There is no question the Local Health Integration Networks have had their share of problems.
When they were first proposed in 2005, OPSEU warned that it would lead to a rationalization of health care services and shield the politicians from unpopular decisions. To a degree, both concerns have turned out to be true.
One of the few promises provincial Tory leader Tim Hudak has made is to scrap the LHINs. The Tories say it would save $250 million, however, that is the total cost of the LHINs since 2006, not the annual cost. At present the LHINs take about $70 million per year to administer. On a $47 billion health budget (about half of which is within the jurisdiction of the LHINs) that’s a very small percentage allocated for administration.
If Hudak were to scrap the LHINs, he would not even save the $70 million. The LHINs replaced seven regional Ministry offices and 16 District Health Councils which previously cost $48 million. With inflation, the costs would likely remain equivalent to the LHINs if Hudak were to turn the clock back.
But Hudak says he would not replace the LHINs, he would simply cut them. We’re not sure how that would work, and likely neither does Hudak.
Dismantling the LHINs would not be free, as we discovered in the transition from District Health Councils and Regional Offices to LHINs. Costs ranging from broken leases to severance costs would be borne by government. Then there is the cost of transitioning the work.
Hudak doesn’t say what existing infrastructure would absorb the LHIN work, from planning and accountability to public engagement and integration. Is he actually suggesting we don’t need these functions?
The recommendations of the Health Restructuring Commission once dominated Ontario’s health care policy-making. Those recommendations are now more than a decade old. The data by which they came to their conclusions is closer to two decades old. There is a need to gather new evidence and make sound decisions around the future of our health system.
If we are to move forward we really have two choices – reinvent the existing LHINs, or come up with a new structure altogether. Both have their pros and cons.
Unfortunately the McGuinty government never followed-through on the requirement in the Local Health System Integration Act to conduct a review of the LHINs after five years. That would be now.
Neither did McGuinty ever produce the provincial plan that was supposed to be the guiding direction for the LHINs. Instead the LHINs scramble to fulfill whatever priority whim is the flavour of the day at Queen’s Park. Nowhere was this clearer than in the province’s focus on alternate level of care.
While the LHINs were making plans to utilize their aging at home funding, the Ministry changed its mind and suggested that at least half that money be devoted to getting ALC patients out of hospital.
Regardless of who gets elected, it is likely the LHINs will look very different after the October provincial election.