The Yukon’s government officials and physicians will have their hands full this spring reviewing the extensive report that calls for an overhaul of the health and social services system (see p. 4).

“It covers health and social services together … (and) I was quite excited to see those things brought together because I think health is very much impacted by social services,” Katharine Smart, the president of the Yukon Medical Association, told the Star Thursday.

“On some level, it feels overwhelming, as well, because obviously these are huge issues, and they’re talking about a massive reorganization of a huge system.”

The 207-page report was released Wednesday. It issued 76 recommendations to overhaul the Yukon’s health and social services system, which it called fragmented and lacking a long-term lens.

Smart told the Star that overall, the impact of the report will be positive for Yukoners.

“It is a bit daunting to think about how all that’s going to happen; however, I think it’s also exciting to really be tackling this from that perspective,” Smart said.

“Let’s really go back to the roots of what’s going on here, and reimagine a system that’s holistic and looks at it from multiple points of view … there’s lots of work to be done, and lots of conversations to be had.”

Pauline Frost, the minister of Health and Social Services, said Thursday extensive consultation needs to be done within her department and with stakeholders before there can be plans to implement the recommendations.

“We have other partners we are obligated to work with, as clearly outlined in the report – education, community services – as we look at a fundamental shift and change, which means we need to take more time,” Frost told the Star.

Frost said she recognizes the review’s claims that the health system works in a siloed nature, with little communication within the system.

“We recognize that the system, as it exists, is one that needed improvement,” Frost said.

An earlier report in 2008 expressed similar concerns, she noted. She couldn’t comment on why those changes weren’t implemented a decade ago, when they were first brought forward.

“I don’t know what happened between 2008 and 2016,” Frost said.

“I can speak from the time I walked in these doors, I had a mandate to deliver a structure that supported Yukoners where they reside in their communities, ensuring we provide appropriate collaborative care models.”

Frost said her department is willing to accept the recommendations, but needs more time to review them to assess what is feasible and when.

“We just got the report, like everyone else, and we’ve taken a very brief stop to review the comprehensive health review,” Frost said.

“Amidst COVID, of course, and our time has been consumed by that, so I will suggest it will take us a little bit of time to review and move forward.”

Frost said she estimates it will take fewer than six months for her department to provide a response to the report.

She said some of the recommendations are already in the works.

Those include improvements to virtual health, hiring more nurse practitioners, enabling age-in-place care models and implementing universal pharmacare.

NDP Leader Kate White and Stacey Hassard, the interim leader of the Yukon Party, said they are wary that yet another report has been presented to the government that will effectively go nowhere.

“There’s been lots of reports with good input over the years, and they all sit and gather dust,” White told the Star.

She noted this report is different from previous reports, because it’s extremely comprehensive and provides a detailed road map to improvement.

She is urging the government to provide an implementation plan this fall. She also wants it to call the experts who compiled the report as witnesses to the legislative assembly so opposition members can ask questions.

White called on Yukoners to put pressure on government officials to implement the changes.

“The unfortunate truth is, it all comes down to the political will; are politicians brave enough to make these changes?” White said.

The public can encourage politicians to implement the changes by writing to ministers, White said.

“There are so many exciting things in that document, it’s telling us that health care in the Yukon can be different, and it’s showing us how to get there .... I’ve never been so jazzed up about a document before.”

Hassard said the review has encouraging components, but also seems to call for more investigation into issues like medical travel.

“It’s a little bit like those Russian dolls, when you open one up and there’s another one inside it,” Hassard said.

“It’s starting to be like that with these panel reviews.”

Hassard said he wants to know the entire cost of the review – which was originally slated for completion in October 2019 and was issued nearly seven months late.

Frost told the Star the panel review was originally budgeted for $550,000, but couldn’t say whether the project stayed on budget.

“I don’t know at this moment in time how much it cost; we haven’t done that work yet,” Frost said.

She said she would provide the final figure later.

Hassard criticized the government for previously ignoring most of the recommendations made by a 2017 financial review panel. He said he isn’t confident this will be handled any differently.

“They need to co-ordinate with all of the health professionals to actually make it happen so … how can we trust that the government is going to follow through?” Hassard asked.

The report calls for the government to implement the recommendations alongside non-government organizations, the Yukon Hospital Corp. and the Yukon Medical Association.

Some of the recommendations, including an adjustment to the current payment structure for physicians, will require that those physicians get on board with the plan.

Smart said that currently, most physicians are paid in a fee-for-payment structure, meaning they are reimbursed according to how many clients they see in a given day.

This could be the cause of one of the issues presented in the report, which was that clients felt rushed by their physicians.

Smart said alternative payment structures would pay physicians an hourly or daily rate, relaxing the desire to see as many clients in one day as possible.

“I imagine what we’ll see is a gradual transition with physicians who want to see a new way of practice, and people who want to continue their traditional way of practice,” Smart said.

Overall, the report outlined many of the concerns that physicians face on a daily basis. Smart said she expects many practitioners will be enthusiastic about a system overhaul.

Increasing communication within the system, for example, would give practitioners the opportunity to consult with social workers, family members and specialists while treating patients.

“That’s the type of care we all aspire to deliver, and I think in different settings it happens more easily than others,” Smart said.

“Right now, our systems are not well designed to make that seamless.”

The report’s recommendation to implement case co-ordinators will create a point-person for this communication, removing the burden from physicians, Smart said.

The report calls for the launch of Wellness Yukon, a new organization that would take over the management of the territory’s hospitals and primary care models.

In an email statement to the Star, the Yukon Hospital Corp. said it’s also looking to take more time with the report before issuing a formal response.

“In general, we agree with many key themes in the report – from better integrating all health services for Yukoners and working as one system to deliver people-centred care, to delivering care as close to home as possible, improving access to care, reducing inequity and promoting cultural safety,” said Matt Davidson, a spokesman for the corporation.

Frost said she hopes Yukoners will be patient as an extensive consultation process is underway for what she called a comprehensive strategy forward.

Overall, she said, the review panel succeeded in its mandate.

“I would say they far exceeded my expectations, I wanted them to do as required, as flexible as possible as they can be, as honest and bold … and look at what’s working, what’s not working,” Frost said.

“They did that, and looked right at the heart of the system, and provided us with a clear vision forward.”