The End of Ontario’s Cancer Quality Partnership
Yesterday there were two announcements related to government policy in Ontario. The Premier announced a substantial expansion of his cabinet with a 33 per cent increase in his ministers and the bureaucracy that inevitably accompanies new ministers. As the best example, the Ministry of Health and Long-Term Care, previously led by one minister, will now have three political leaders at the cabinet table. The Premier also announced four new patronage appointments to open Ontario offices in the U.S. and Britain (two were revoked the next day).
Concurrent with this expansion of political bureaucracy and patronage was the quiet message that the new provincial super agency, Ontario Health, has eliminated about 170 positions at Cancer Care Ontario (CCO) and has cancelled the Quality Management Partnership (QMP). This important QMP program was started in 2013 in response to women undergoing unnecessary mastectomy for mistaken diagnoses of breast cancer. These tragic medical errors were investigated by an external panel that released a report with 19 recommendations.
Two of the recommendations spoke to the need for improvement in pathology quality across the province and instructed the ministry to work with Ontario professional organizations to initiate pathology quality improvement.
The ministry directed CCO and the College of Physicians and Surgeons of Ontario (CPSO) to respond to the recommendations of this report and the collaboration of these groups resulted in the QMP. The QMP was charged with tackling three important quality domains for cancer care — developing quality standards for mammography and colonoscopy (as part of cancer screening) as well as a comprehensive quality improvement program for pathologists.
Pathologists are the medical specialists who diagnose cancer. Poor quality pathology diagnosis can lead to tragic outcomes like unnecessary breast removal.
Developing quality standards for pathology requires a sensitive approach that involves both improvement in laboratory processes as well as the professional skills that pathologists must develop and update. With similar process and professional issues in mammography and colonoscopy quality, the collaboration of CCO (responsible for improving processes in cancer care) and the CPSO (responsible for ensuring high professional skills in Ontario doctors) was ideal for developing the QMP.
Over the past four years, quality standards in these three important areas of cancer care have been developed and the QMP was now at the stage of implementing standards and improving quality. Today, Ontarians are starting to benefit from steady improvement in the quality of our cancer care through the work of the QMP.
And now the QMP is terminated.
The decision to terminate improved cancer quality was presumably approved by the new Ontario super agency Ontario Health board. The board will undoubtedly say that the course was recommended to them by CCO management. However this course of action would never have occurred when CCO was governed by its own independent board, rather than a super agency responsible for governing all of Ontario health care.
CCO’s board would have refused to allow management to respond to the government’s impossible choice of terminating quality or cutting clinical services to achieve budget targets. The Chair of the CCO board would have been in the minister’s office and the premier’s office, protesting that the minor savings associated with terminating quality were not worth the risk of another unnecessary mastectomy. However, the chair of Ontario Health, presumably unaware of the crucial importance of cancer quality, accepted this budget cut imposed by the government.
The Premier has changed his pre-election promise to avoid lay-offs in health to state that he will eschew “front-line” lay-offs. As a former cancer surgeon, I can readily attest that front-line workers in cancer care need support from small numbers of staff who advise on quality improvement. Many of the people being side-lined are actually cancer clinical leaders — doctors who have a passion for improving the care that Ontarians receive.
On a day when patronage appointments were announced and bureaucracy bloats to service a 33 per cent increase in cabinet ministers, Ontarians can see what is important to this government.
Unfortunately, like those women who underwent unnecessary surgery for misdiagnosed cancer, Ontarians should be concerned that the government’s current priorities do not include improving the quality of cancer diagnosis and treatment.
Image Credit: ©Frank Gunn/The Canadian Press
28 Replies to “The End of Ontario’s Cancer Quality Partnership”
Well written and informative
thx John. Appreciate your comment
It is a travesty that no nothing ford would compromise cancer, especially as the other gross person is waiting for him down below after succumbing to cancer himself
btw . we need more of other professionals making the front line care work better. ever see a nurse try to arrange taxi trans for an income assistance patient ,that would be as bad as oncology social worker trying to start a large bore iv
The Ontario Health Agency includes “improving the quality of care”, “measuring and managing how the system performs” and “providing clinical leadership” within its responsibilities. The QMP targeted all of those areas and was an important piece of work to set standards, report on metrics and offer support for improvement for facilities and physicians to meet those standards, thereby supporting and improving front-line care and service delivery.
Thnx Ivana. 100% agree
I don’t know if Fords doing the right thing with these cuts.I do know he’s trying to balance…the books . Something the Liberal Gov. doesn’t seem to care about!Thats the biggest fault with our system is that Politicians know what they should do but that won’t get them elected again.They promise they will this and that .Guess who is going PAY? Canada has the highest household Debt per family….! Can bitch about Liberals but that won’t solve anything.Ron Martin Elora
Ron, how do you figure that’s what he’s doing? His budget is already larger than Wynne’s, he cancelled a major source of revenue for the province, is spending millions on lawsuits against the Feds that he has no hope of winning, is cancelling a 10 year contract with the Beer Store that will cost the province billions, etc, etc, etc.
thx Janet. Cannot disagree. Bob
Thx Ron. I have no economic credentials- and recognize that Ontario has one of the highest (if not the highest) non-sovereign debt totals in the world. However, Canadian public spend on health care (as a proportion of GDP) is second lowest in wealthiest ten nations with only Australia spending less than Cdn. per capita.Even the USA has a higher PUBLIC spend on health care than Cdn. And Ontario spends less per capita on health care than other provinces. Canada is also a very low spender on social services. This data can be found at https://jamanetwork.com/journals/jama/article-abstract/2674671. I wonder if we do not have to look at revenue gains to reduce debt rather than reducing health and social spending even further? Bob
balance the books at what cost to the people of Ontario!!!!
and US has probably an even higher debt ratio and so what’s happening to them?
this debt ratio thing is all such a myth..people need services…what if your wife had need of this service..you would be crying foul!!
