Category Archives: Local Health Integration Networks

Will NHS supervisor rebuild public confidence?

Posted on August 16, 2011 | 1 comment

The troubled Niagara Health System is getting a supervisor appointed by the Ministry of Health to take over the hospital.

According to the Ministry of Health news release, “these steps are being taken to restore necessary public confidence in the local hospital system. Despite the hospital’s best efforts, doubts remain about its ability to meet Niagara-area residents’ expectations of their local health care system.”

The appointment follows local pressure over more than 30 C. Difficle-related deaths at the hospital since May 28, although Health Minister Deb Matthews told the CBC that the issue is much more than that – that she had heard concerns about NHS right from day one of her appointment.

Much of the negative publicity the NHS has received stemmed from a hospital “improvement plan” that included closure of ERs in Port Colborne and Fort Erie and the planned transfer of maternity services to the new St. Catharines hospital.

The new hospital itself has been the focus of much criticism over the high cost of building and operating the facility as a public-private partnership.

This lengthy community turmoil was noted by the New Democrats. NDP leader Andrea Horwath told the St. Catharines Standard: “It seems to me that the Health Minister is the last person in Ontario to realize there’s a crisis in confidence in the Niagara Health System. Where has she been for the last couple of years?”

Matthews statement would suggest that the supervisor will have a much greater mandate than exploring hospital-based infections at NHS.

Unlike other hospitals where senior staff and board have been dismissed following such appointments, Matthews has made it clear that she expects the supervisor to work with existing staff and board.

Who gets appointed may be of concern.

The community may perceive an appointment of a nearby Hamilton hospital executive to be a conflict of interest, particularly if recommendations emerge to move any regionalized services to that city.

Given the Minister’s desire to rebuild confidence, it would be preferable to bring a supervisor from outside the region given the track record in the Hamilton Niagara Haldimand Brant LHIN on public consultation. In 2010 the ombudsman was particularly critical of the lack of proper public consultation over changes to the NHS and Hamilton Health Sciences, calling existing practices “simply illegal.”

It is also not clear how this will impact the review of the misnamed “hospital improvement plan” (HIP) in Niagara. The review was supposed to involve appointees from area municipalities in addition to the LHIN and the NHS. There was widespread suspicion over the review given two of the three organizations on the review were responsible for the original HIP.

The appointment of a supervisor may also open up the NHS to investigation by the ombudsman’s office. As private not-for-profit organizations, hospitals are normally off-limits to the ombudsman. The appointment of a supervisor effectively places the hospital under the direct control of the Ministry of Health and Long Term Care and subject to the ombudsman’s jurisdiction.

The Ombudsman has made no secret of his desire to be able to investigate the MUSH sector – municipalities, universities, school boards, hospitals, nursing homes and long-term care facilities, police, and children’s aid societies.

While the St. Catharines Standard says it will be 14 days before a supervisor is named, there is anticipation that such an announcement may come much sooner.

1 Comment

Posted in Hospitals, Local Health Integration Networks

Tagged , , , ,

Ontario hospital data less than timely, transparent

Posted on August 12, 2011 | 3 comments

How transparent is data from Ontario’s hospitals? And does it really tell the true story?

In July the far right Fraser Institute took a shot at Ontario hospitals claiming they lacked transparency when it comes to reporting performance indicators.

The Ontario Hospital Association shot back, claiming the Fraser Institute was likely unaware of  www.myhospitalcare.ca –an OHA site that provides data on more than 40 performance indicators.

The release quotes OHA President Tom Closson as saying Ontario’s hospitals are among the most accountable in Canada. The question is: how does Closson come to that conclusion? Is the OHA web site intended to be the evidence to support such a claim?

It’s true that there is a lot of public information on hospital performance, although what gets reported varies from hospital to hospital, the manner in which it is reported is often difficult to understand, and the information is usually less than timely.

The information is also in different places. Some of it is on individual hospital web sites. A select number of indicators are on the OHA site. Wait times information is on a Ministry of Health web site. To complicate matters, the information reporting dates are not the same on these sites, leading to conflicting data results.

It is also not unusual to see wild swings in the information reported, leading to questions about the quality of the data.

