to bring it here?” she asked.

Lindblad said the previous Liberal government was “on the right track” when it increased funding and extended eligibility for ABA beyond age 5, and allowed parents to choose between agency-based therapy or privately purchased services.

Milton mom Maria Garito doesn’t like the current system — she does not believe service providers spend money efficiently — but nor does she think moving to a direct-funding model for parents is the answer.

Her 4-year-old son Max has been on a wait list for more than two years and right now her family can’t afford the behavioural therapy he needs, so she takes time off work to care for him and they pay out-of-pocket for speech therapy and other programs.

A direct-funding system means “some children get many hours of service, and many children get none,” said Garito, who believes it is open to abuse. She also doesn’t think there are enough services as is for families to spend any money they receive.

“The worst part of this model is that many of the private centres sign off on unnecessary services, because they (stand) to make profits knowing full well the government” will pay hundreds of thousands of dollars, she added, wondering if money would be better spent on more staffing and programs — and better oversight — of government-funded regional centres.

New Democrat MPP Monique Taylor, her party’s children services critic, said direct funding is not an option for everyone. “In Northern Ontario — the services just would not be available … they have nowhere to spend (the money). That’s a real issue in smaller communities in the north.”

And she said stressed families don’t have the time, knowledge “or the energy to be an employer,” which is what the direct-funding option would essentially entail. “For a lot of reasons, a lot of families just won’t be able to manage. It’s very concerning.”

Lindblad said the new Ontario Autism Program, introduced by the former Liberal government, while successful in some areas, failed to provide government regulation of autism professionals, no quality assurance oversight or peer review of outcomes.

But those are things that could have been fixed, Lindblad said.

“I am concerned we’re going to go from one mistake to another mistake and not achieve our goal of ensuring all individuals achieve their best outcome,” she said.

A PC government source said oversight of professionals will be part of the coming changes. “There’s no list that says where you should go for service” as there is in other jurisdictions like B.C.

In 2016, the Liberals had pledged $533 million over five years for autism.

Minister Lisa MacLeod announced $100 million in emergency funding after the PCs took office, to keep the system going, which government sources describe as “verging on the brink of bankruptcy.”

“The most responsible way to use publicly funded dollars is to consider each child’s need,” said Nancy Marchese, a psychologist and ABA therapist in Richmond Hill, adding that a “rate card” for services would protect families and ensure public funds are spent responsibly.

The parent-led Ontario Autism Coalition stormed the Legislature in 2016 under the previous Liberal government over age-based funding caps, and coalition president Laura Kirby-McIntosh, said her group will fight any provincial move to the B.C. model.

PC MPP Amy Fee, in an opinion piece for the Star, said “early diagnosis will be one of our key areas of focus.”

“We need to respect families. We need to work to clear these wait-lists and put the decision-making back in the hands of parents. We need to get the youngest children into autism services as soon as possible.

Fee — who has two children diagnosed with autism spectrum disorder — is the parliamentary assistant to MacLeod and has spoken to parents across the province about services.

“We’re going to put families in control, and bring equity to a broken system,” she wrote.

Kristin Rushowy is a Toronto-based reporter covering Ontario politics. Follow her on Twitter: @krushowy

Laurie Monsebraaten is a Toronto-based reporter covering social justice. Follow her on Twitter: @lmonseb

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Why Canada Post needs an overhaul

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In its pricing, logistics and financial controls, Canada Post is running like a top.

The Canada Post Group of Companies, as it’s formally known, is consistently profitable. Net income in its latest year was $144 million, a near-doubling over the previous year. The United States Postal Service (USPS), by sharp contrast, reported a loss of almost $4 billion (U.S.) in the fiscal 2018 results it released Nov. 14 – the USPS’s 12th straight year of losses.

