For years the Ministry of Health has beat the drum on the benefits of shifting hospital-based services to community agencies. Now that the Local Health Integration Networks (LHINs) are signing accountability agreements with these agencies and monitoring their activities, the Minister of Health may wish to have second thoughts about this direction.
At its May 18 meeting, the Central East LHIN board were given their first look at the difficulties of working with this sector, which includes community support services, community mental health and addictions, community health centres and the Central East Community Care Access Centre (CE CCAC).
Staff cautioned that the agencies had data quality issues, meaning any evaluation of their performance had to be taken with a large grain of salt.
While the LHIN claims it has to do a lot of initial handholding, including actually filling out reports for some of the smaller agencies. The LHIN claims that some agencies have been submitting blank forms, while others are not even familiar with how to use an Excel spreadsheet. Some have reported balanced budgets, only to have deficits revealed through an audit. The LHIN reported that staff turnover is very high at these community agencies. As soon as the LHIN trains someone in how to carry out the reporting requirements, the individual ends up leaving to work somewhere else.
“We are bending over backwards to work with these groups,” said CE LHIN Chair Foster Loucks, “but some day there is going to be a reckoning.”
The LHIN has said that some of the small agencies may be forced to integrate with other health care providers if they cannot carry out the administrative reporting required of them. The LHIN has also threatened providers who cannot meet deadlines with fines.
Paul Barker, a Senior Director with the CE LHIN, said there were a number of organizations in the community sector where program quality and financial management is an issue.
Many of the agencies the LHIN is left to work with have chronic deficit situations, a situation the Ministry of Health overlooked, showing more interest in recouping surpluses than giving consideration to growing deficits.
Unlike the hospital sector, there are no industry benchmarks by which to measure the performance of these community-based organizations.
One LHIN board member looked at the charts and wondered if it was a case of “garbage in, garbage out,” since the information was unreliable.
The LHIN also said it was having difficulties even establishing what the benchmarks should be, especially in mental health.
Board members had a difficult time understanding the context of the projected deficits for these agencies without having their full budgets. The biggest deficit is being faced by the CE CCAC which is looking at a $9.6 million deficit to finish the fiscal year.
Given the Minister of Health’s other mantra – of evidence-based decision-making – one has to wonder where any of the evidence existed to suggest taking quality services out of accountable public hospitals and giving them to a select group including a number of poorly run community-based agencies was ever going to benefit Ontarians.