It’s truly remarkable how much news happens these days. I’ve been in the business for almost two decades, and I can’t recall a time when so few news people were responsible for so much news. It’s inevitable that some stories will fall through the cracks or receive only passing mention. Some of those stories absolutely deserve more than a quick recap before being forgotten.
In recent days, the government has been forced to acknowledge and respond to a major procurement failure. Ontario patients receiving home care or, in some cases, palliative services, have not been getting the medical supplies necessary for their comfort and care. A government initiative to standardize and streamline the procurement of medical supplies and some medications has not gone according to plan and has resulted in shortages. Patients and/or their families have been scrambling to purchase their own supplies at their own expense; the province has said it will reimburse them. But more alarming is simply the reality that vulnerable people who have been promised care by their government are being let down because the government has run out of supplies.
This is likely — he says hopefully! — to be a temporary problem that will be rectified. This isn’t like early in the pandemic, when there was a sudden rush on supplies on a global scale, and there truly were shortages. The current issues seem more about bureaucratic adjustments and inventory management than any true scarcity of the relevant drugs and equipment. But that’s all academic to the people who are currently purchasing their own medical supplies or enduring pain without proper medications. It’s also academic for our already overworked hospital staff, who are having to pick up the slack as patients who are supposed to be at home show up at hospitals in the hope that the hospitals will have the supplies and medications they need. The whole purpose of home care is keeping patients who don’t require hospital-level services out of the hospitals. This is a pretty major failure.
This is an issue I wanted to flag because I think it’s important. We need to shine a light on this sort of thing because the people who have been failed deserve accountability and support. This kind of attention is also a good way to motivate the government to do better. I also wanted to flag it because I think this episode speaks to a broader challenge that we will face in our health-care system: with any reform will come dysfunction, even if the reform is necessary and good.
Fundamentally, the change that led to the suffering of patients in home care was probably, in isolation, a smart and warranted decision. Finding ways to streamline procurement processes is a good thing, especially in a country like Canada, where procurement is a notorious disaster. We struggle to buy anything, from syringes to submarines. It’s a massive problem that absolutely needs to be fixed if we’re going to improve our ability to do basically anything. I want to see governments more focused on improving procurement, not less. We simply cannot afford — literally afford — to try to run a society in which we’re paying massive premiums to buy all the things we need simply because we’re terrible at organizing procurement programs.
This brings us to the obvious problem, though: it’s hard to repair an engine while it’s running or to build a plane in the air. There is no way we can make big, meaningful reforms in our health-care system — the kinds of reforms everyone agrees are needed, even if they disagree on some specifics — without risking significant disruption to the health-care system we already have and to the medical care of the patients within it. Some of this is likely due to the entrenched bureaucratic fiefdoms in our system; they’ll actively resist change, betting on their ability to outlast whatever political attention and pressure are being brought to bear on them. Some of it is because, even when everyone is working positively toward the same goal, our health-care system is a massive, complicated machine with billions of moving parts. Making big changes, even necessary ones, is disruptive. Those disruptions will lead to poorer patient outcomes, which is a polite way of describing sickness, suffering, and death.
I believe reforms are coming. I am agnostic about whether they’ll be initiated proactively by the government or in response to a functional system collapse, but reforms are going to come. When they do, among all the challenges brought about by the reforms themselves, there will be the challenge of maintaining effective, continuous care for the people who are already in the system when those reforms are enacted.
We can’t run out of medicines on a regular basis or drop the ball on patient care or hospital staffing. But we also can’t continue as normal.
This is the challenge that lies ahead. Hopefully, we will learn lessons from what’s happening in the home-care sector — ones that will help us avoid similar or worse problems in the rest of the system at large.
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