The Canada Post Group of Companies, as it’s formally known, is consistently profitable. Net income in its latest year was $144 million, a near-doubling over the previous year.
The Canada Post Group of Companies, as it’s formally known, is consistently profitable. Net income in its latest year was $144 million, a near-doubling over the previous year.  (Darren Calabrese / THE CANADIAN PRESS FILE PHOTO)

In a transformation for the record books, Canada Post reinvented itself, cutting its reliance on a lettermail business that the Internet has been killing off, and becoming a parcel-delivery service tailor-made for the new world of e-commerce.

Unfortunately, there was no parallel reinvention of Canada Post’s labour-relations practices.

In recent years I’ve spoken with about 20 postal workers, mostly letter-carriers and truck drivers. And about 20 of them have brushed off my thanks for their excellent service to complain of stress from overwork, lack of job security, and meddlesome, insensitive supervisors.

There is a cure for this, short of another round of rotating strikes. Canada Post needs a new board chair and a new CEO and top management team focused on building a harmonious workplace.

What we’ve learned in the latest dispute is that even the greatest expertise in logistics, automation efficiencies and financial controls is insufficient to prevent an otherwise estimable enterprise from grinding to a halt because of chronic and widespread disrespectful treatment of employees.

Will Canadian business ever kick its U.S. addiction?

Canada might just be more committed to global trade than any other country, in striking contrast with a Canadian business sector that is perhaps the least intrepid among its world peers.

It’s worth noting that the Americans who cracked global markets were the likes of IBM Corp., Coca-Cola Co., Procter & Gamble Co., Microsoft Corp. and most recently Facebook Inc. and Amazon.com Inc.

Their Canadian counterparts in that role have been politicians: Lester Pearson (the 1965 Auto Pact), Pierre Trudeau (the first “Team Canada” trade missions to China), Brian Mulroney and Jean Chrétien (the Canada-U.S. Free Trade Agreement and its successor, the North American Free Trade Agreement, or NAFTA) and Stephen Harper and Justin Trudeau (the Canada-EU Comprehensive Economic and Trade Agreement, or CETA; the Comprehensive and Progressive Agreement for Trans-Pacific Partnership, or CPTPP; and a renegotiated NAFTA, the U.S.-Mexico-Canada Agreement, or USMCA).

In last week’s federal mini-budget, Ottawa is yet again striving to help Canadian business strengthen and widen its export prowess. The feds are spending $14 billion on accelerated corporate investment writeoffs, and more than $1 billion to upgrade Canadian transportation infrastructure to get Canadian goods to export markets beyond the U.S.

Yet it’s reasonable to wonder if that will do any good.

A recent analysis shows that European exporters to Canada are making much more use of CETA than Canadian businesses. And the federal finance ministry notes that Canada is far behind its G-7 peers in exports to emerging markets, the world’s fastest-growing economies.

The real solution might be federal largesse that is earned only by Canadian firms able to report that more than 30 per cent of their exports are to non-U.S. markets.

Stunning fall of a corporate superstar

The downfall of Carlos Ghosn is a reminder that reputation is fleeting.

A brilliant industrial strategist with an iron gut for risk, Ghosn revived one major automaker, Renault S.A., and rescued another, Nissan Motor Co., that had one foot in the grave.

Ghosn was also an empire builder: The enterprise from which he retired, last year, combined Renault, Nissan and Mitsubishi Motors Corp.

But on Nov. 19, Ghosn was detained by Japanese authorities on suspicions that Ghosn had for years understated his compensation in regulatory filings. That’s a polite way of describing an alleged tax cheat.

It has since been revealed that Ghosn raided Nissan’s treasury to buy at least five homes.

Though he has not been convicted of anything, Ghosn’s reputation is already in ruins. A Japanese press that long fawned over him now dismisses Ghosn as having gone from “hero to zero.”

At the height of his renown, Ghosn was a populist hero in Japan, an exemplar of continued Japanese industrial strength in the shadow of a rising China. He was routinely mobbed for autographs during plant tours, and starred in a series of manga comic books.