The household debt is a result of suppressed wages, inadequate revenue and poor government fiscal management and regulation. You would do well to read Pierre Berton’s excellent history of the Great Depression, Ron, to see what a mess the Conservatives and Liberals made of government during the 1930s and how the stupidity of Canada’s leaders with their obsession with balancing the books, virtually wrecked the country! The Depression naturally was followed by the massive debts incurred by Workd War Two, but that was okay, because war, like privatized health care gives big business the opportunity to make big bucks at the expense of the tax payer.
I agree 100% with your comment
As a cancer patient, breast cancer survivor and patient t advisor that has worked on these QMOs all I can say this is sad time for all patients in the province.
thx Joanne and sorry for delay responding. I appreciate your work as a patient advisor and agree with your assessment Bob
That is exactly what needs to happen Bob. This gov’t cut a billion dollars from social services. Money that directly impacted the lives of many under the guise of tackling the deficit. But has no qualms about spending a billion dollars to break a contract with the beer store. For the people? Which people?
Thx Tracey. Cuts to social service budgets are really cuts to health care. Especial for folks with social deprivation.
thx for your comments Tracey and sorry for delay in responding
Once again they are taking and taking EVERYTHING from us ordinary citizens and giving NOTHING in return. It’s Mike Harris dictatorship all over again and this time so much worse. They have given NOTHING!!
They are attempting to balance the books that the previous Liberal Government just spent and spent and spent every penny and more. Of course it means cuts but in the long run better for the country. Canadians have to stop thinking just about themselves and begin looking at the whole picture and stop bitching.
Lynda wells, I don’t understand. I have cancer and have made decisions about what treatments to endure. When I was deciding about having radiation or not I gave thought to the use of uranium and the use of nuclear energy. Please give an example of what illness a person should not be narcissistic about and what you mean by the big picture. What you seem to think as bitching I see as questioning.
Oh my, so why don’t we just make people sicker and increase the cost of health care! As someone, over 65, embarking on a second journey with breast cancer, this time in the previously unaffected breast, I find the cuts to be extremely scary, unwarranted and so retrogressive. People in power without a clue.
Pretty short-sighted move for a guy with 4 daughters and a wife.
I am one year since completing treatment for breast cancer. I had great care in Ottawa at the General and Queensway Carleton. From the moment I walked through the clinic doors I knew I would be getting the best treatments available by skilled Oncologists, technicians, nurses and support staff. I was alone but It didn’t feel like it.
It saddens me greatly to see changes to healthcare in Ontario. These changes are pushing cancer care backward. Changes such as limiting ultrasound and mammograms will not save lives, particularly among women with dense breasts.
Just my thoughts 💭
thx for your comments Wendy and sorry for delay responding. Bob
What are we doing allowing this shit to beat us down and dump on the sick , he needs to go
14 1/2 years ago I was diagnosed with Esophageal Cancer. I spent over a year in treatment, surgery, chemo and rad and then 6 months fighting off the side effects of chemo which almost killed me. At the time I had nothing but accolades for my ” Dream Team”. Each of them personally and collectively contributed to my recovery from the Dr in emerg who started the ball rolling, to my Gastroenterologist who was fortunate enough to do his residency with one of the best thoracic onco surgeon, to the rad onco and techs and the med oncs, the nurses and even the volunteers made my very scary journey easier than it could have been. Now the state of our health Care system makes me both angry and sad. It wasn’t just the present government, it wasn’t just the previous government. The breakdown started before that and I was lucky enough to get the best before the system imploded.
Additionally, along the way I took care of both my parents who were diagnosed with Alzheimer Disease. Again, I was lucky. The help I received was incredibly awesome. Now, with an aging population the government has managed to undo so much of the good of the system we had. .
Obviously the Premier wasn’t paying attention when his brother was sick or he would have seen how bad the system had become and instead of worsening it he would have tried to fix it.
Education and health care are two of the most important areas of our province. I’m don’t know how Premier Ford sleeps at night. I don’t .
Dr Bell, you operated on me in 1992 (when I was 19 years old!) to remove a tumour in my proximal right tibia. The pathology report indicated that I had a cancerous tumour at one end of the report and the other end of the report said it was benign! So, obviously, you can add me to the list of patients who would suggest that pathology training needs to improve.
From an economic perspective, how much did all the follow up imaging and hospitalization that I went through to determine that it was benign cost the tax payer? How much does an unnecessary mastectomy cost the system? It sounds to me like it is a budget cut that costs us more in the long run financially, not just on a quality of care level.
Thx Chris- sorry for delay in responding and remember you well. Pathology quality is hard to cost estimate- like those old ads used to say- its priceless!