Category Archives: Local Health Integration Networks

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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Could this be a moment where the LHINs turnaround public perception?

Labour has long remained skeptical about the value of the Local Health Integration Networks. From the start the perception was the LHINs would be used to distance government from unpopular decision-making and destabilize the health sector through continual integrations.

With the government now into full-fledged austerity mode, this may be an opportunity for the LHINs to gain currency with labour.

At stake is the government’s claim that cuts to hospitals are no more than a process of restructuring. With a freeze in base hospital funding and no obvious sector to pick up the slack, there appears to be a credibility gap between the rhetoric and the reality on the ground. When home care is the big funding winner with a four per cent increase this year – about 0.8 per cent when you exclude the impact of population growth, aging and inflation – it does leave us scratching our heads.

However, when the government introduced the Local Health System Integration Act, labour fought hard for protections and disclosure so that restructuring wouldn’t simply become an exercise in beating down worker’s wages.

As the regional health planning entities, the LHINs should be active in insisting that hospitals are not furtively closing or transferring services without first going through the integration process. That includes an insistence that the transferring provider, such as a public hospital, puts forward a plan that identifies where these services are going, what the cost will be and an assessment of the impact on access to care. As part of an integration process, the health care provider must also submit a human resources plan and demonstrate that they have undergone stakeholder consultations. Under LHSIA, when the work is transferred, so are the rights of workers presently attached to that work.

If we look at recent hospital announcements in Ottawa as well as in Perth and Smiths Falls, the hospitals are talking transfer but all we see are cuts.

The LHINs should be opening up this process to ensure that services are not just shuffled off into the void.

If the LHINs want to gain credibility with both labour and their regional communities, they need to do more than approve hospital restructuring plans, they need to ensure that the Act is followed and transfers occur in a planned, open and transparent manner.

This could very well be their moment. The question is, will they seize that moment?

News of failed private endoscopy clinic coincides with hospital’s intent to divest more endoscopies

It shouldn’t have been a surprise to anyone in Ottawa.

When the College of Physicians and Surgeons of Ontario finally released the list of private clinics that failed their inspection, it included one Ottawa endoscopy clinic that was already the subject of a rare public warning in 2011. The 2011 warning suggested that patients of the private endoscopy clinic may have been exposed to HIV, hepatitis B, and hepatitis C as a result of equipment that may not have been properly sterilized.

After nearly 7,000 patients were asked to get tested, five were found to have contracted either hepatitis B or C. The five are part of a larger class action against the clinic, although connecting their disease to unsanitary equipment may be difficult to prove.

Given everyone knew the list of clinics that failed inspection would soon be made public, it is curious that Dr. Jack Kitts, CEO of The Ottawa Hospital, should suggest during the same week that he intended to divest 5,000 endoscopies a year from the hospital to private clinics. Perhaps unfairly, the question must have been none-the-less on everyone’s mind: divest to clinics like this?

An endoscope is a diagnostic procedure that inserts a camera inside the body with a flexible tube to look at internal organs.

This week’s disclosure by the College gives us a view of the clinic that goes well beyond the issue of improper sterilization.

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De-integrating home support services in Ontario

Ontario has promised three million new hours of home care personal support services over the next three years. While it sounds like a lot, keep in mind that about 32 million hours of public home care are delivered annually and another 20 million hours are paid for privately. Further, the province is leaning heavily on the sector to offload clients from Ontario’s hospitals. The province tells us that the new hours will assist 90,000 more seniors, or 30,000 more per year. In 2011/12 a total 637,727 clients were served by home care according to the Ontario Home Care Association.

Last year the province introduced a PSW Registry (Personal Support Worker), which sets qualification standards for these workers in order to be on the registry. Without the bother of creating a specific professional college for these workers, the registry was supposed to be a way of maintaining discipline among a group that is generally ill defined and whose duties can vary dramatically.

Just before the December holidays, the province quietly introduced regulatory changes to expand which agencies can provide PSWs to do this work.

The change in policy allows community support service agencies (CSS) to deliver personal support services, but will not require the PSWs hired by these agencies to be on the new registry – at least not yet.

These support agencies have traditionally carried out functions such as delivering meals on wheels, carrying out homemaking duties, running social day programs, and providing transportation services to the frail and elderly. While such services can include respite care, they are generally not the kind of agencies that would provide a bath or assistance with toileting or dressing, for example.

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The best of Diablogue in 2012

It’s time for us to take our seasonal break and wish the best of the season to all our readers and posters. Next year will be challenging for health care activists as hospitals continue to shed services to balance their budgets, home care faces unrealistic and high expectations over relatively modest funding increases, bed shortages compound wait times in long-term care and all health providers try to find ways to better work together.

If you are new to our BLOG, or are an occasional viewer, you may have missed some of our postings throughout this year.

