Integration process missing from new round of hospital cuts

Local Health Integration Networks were purportedly created to bring health care planning, integration, accountability, and funding closer to the 14 regions they serve. A key role for the LHINs was to engage their regional communities in this process. The Ministry of Health and Long Term Care was supposed to set the strategic directions, and the LHINs were supposed to operationalize them within the context of regional planning.

While the Health Minister has mused about further empowering the LHINs, recent signs suggest that perhaps the opposite is taking place.

The South Bruce Grey Health Centre is a case in point. Comprised of four small hospitals working under one umbrella, the Ministry of Health is not exempting SBGHC from implementation of the new funding formula. Small hospitals were supposed to be excluded from a funding system that was becoming far more reliant on volumes that rural communities could not possibly muster. By sharing resources, the four small rural hospitals that operate as SBGHC are over the budgetary threshold for exemption. SBGHC has an operating budget of $43 million – a pittance compared to some of Ontario’s billion dollar urban behemoths like The Ottawa Hospital or Hamilton Health Sciences.

SBGHC took their case to the South West LHIN and they agreed implementation of the formula on this hospital would be unfair. It would also throw SBGHC $700,000 further in debt next year if they failed to cut needed services.Michael Barrett, CEO of the SW LHIN told the Owen Sound Sun Times that SBGHC “is doing all the right things in terms of how they’re working together.”

Yet with the LHIN on their side, the LHIN that is supposed to make funding decisions, the Ministry has so far refused to budge, instead deferring the decision for another year and guaranteeing cuts to hospital services.

We also question how much pressure is being placed on the LHINs not to treat the widespread cuts we are seeing as integration decisions.

Under the legislation that created the LHINs, the definition of integration is quite broad. We often think of integrations as mergers, coordination or transfers of services, but they can also be cuts to services.

When The Ottawa Hospital announced a series of significant service cuts, CEO Dr. Jack Kitts framed reductions in the number of endoscopies as transfers to private community-based clinics. That’s an integration by anyone’s definition.

We know how many he plans to cut – 5,000 per year – but there was no specific detail on where these services would go, how they would impact patients, whether affected staff could follow their work, who was consulted, or whether it made any financial sense at all. This is usually the role of the LHIN to ask these questions as part of an open integration process.

The Premier similarly weighed in suggesting this was all part of health care restructuring – precisely the reason the LHINs were set up and why we have an integration process in the first place.

So far the Champlain LHIN has refused to recognize these cuts or transfers as an integration decision and subsequently all those questions remain unanswered.

This is despite a clause in the accountability agreement between the Champlain LHIN and The Ottawa Hospital that specifically calls on the hospital to consult the community when developing plans and setting priorities for the delivery of health services.

The community that was supposed to be consulted never was.

The LHINs have struggled to demonstrate value to Ontarians amid promises by the Hudak Tories to scrap them or the Horwath NDP to restructure them.

If they simply roll over and treat these considerable changes to service as simply part of the hospital accountability process – in other words ‘cut what you will as long as you balance your budget’ – then it makes a mockery out of the idea of system planning.

The question is, have the LHINs decided independently to wash their hands of these cuts, or are they getting new marching orders from Queen’s Park to ignore key parts of the legislation that created them?

In the past we have seen LHINs do their job and intervene when services were threatened. Why not now?

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