But today, Ghosn is a symbol of the widespread moral rot in Japanese industry, notably the auto sector, source of the deadly exploding air bag (Takata Corp.), a quality scandal at Mitsubishi, and the recall last year of 1.2 million Nissan vehicles whose quality approval for years had been conducted by unqualified inspectors.

The global auto industry has lost two giants this year. But the late Sergio Marchionne, who died in July after turning around Fiat SpA and Chrysler Corp., did not leave in disgrace as Ghosn has.

David Olive is a business columnist based in Toronto. Follow him on Twitter: @TheGrtRecession

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Coroner’s panel calls for overhaul of Ontario child protection system

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A scathing report from Ontario’s Coroner urges Queen’s Park to step-up reform of the province’s child protection system in the wake of 12 deaths of mostly Indigenous youths in residential care facilities.

“Change is necessary, and the need is urgent,” said the report, written by a panel of experts appointed by Chief Coroner Dirk Huyer last November to examine the spike of deaths between January 2014 and July 2017.

Tammy Keeash from North Caribou Lake First Nation was living in a group home when she disappeared. Her body was later discovered in the Neebing-McIntyre Floodway in Thunder Bay.
Tammy Keeash from North Caribou Lake First Nation was living in a group home when she disappeared. Her body was later discovered in the Neebing-McIntyre Floodway in Thunder Bay.  (FACEBOOK)

“Despite complex histories and the high-risk nature of these young people’s lives, intervention was minimal and sometimes non-existent,” said the panel in a withering report released Tuesday.

“Child protection agencies seemed to be overwhelmingly concerned with immediate risk and more often than not failed to address longer term risks, which the panel often felt were both predictable and preventable,” it said.

Eight of the 12 youths were Indigenous and all were in the care of children’s aid societies or Indigenous well-being societies where they were experienced multiple short-term placements. On average, the young people were moved 12 times in their short lives.

“Ontario’s most vulnerable young people, those with multiple needs in complex environments, need a system that is intentionally designed to provide wholistic, early, ongoing and prevention-focused care and treatment that works for them, their families and their communities — and they need it now,” the report concludes.

In the wake of the report, Nishnawbe Aski Nation (NAN) Grand Chief Alvin Fiddler wants Ottawa and Queen’s Park to strike a committee to ensure the panel’s recommendations are carried out and that the tragedies aren’t repeated.

“This report shows the urgent need for change in the care of at-risk youth,” he said in a statement. “I thank the chief coroner and panel members for this report, which echoes our fears over the treatment of youth in the child-welfare system. I also acknowledge the families who shared the stories of these youth during this investigation, and we share their grief during this difficult process.”

The developmental and mental health challenges faced by the Indigenous youth who died were compounded by systemic barriers including inadequate shelter, water, and food in their communities, the panel found. And many of them did not have equitable access to education, health care, social services, and recreational activities, the report said.

The panel, which included a team of 13 youths with experience in the system, noted the young people who died had minimal opportunity to have a voice in their care.

Instead, “their attempts to communicate their needs were often overlooked, ignored and characterized as “attention-seeking,” the panel found.

Ontario’s Child Advocate Irwin Elman was outraged by the panel’s findings.

“Enough is enough. Enough loss of life. That young people should survive our province’s attempts to protect and support them is a low bar to set, but that is where we are,” he said.

The report comes on the heels of a Star investigation into a Lindsay-area group home fire, as well as Star stories about a rash of suicides and unexplained deaths of Indigenous youths in residential care.

Indigenous children are commonly sent as far as 2,000 kilometres away from their homes because of a lack of resources in the North.

All of the youths suffered from mental health challenges and seven of them died by suicide. One, Kassy Finbow, was the victim of manslaughter in the Lindsay-area fire.

Laurie Monsebraaten is a Toronto-based reporter covering social justice. Follow her on Twitter: @lmonseb

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