If you look up the Niagara Health System (NHS) on the OHA’s site, the infection rate for C-Difficile is similar to many other hospitals, although above the provincial average. That may have something to do with the fact that the data was collected in February of this year. Similarly, the Hospital Standardized Mortality Rate for the NHS is above average but below many other peer hospitals. These numbers don’t tell the real story – the Niagara Health System has recorded 37 C-Difficile-related deaths this year – so far.

In the age of real-time technology, is it reasonable for the public to try and make decisions based on data that is often more than six months old?

The OHA specifically cautions about using standardized mortality scores in determining which hospital to go to, instead suggesting such data should be used to track the performance of the hospital. What’s the point of standardizing such scores if they are not meant for outside comparison?

At the Local Health Integration Network board meetings, explanations over how to interpret this data are frequent. Yet the public is expected to go to web sites and understand such concepts as compliance with pre-surgery antibiotics, percentage of near miss reporting, or how inpatient weighted cases are determined. Could there not be at least a glossary and some explanatory notes to go with this data?

Try and decipher this reported action on the Peterborough Health Center web site: “Monitor and review VAP and CLI cases, rates and compliance with Safer Healthcare Now! Bundles.” Reading this, I’m sure the public can sleep more soundly now.

Clearly there is a need to provide a more simplified overview that puts this data into a more meaningful context.

Often data is hiding in plain site – on some hospital sites there is so much of it, finding what you are looking for is a considerable challenge on poorly organized web sites.

The myhospitalcare web site does provide provincial averages, but it does make it difficult to look at comparisons without going to each specific hospital location on the site.

Closson’s pronouncement of Ontario’s transparency ignores the fact that the province is the last to bring hospitals under Freedom of Information legislation. Ontario hospitals finally come under the Freedom of Information and Privacy of Privacy Act in 2012, but the OHA successfully fought to bring in additional exemptions for quality information as part of this year’s budget bill. In fact, the broad-based wording of the exemption will allow hospitals to conceal considerable information from prying eyes looking for public accountability.

Curiously, the OHA recently posted its advice to hospitals about the upcoming FIPPA deadline. You need a login and password to read it.

Ontario is also the last province in Canada to open up public hospitals to the scrutiny of the ombudsman. This is one office that has the expertise to cut through the dense jargon OHA members use in their reporting and to demand the data that isn’t publicly posted.

Last October Osler, Hoskin & Harcourt LLP raised eyebrows when they sent out an information bulletin warning hospitals that they should be “cleansing existing files on or before December 31, 2011, subject to legislative record-keeping requirements.” Osler was warning Ontario hospitals that they could face the same kind of reputation risk as e-Health if they failed to do so.

While there was shock and dismay, nobody knows to what extent Ontario hospitals took that advice to heart.

It is interesting that Closson used the word “accountable” and not “transparent” in the OHA’s defense.

Clearly there is a way to go for hospitals to be transparent in a truly meaningful way.

3 Comments

Posted in Health System, Hospitals, Local Health Integration Networks

Tagged , , ,

High cost of parking a barrier to hospital services?

Posted on June 15, 2011 | Leave a comment

Does the high cost of hospital parking deter the public from accessing health services?

In 2006 we sought the answer to this question through a Vector Poll.

Over half of those surveyed in Ontario – 55 per cent – said the high cost of parking would deter low-income people from getting the health services they need. Another four per cent said it would depend on circumstances.

When the survey was broken out by income, that response climbed to 74 per cent among those earning less than $30,000 per year.

For those accessing regular services at their local hospital, this can add up to a significant amount, particularly for those on fixed incomes. We recently calculated that a rise in parking charges at Rouge Valley Health System would cost weekly users a total of $800 per year. For cancer patients attending three times per week, that would mean $2,400 per year.

One local community approached their local hospital and the Local Health Integration Network to complain about this access barrier in the wake of increased charges. Both the LHIN and the hospital pointed fingers at each other, the LHIN saying such charges were up to the hospital, the hospital charging the LHIN forced the hospital to increase its “own-source” revenues. Doing their own research, they told OPSEU that only four hospitals are left in the province that offer free parking.

