Category Archives: Local Health Integration Networks

A tangible response to physiotherapy cuts – the province finally adds community capacity

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.”

Huh?

Did they forget about the 50 per cent of hospitals that recently cut outpatient physiotherapy services?

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Perram House: Why health professionals increasingly don’t want to work in community agencies

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.

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A tale of two LHINs – Champlain could learn from Central East when it comes to community involvement

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.

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The Ottawa Hospital: Restructuring now called cutbacks?

Last week we were in Ottawa publicly challenging the Champlain Local Health Integration Network to treat service transfers from The Ottawa Hospital as an integration decision.

There was a terrific media turnout for the press conference we shared with the Ontario and Canadian Health Coalitions.

Following the press conference, one of the local newspapers, the South Ottawa EMC, contacted Champlain LHIN CEO Chantale LeClerc for comment.

According to the EMC, LeClerc told them the cutbacks don’t count as an “integration,” so no formal consultation or board decision was required.

Cutbacks?

Up until now the Minister of Health and the LHIN had maintained changes at the hospital were about health care restructuring.

Now that health care activists are asking the LHIN to follow process that normally accompanies such restructuring, the changes have become cutbacks after all.

The reality is nobody knows what the impact of these cuts or restructuring or whatever-you-want-to-call-it will be.

The LHIN could require the hospital to come forward and present its plan. That plan should tell us where the services are being transferred to, what the cost will be, and how it will impact patient access.

You might call it health care planning.

Instead we have had a litany of excuses as to why such massive cuts to the hospital and potential privatization of services are not being treated in an orderly and transparent fashion.

Yesterday we learned of another LHIN that required repeat prompting by the local MPP before they would launch an investigation into a northern hospital that was generating considerable community concern.

Is this really how it’s supposed to work?

If hospital cuts are restructuring, then let’s see the evidence

There is little question that a provincial freeze in base hospital operating funding is motivating the present shedding of staff positions and services across the province.

Hospitals are required to balance their budgets by law, but Local Health Integration Networks regularly extend exemptions conditional on the hospital following an improvement plan worked out between the LHIN and the hospital.

Hospital CEOs and LHIN officials are usually reluctant to admit that significant budget cuts will impact service delivery, even if the impact is obvious in examples where hundreds of staff positions are lost (ie. Peterborough Regional). That’s because significant changes in service delivery should be treated as an integration decision, a 60-day process that puts on the onus on the service provider(s) to make a case for change in delivery to the LHIN. That case usually includes evidence of community consultation.

With the latest round of hospital cuts the Health Minister and Premier are suggesting what is taking place is not belt tightening, but restructuring.

If that is the case, then why not have the LHINs treat these changes as integration decisions where all the facts are put on the table and the community is consulted?

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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. Continue reading

No community involvement, details needed when cutting or transferring services to balance a budget

The Local Health Integration Networks were initially set up to involve communities in the decision-making process around delivery of regional health care.

We have witnessed health care providers, such as hospitals, coming forward to the LHINs with proposals to shift services, identifying how they engaged stakeholders in the planning process before coming forward with a plan for integration.

Recently we contacted the Champlain LHIN to ask if the same process is applying to the recently announced changes to service at The Ottawa Hospital, including the so-called “transfer” of endoscopies and cataract services to unidentified providers within the community.

Much to our surprise CEO Chantale LeClerc replied that no integration is triggered because the hospital was making these changes under the terms of its accountability agreement.

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