It may be tempting to fixate on the salary that Premier Doug Ford’s new health czar will be paid — nearly $350,000 a year. And there is certainly an argument to be made that these kinds of outside advisers, who are often in their 70s and have come out of retirement to run a victory lap in public policy, ought to be dollar-a-year folks — or at least work for a lot less than normal.
But to me, that’s not the most important thing to consider when it comes to Rueben Devlin’s appointment to the new Premier's Council on Improving Healthcare and Ending Hallway Medicine.
In any ministry of government, there is a not-so-delicate balancing act between what the premier wants, what the minister wants, and what the bureaucracy wants. That balancing act is never more important than in the health ministry, both because the costs are so monumental (north of $60 billion annually now) and because the consequences are literally life-and-death for citizens affected by the ministry’s decisions.
Technically speaking, the minister of health and long-term care is the leading decision-maker — in this case, Christine Elliott, who’s got the added authority of being deputy premier.
But the health-care ministry is astonishingly big — too big for any one minister to completely wrap his or her arms around. By way of example (and of full disclosure), when my wife was director of policy for the health minister in 2002, there were nine “silos” in the ministry, each responsible for different issues, such as long-term care or community health. They were led by senior bureaucrats (assistant deputy ministers, say). When the Liberals left office last month, the number of silos had increased to 18. You’d have to have very long arms indeed to get around all that.
That’s clearly why the current premier’s office felt a need to appoint Devlin, someone from outside the bureaucracy who would not have to worry so much about his relationship with the civil service and would instead be able to focus solely on the task of realizing the policies the new government wants.
And it’s hardly a shock that the new premier wants to task his closest health-care adviser with helping make long-term progress with the government’s most important ministry.
The precedent for appointing an outside adviser was set more than 20 years ago, when then-premier Mike Harris chose Duncan Sinclair to head up a new Health Services Restructuring Commission. Harris understood that the job of closing some local hospitals and merging others was politically fraught, so he tasked Sinclair’s group with making recommendations strictly on merit. Yes, plenty of Ontarians protested the decisions — no one likes losing their local hospital. But by tapping an outsider to do its “dirty work,” the government avoided the charge that hospitals in Tory ridings were safe while hospitals in opposition ridings were vulnerable.
Compare that to the process a different Progressive Conservative government — that of Bill Davis — undertook back in the 1970s, when then-health minister Frank Miller (Davis’s eventual successor) was tasked with shutting down remote or underperforming hospitals. The ensuing political firestorm was so massive that Miller, facing a hostile crowd, once had to hide in a community centre’s kitchen, then sneak out of the building on a gurney carried by ambulance attendants.
As a lifelong Tory, Devlin is no doubt aware of these previous examples and will hope to emulate the more successful restructuring accomplished during the Harris years.
At the moment, Devlin is focused on finding 10 other members to join his special committee. Then comes the task of figuring out how to achieve Ford’s campaign promises (ending hallway medicine, dental care for seniors, improved mental-health services), all while ensuring stable, long-term funding for the system.
While Elliott will have the responsibilities every politician does (attending question period, House duty, political events, etc.), Devlin can focus on the task at hand and give the premier the best advice possible.
I spoke with Elliott by phone yesterday evening. Ever since her swearing-in on June 29, she says, her days have been packed with briefings from ministry officials. “There is no scarcity of issues,” she laughed. “My House briefing book is not brief.”
Of course, the other major question Devlin’s appointment raises is: How will it affect Elliott’s role? Did she get a heads-up on the appointment? Have she and Devlin had discussions so as to ensure they don’t step on each other’s toes? Are the lines of responsibility clear?
George Smitherman, who served as health minister for five years under the Liberals, says these questions must be answered and understood by everyone if the new government is to succeed. Smitherman, who held the portfolio from 2003 to 2008, says he had a good relationship with Devlin when the latter was CEO of the Humber River Hospital; in fact, Smitherman says Devlin endorsed him for mayor of Toronto in 2010. Smitherman called Devlin’s appointment “a positive thing” for Ford but acknowledged that “the real threat is to Christine Elliott, and it now seems like the premier has established neither the deputy nor the minister as the most important people in health care, having given Rueben all the opportunity in the world to do end-runs if he is so motivated.”
Elliott said that was not the case. “I think it’s great that he’s working with me,” she said. “We speak daily on issues. We keep touching base with each other.” Elliott said she was given a “heads-up” about the three-year appointment and noted that Devlin “is acting in an advisory capacity,” meaning she and the premier will still have the ultimate say on policy implementation.
I also spoke to Devlin on the phone yesterday. He didn’t want to get into the political speculation that his appointment has raised. “I am very outcomes-based,” he said. “My immediate job is to get our committee up and rolling, let people see how we work, and implement our plans.”
At any rate, if Devlin can figure out how to improve health-care services by redirecting money away from bureaucracies and into better patient care, and helping deliver a more efficient, effective health care system, few Ontarians will be inclined to squawk at the size of his salary.
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