Pushing hospitals to raise the rate of parking and other own-source revenues is not new. The province’s annual hospital planning submission guide always suggested raising revenues in the event of a funding shortfall. Parking was always on the list.

With hospitals continuing to see less funding for their core budgets, it is no surprise to see them picking away at more user-pay options allowed them under the Canada Health Act.

The question is, where do you draw the line? It appears hospitals are indifferent to market rates in their communities. In many small towns the only pay parking is at the hospital.

It is clear that these charges are no longer restricted to the costs of maintaining the parking facilities.

One municipality thinking aloud suggested making parking charges tax deductible, a cumbersome method that would only benefit those who pay taxes. If it is going to be tax supported, why not filter out all the steps in between?

Ironically, hospitals have used their own high-parking charges to justify cuts to services. At one hospital they suggested the closure of their outpatient lab would be welcomed by users who would no longer have to pay the hefty hospital parking fees by attending private lab collection facilities in the community.

So what is the solution? If Toronto’s University Avenue hospitals made parking free, everybody would park there, from Blue Jays fans to those ducking out of the cost of parking underneath City Hall.

In some local communities citizens have learned how to game the parking lot, taking a new tag before they return to the vehicle, often in lots where the first half hour is free.

Some hospitals have offered discount rates for patients or those who have family in their care. This appears to make some sense in high traffic areas, although there is some concern hospitals desperate for revenue may be moving away from this.

Perhaps it’s time the LHINs, the Ministry and the hospitals stop pointing fingers at each other and start to address this question in a constructive manner.

Five years ago Ontarians said this was a legitimate barrier to health care we all pay for. When Rouge Valley raises the parking fees from $8 to $16 for patients in their cardiac and cancer programs, it is clearly only getting worse.

Leave a comment

Posted in Hospitals, Local Health Integration Networks

Tagged , , ,

PC Platform: Tim Hudak wants you to compete for the job you have

Posted on June 7, 2011 | 3 comments

Tim Hudak is no longer the mystery man. The question is, now that his Ontario Progressive Conservative (PC) platform is out there, will it matter?

Hudak has made it clear that he intends to make public sector workers a target, including workers in health care.

“We will introduce initiatives requiring public sector unions to compete for government contracts, where appropriate,” the Tory Changebook states. “If another organization – whether a non-profit group or private business – can provide better value for money, taxpayers deserve to benefit.”

The platform goes on to suggest support services “like food preparation or laundry” in our “public institutions” are a prime example where he expects these competitions to take place.

If you are spared the competition, you may not have your next contract fairly arbitrated. Hudak plans to challenge the independence of the arbitrators, claiming recent awards have been “excessive.”

“We will require arbitrators to respect the ability of taxpayers to pay and take into account local circumstances,” the document states.

Changebook claims the Tories will “bring public sector paycheques in line with private sector standards.”

Specific to health care, Changebook makes the same promise as the McGuinty Liberals when it comes to funding – reduce increases to three per cent per year.

Hudak promises a review of all agencies and commissions, but would axe the LHINs before that even takes place. He would not replace the LHINs, which raises questions about how health care planning, local funding, and community engagement will take place. He says he will redirect the $70 million per year from closing the LHINs into front line care. At present Ontario spends $47 billion on public health care.

The Tories say they will add 5,000 new long term care beds and increase investments in home care to “give families more control over services.” That includes the ability to stay with the provider they have now, or pick a new government-funded home care provider who better meets their individual needs. Given the Tories have supported competitive bidding in home care, it is unclear whether an individual will be able to maintain their provider after they have lost the CCAC contract. While the Tories promise to increase investments in home care, they also promise to find savings at the CCACs.

Hudak says he will clamp down on fraud, but the only specific promise is to demand that people using the old red and white health cards also present another form of government-issued identification, such as a driver’s license or passport.

Unlike the Federal NDP, which promised more doctors and nurses, the Tories only claim to add to the number of doctors by increasing residency placements for medical students from Ontario who have pursued their education outside Canada. They call upon doctors, nurses, nurse practitioners, and physician assistants to work collaboratively, particularly in underserviced areas. There is no mention of the other health professions integral to the public health system.

