LHIN Review: Unifying a system, dividing a community

You have to feel a little bit for the MPPs that are sitting on the all-party Standing Committee on Social Policy. Somehow in the sweet victory of election night it is unlikely the elated victors dreamed of this – spending hour upon hour in a room listening to a long succession of 15-minute presentations, frequently left with a minute at the end to ask a question and receive a somewhat truncated answer. If it weren’t for the question, the MPPs could probably just zone out at will.

We were in Kingston yesterday to make our recommendations to the Standing Committee on the thorny question of what to do with the Local Health Integration Networks.

The hearings were mandated by the legislation that created the LHINs. They were supposed to take place in 2011, but that timing was just not convenient to the Liberals who had a general election to fight. Talking about the LHINs was likely not the route to victory.

On this day one presenter told an MPP afterwards that she was impressed by her question. It demonstrated that somebody was actually listening. Clearly the expectations by the public are not all that high.

We have to admit we like the angry presenters better, not so much for the politics, but at least to keep us from nodding off. It’s not that the presenters were necessarily boring, but more of a question of just too much information.

Each person usually begins with a lengthy descriptor of where they fit within the health system, kind of a Where’s Waldo prerequisite.

We were by no means the exception to that rule, although on this day we erred on the angry side (even if the Blueberry pancakes were giving this writer kind of a nice warm feeling inside).

There appears to be considerable interest in these committee hearings even if the talk of LHINs usually induces a brain freeze in most Ontarians.

On this morning the presentations seemed to be divided between the insiders and the outsiders. The insiders are those who are actively participating in the LHINs and see them as much more responsive to regional need than a distant bureaucracy in Toronto (even if the regional LHIN board is made up of local people appointed from Toronto). The angry outsiders are those who feel neglected by the LHIN and don’t see their concerns reflected in policy or in the make-up of the LHIN board. When they get referred back to the LHIN by their MPP, it usually ticks them off.

Many of the things people were angry about – or pleased about – really had little to do with the LHINs. Much of it was about money.

One community service provider wanted to know when the LHINs would live up to the original legislative act of creation and start redistributing money around. We know what that’s code for – take it from the big fat hospitals and give it to me.

While the LHINs may have got the health providers talking to one another, it doesn’t necessarily mean they actually understand one another.

When we hear community health providers speaking like that, it conjures up big piles of cash that the LHIN could scoop from the hospitals and toss it into the outstretched hands of small community-based agencies chirping like hungry little birds.

Do we really even need to say it doesn’t work like that?

Health Minister Deb Matthews believes she is already doing that redistribution work by freezing hospital base budgets and giving more money to home care. We also now have a hospital funding formula and money that follows the patient and wait times cash and competitions with independent health facilities for the right to keep on carrying on and a special fund for small hospitals… it’s hard to imagine the hairy hand of the LHIN groping into that confusion and hauling off some additional spare change for these agencies.

And when you take money from an existing health provider, there are usually consequences.

Several presenters talked about indicators. Most of the indicators that tell us whether a LHIN is doing a good job or a bad job are really about hospitals. They don’t particularly work well for community-based providers. That may leave some to feel less than valued for the work they do.

We were told that specialized geriatric visits, for example, can take longer to carry out. That may not look so good on an accountability scorecard when the valued indicator is about the number of visits, not quality or length of visits.

A public health nurse woefully described how one LHIN had contacted her unit about implementing a falls prevention program, while another adjacent LHIN ignored it. The problem was the public health unit straddled the territory defined by the two LHINs. She did say this was supposed to be a pan-LHIN initiative. We noticed South East LHIN CEO Paul Huras scribbling away at that point.

You could hear the weariness in her voice as she said it was better to work without the other LHIN because of all the energy it took to build relationships. We felt her pain. Some people have been brought to the party for simply too long a time. They want to go home.

Two local presidents from OPSEU had their brief moment before the committee. Dan Anderson (Kingston Providence Care Mental Health) and Herve Cavanagh (Perth and Smiths Falls District Hospital) spoke about their own frustrations, seeing the health system move away from what they consider to be good clinical practice. Herve bluntly told the committee that it didn’t make sense to be cutting hospital rehab because it was cheap to deliver and had a significant impact on length of stay. Dan emphasized that mental health delivery was getting more fragmented, and that was leading to more bureaucracy.

During the lunch break the politicians wandered over to informally chat with the presenters who stuck around. Outside the stilted rules of the standing committee, the conversation seemed much more natural.

The LHINs were meant to shape health care into a system, bringing providers together. Over the course of these hearings it may just be that the LHINs are also dividing the community in ways that may have not been foreseen. The challenge will be how to bring everyone into the tent, not just the few.

For OPSEU President Warren (Smokey) Thomas’ remarks to the committee, click here.

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