Health care providers have found religion when it comes to involving patients in the planning and decision-making process. At this year’s OHA HealthAchieve every administrator was quick to extol the virtues of soliciting community participation.
In a meeting in Belleville yesterday, Paul Huras, CEO of the South East Local Health Integration Network, told us they constantly review new proposals from a patient perspective.
That, after all, is what this is all about.
LHINs are also subject to a parade of presentations by health care administrators that tend to gloss over the problems and highlight the progress, unless the problems are leading to a specific ask. Let’s face it, who wouldn’t want to look as competent as possible before the funding body they report to? That does mean, however, the LHINs are not always seeing the complete picture, especially the many realities not captured by scorecard data.
Contrary to former Ontario PC Leader Tim Hudak’s wild assertions about the LHINs being some huge bureaucracy, the reality is they are tasked with a big job and very little in the way of resources. We all want accountability, transparency, community consultation and responsive regional planning — the question is, how much are we willing to pay to get it? Last year Huras’ LHIN transferred a little more than $1 billion to provide health services in his region – about two-thirds of that going to hospitals. The amount Huras has to run his own administrative shop? In 2012-13 it was about $4.6 million – a drop of about $200,000 from the previous year. The LHINs have not been immune to government austerity.
Our meeting with Huras was the second around a proposed redesign of mental health services within the SE LHIN. In addition to OPSEU staff, there were front line representatives from Providence Care, Hotel Dieu Hospital and Frontenac Community Mental Health and Addiction Services.
The Greens had an in-depth party platform on health care in 2011. In this election they can barely bring themselves the say the word “health.”
The only mention it gets in the Greens streamlined platform is around poverty reduction and their commitment to double the exemption for small business to pay the employer health tax. That, incidentally, means less health care revenue.
Last time out they were raising warning bells about health care sustainability while promising billions more for seniors care and the interdisciplinary primary care sector. Despite the endless scandals around long-term care, they wanted to cut the number of regulations that protect frail residents in Ontario’s nursing homes. They also wanted to make the LHINs more responsive to their communities.
This time the Greens plan to tackle poverty reduction by setting a longer term goal of establishing a guaranteed annual income for all citizens, not just seniors. In the meantime they would double the Ontario Child Benefit for children of families who live close to the poverty line. There is also a vague commitment around youth unemployment, although it goes no further than urging young people “to tell us what they have to offer … we want to hear about their great ideas.”
Curiously after months of saying they’ll do away with both the Local Health Integration Networks and the Community Care Access Centres, both direct promises are conspicuously absent from the formal Tory election platform. That doesn’t mean they will stay in place either.
They do say they’ll instead place decision-making in the hands of “health hubs,” which will bring together “front line local experts from every aspect of health care together at the same table.” Elsewhere they define these local experts as “front-line professionals.”
“We think your nurses, doctors, community care organizations and hospitals know best what care you need,” the platform document states.
So what’s a health hub? Previously the Tories had described these not as some kind of broad-based panel of front line health professionals, but instead 30-40 large central hospitals which would run the health system within their sub-region.
The Tories may be massaging that pledge given it would strike at the independence of mostly local rural hospitals — which is where much of their electoral base resides. The first round of hospital consolidation under the Harris government created a lot of friction as smaller community hospitals found many of their services consolidated in larger urban sites. If the “health hubs” idea is to be implemented according to their earlier “white paper” it may be a vote loser in many smaller communities across the province. Nobody wants to see their hospital services taken away.
The platform is remarkably vague on how these “health hubs” would now be constituted. Watch for a possible name change, some new signs and a coat of paint applied to the Local Health Integration Networks.
When the province decided to call its most recent crown agencies Local Health Integration Networks, it was clear where the emphasis lay.
Rather than plan a system based on need, it appears the primary function of the LHIN was to ‘integrate’ health services.
Integration can be broadly interpreted – it doesn’t necessarily mean mergers of health providers, although it can be. It can also mean greater cooperation and collaboration between providers, or transfers or even swaps of services from one entity to another. Under the Act’s definition, integration can also be the winding up or closure of a service – something most of us would not see under the normal dictionary interpretation of ‘integration.’ The extension of that illogical concept is that by blowing up the entire health system you’d have full integration.
It seems the province was short a philosopher when they needed one.
The province maintains that about 250 integrations have taken place since the LHINs came into effect in 2006 – most being of more recent vintage. That surprises us given much of the system seems to be still dipping a toe into the integration pool.
Some integrations happen by default. Sometimes a small agency just decides it can’t continue any more and the LHIN is left scrambling to transfer the work to another health provider. Perram House hospice, for example, gave the Toronto Central LHIN just a couple of weeks notice to say they were calling it quits.
Just because a service transfers from point A to point B, doesn’t mean that the system as a whole becomes any more fluid or patient-centered. Sometimes it makes it worse.
The role of the Ontario Tories on the review of the Local Health Integration Networks is an interesting one to observe.
Mandated by the legislation that created the Local Health Integration Networks in 2006, the review has been handed over to the legislature’s Standing Committee on Social Policy. The NDP had argued to no avail that this standing committee was already stretched and that a special select committee should be struck given the central role the LHINs play within the health system.