Here is a sampling of some of our more popular stories from 2012:

1. In recent days we have been unpacking the contents of the Auditor General’s chapter on long-term care in his 2012 annual report. Much of Ontario’s bed shortage problem is based on the Health Minister’s insistence on holding the line on opening new beds, noting Denmark’s success in diversifying long-term care options. But Denmark still has more nursing home beds per capita than Ontario and has made massive investments in home care. To read more, click here.

2.  When the province introduced its new Long Term Care Act, it was to include stepped up inspection. Problem is, they never hired enough long-term care inspectors to get the job done. Most Ontario nursing homes have not had a thorough inspection since 2009, and some may never see a detailed inspection. To read more, click here.

3. Norma Gunn won a disability rights award this year from the Ontario Federation of Labour for telling her own story about being assaulted at the Ontario Shores Centre for Mental Health Sciences and coping with the subsequent post traumatic stress disorder. A psychiatric nurse at the Whitby-based hospital, Gunn has been at the center of a struggle to reduce incidents of violence at the hospital. In recent days we’ve learned that CEO Glenna Raymond is stepping down in April. Will it be an opportunity for the hospital to press its own reset button on this issue and repair its relations with the staff who work there? To read more, click here.

4. This spring we were in Thunder Bay for a rally around the closure of the Canadian Blood Services plasma donor clinic.  Canadian Blood Services was created following the tainted blood scandal of the late 1980s and the subsequent inquiry by Justice Horace Krever. As we probed the decision by CBS to close down the Thunder Bay donation centre, we began to wonder if all the lessons from the inquiry were truly learned. To read more, click here.

5. One of our most popular stories this year was a posting about corporations stashing away record amounts of “dead” cash and the rich squirreling away billions in tax havens while insisting on further tax cuts. The impact is juxtaposed against a backdrop of hospital cuts across Ontario as the province claims it is broke. To read more, click here.

 6. This was the year that P3s (Public Private Partnerships) came back into the news. This summer we were reminded of how bad the situation is in Britain, the birthplace of these schemes. These so-called PFIs — Private Finance Initiatives — are saddling generations of Britons with a mountain of debt. Worse still, the actual value of these projects is about half the size of the accumulated debt, raising questions about value. Ontario represents more than half of such P3 projects taking place in Canada. To read more about the British experience, click here.

7. Ontario is the only province where the ombudsman does not have jurisdiction over the health sector. In BC the ombudsman has made significant contributions to staffing issues in that province’s long-term care homes. Why not here in Ontario? Click here.

8. What would Diablogue be without its bad hospital food stories? Truly if there is one issue that galvanises everyone — including hospital administrators concerned about patient satisfaction scores — it’s bad hospital food. Now the evidence would suggest it’s about more than just tasteless taters and mountains of wobbly Jello. Click here for more.

9. It’s a catch-22. We criticize much that takes place within our public health system. Then we defend the hell out of it when someone suggests we should replace it. This post reminds us of what it is we are fighting for. Click here.

10. Another of our more popular posts this year was the analysis of how former bank executive Don Drummond has skewed his economic projections to make it look like Ontario was in an even worse crisis than actually existed. To what end? Click here.

See you all back in January!

What took so long for community funding to arrive?

Community health care received the biggest percentage increase from this spring’s provincial budget, signalling the government’s intention to transition more of the health system into home care and other community supports.

At four per cent clearly that transition is not going to be at an overwhelming speed, the money barely enough to cover inflation, population growth and the impact of an aging population. However, compared to the base funding freeze for hospitals, this looked like one sector that at least wouldn’t be scaling back health services this year.

For much of 2012 many home care watchers were wondering if and when the money would actually arrive in the sector. Finally in recent weeks there has been a series of announcements around new funding to Community Care Access Centres (CCAC) and other community-based services agencies.

The funding will extend beyond traditional home care. The Central East LHIN, for example, has allocated $9 million in funding to the CCAC, but there is more than $2.6 million more going to other recipients, including new and expanding adult day programs in Whitby and Peterborough, increased hours for the Nurse Practitioner clinic at the Port Hope Community Centre, expanding advanced addiction and concurrent disorders treatment capacity in Scarborough and Durham, more services for individuals living with acquired brain injury and increases in assisted living for a number of communities. The November 14th CE LHIN press release noted that $1.08 million was still not earmarked.

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“Ontario Health Links” initially intended to look at high users

Commisioner Don Drummond raised it in his report. Former OHA President Tom Closson frequently spoke about it. Five per cent of the Ontario population uses up about 40 per cent of the provincial health budget each year at an average per patient cost of $44,500.

The thinking is, if we better understood these “high users,” could we streamline the local services they receive and save money in the process?

There is no question that Ontario’s health system is incredibly fragmented and surprisingly getting more so as hospitals are urged to further divest services. The Local Health Integration Networks have been given the difficult task of turning a mix of independent private for-profit, private not-for-profit and public entities into a coherent public system for patients.

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