The Tories are trying to play nice despite the fact that they have already issued a white paper than advocates simply doing away with the Local Health Integration Networks. To some that may sound promising, but the reality is the LHINs replaced 16-18 district health councils and seven regional offices of the Ministry of Health. The creation of the LHINs also led to the reduction of the Community Care Access Centres from 42 to 14. To simply cut them would create a substantial void.
The Tory plan is to replace the LHINs by giving the work to “hub hospitals,” which would effectively commission or contract local health care. The Tories would also completely do away with the Community Care Access Centres.
The Tories never calculated the cost of transferring these roles to the hospitals, instead insisting that shuttering the LHINs and CCACs would be all gravy. Clearly they think planning, contracting and accountability all come for free.
Ontario’s public hospitals are private not-for-profit corporations. Most are built and operated with public money and sign accountability agreements with the provincially appointed Local Health Integration Networks.
At any time the Minister of Health can take over a hospital, appointing a supervisor who assumes the power of the CEO and board as she did this month in Iroquois Falls.
There used to be a time when most hospitals sold “memberships.” A membership was largely limited to voting to ratify a nomination to the board and getting to ask questions at the hospital’s annual or general meetings.
Over the years many hospitals have transitioned to self-appointing boards, cutting the public out of any direct power relationship, as limited as it may be.
Ontario is unusual in preserving individual hospital boards at all. Many provinces run their hospitals through more centralized bodies, such as directly through their Ministry of Health or by a regional health authority.
After significantly cutting outpatient physiotherapy at hospitals across Ontario, the government is finally putting something back.
The Ministry of Health says it is making a major investment in community-based physiotherapy, exercise classes and falls prevention services that will benefit up to 218,000 more Ontarians.
The Local Health Integration Networks (LHINs) will receive $10 million more for falls prevention and exercise classes – giving them an ability to serve 68,000 more seniors. This is in addition to $44.5 million to provide physiotherapy in community-based settings that will increase capacity to 90,000 more seniors and “eligible patients.”
These community-based settings could include Family Health Teams, Nurse-Practitioner led clinics and Community Health Centres.
Long term care homes will get the biggest share — $68.5 million for one-on-one physiotherapy with seniors in their care.
Community Care Access Centres are also to receive $33 million to reduce the wait list for in-home physiotherapy, giving them the capacity to add up to 60,000 clients.
Oddly the Ministry’s release suggests that “until now, a small number of for-profit companies have had almost exclusive control over the delivery of publicly-funded physiotherapy.”
Did they forget about the 50 per cent of hospitals that recently cut outpatient physiotherapy services?
The closure of eight downtown Toronto hospice beds is hardly creating buzz in the health care community. But it should.
Perram House hospice is not big enough to warrant major headlines, but it is symbolic of why the government’s policies around service transfers to community-based providers are so flawed.
Perram House gave its workers two days’ notice that the hospice will close on Wednesday. Up until this point, there was no indication that the operators were even considering closure. If you visit the Perram House website, as of this afternoon it still is promoting its services. There’s still a button to become a “friend” of Perram House. There’s still an endorsement from actor Eugene Levy, even if the internet link to the video doesn’t work anymore.
We don’t know when the Toronto Central LHIN found out about it, but they reported to us that three of the patients have been transferred to the Grace Hospital and two more are now at home in the hands of the Community Care Access Centre. They figure their job is done.
Eight hospice beds are now gone from the mix. This is not how health system planning is supposed to take place. There was no public consultation. There is no assessment of need. It is closing because the Perram House board has decided to do so.
Perram House’s board has offered no explanation for the sudden closure.
In the past few weeks we have been challenging the Champlain Local Health Integration Network (LHIN) to step up to the plate around cuts and transfers of services from The Ottawa Hospital.
Champlain LHIN CEO Chantale LeClerc has dug herself in for the fight, insisting that considerable changes to health service delivery in her region do not warrant an integration decision nor any additional public consultation.
Curiously, in her most recent letters to both OPSEU and the Ontario Health Coalition, she has suggested that regional volumes of endoscopies have not yet been decided and that the LHIN has no mechanism to transfer them outside of a hospital environment (LHINs have no jurisdiction over private clinics performing public OHIP work).
The Ottawa Hospital CEO Jack Kitts is publicly stating the hospital will perform 4,000 fewer endoscopies per year (initially it was 5,000 fewer) and that it was his expectation that these volumes would be picked up by independent community-based clinics and other regional hospitals.
Clearly the hospital CEO and the LHIN CEO are not on the same page even though the LHIN is telling us the hospital is merely following its accountability agreement.
Endoscopies will be coming under what are called “Quality Based Procedures” for the coming year. These QBP get funded separately from hospital global budgets. That means if The Ottawa Hospital decides to stop doing 4,000 endoscopies, it also stops getting funding for them. Unless TOH is losing money on these procedures, it doesn’t suggest that such cuts will do anything to aid their bottom line – the whole point of this “restructuring.” Until we know where these procedures are migrating to (if anywhere), we have no idea whether the region will be saving any money or whether the public will be maintaining access.