Like the McGuinty Liberals, the Tories vow to be as obsessive about measuring health outcomes and “introducing a rigorous system of patient satisfaction.” Do we read that as even more patient satisfaction forms to fill out? And how does this square with the promise to reduce bureaucracy?

The Tories say they will make it law that the province cannot raise taxes without a clear mandate. Unfortunately, it is silent on needing the same to cut taxes, particularly for corporations.

They also promise to expand the scope of Freedom of Information, but it is not clear how.

The Tories have already come under fire for their spending commitments and tax cuts. The normally conservative Ottawa Citizen called it the “common nonsense revolution,” comparing Hudak’s plans to reckless debt run up by U.S. President George Bush. “Unlike Bush,” writes Citizen editorial board member Ken Gray, “Premier Dalton McGuinty has required Ontarians to pay for the services they receive for which his government has been dubbed ‘tax and spend’ by people who would rather spend, borrow and pay interest.”

“Hudak’s election platform is the kind of document that made Greece the model of fiscal prudence it is today,” writes Gray.

3 Comments

Posted in CCAC, Health Care Professionals, Health System, Local Health Integration Networks, Long Term Care

Tagged , , , , , , ,

Minister asks for review of Niagara Health System plan

Posted on May 31, 2011 | 1 comment

Niagara Health System (NHS) will get a fresh look at its controversial Hospital Improvement Plan (HIP) that closed down two ERs in Fort Erie and Port Colborne.

The Minister of Health has ordered what is called a “third party” review although members of the NHS board will be part of that review along with representatives of the municipalities and the Local Health Integration Network.

The review will only look at phases of the hospital improvement plan that have already been implemented. It will not look at phases that have yet to be implemented, including changes to pediatrics and birthing.

According to Niagara This Week, the Minister stated in her letter to Niagara Regiojnal Chair Gary Burroughs “after thoughtful deliberation and consideration, I have come to the conclusion that an independent, third-party evaluation of the implemented phases of the HIP would be valuable.”

The review is certainly welcome, although two of the three parties engaged in the review were responsible for the initial HIP that has upset residents of the Niagara Region.

While deficits at NHS have been again climbing, Matthews insists the original HIP moved the hospital in the right direction.

Further terms of the review have yet to be determined and will be left up to the LHIN.

On the eve of an election, the news opens the door a crack after years of active lobbying by the local community, including Sue Hotte and the Yellow Shirt Brigade.

The HIP was ordered by the LHIN in May 2008 and was conducted largely by executives from the Ottawa Hospital, including Dr. Jack Kitts. The report was submitted in October 2008 and approved by the LHIN in January 2009.

1 Comment

Posted in Hospitals, Local Health Integration Networks

Tagged , , , ,

LHINs — It’s not so much what you put in or out

Posted on May 25, 2011 | 1 comment

There are three issues that really coloured OPSEU’s initial relationship with the LHIN – both of them taking place long before the LHINs were even a concept in former Health Minister George Smitherman’s brain.

One is competitive bidding in home care, where contracts come and go, and so do the workers.

The second is the dramatic difference between what workers earn in the hospital and how they are remunerated in the community.

The third is the betrayal of mental health. Significant cuts to psychiatric hospitals were made and the promised alternate services were only partially re-established in the community.

In 2005 when we first learned of the LHINs, it sounded like more of the same.

The 2006 Act that brought the LHINs into being did make some adjustments to recognize the transition of health care workers between employers, but as one presenter to this week’s Central East LHIN board remarked, “often you enter in an integration and people are afraid.”

When people are afraid, they fight the change.

Long before the LHINs there was something called Hospitals In Common Labs. It is a non-profit corporation run by Ontario hospitals that does lab work for 250 health care provider clients from across Canada. HICL has generated $100 million in revenue over the last decade that has gone back into its participating hospitals. It is considered to be the gold standard for medical lab testing. It is therefore astonishing when the South East LHIN tells the media they had to make hospitals in their region play nice in the sandbox. Sorry SE LHIN, your hospitals were light years ahead of you. HICL has been around since 1967.

With a focus on transitioning work, often overlooked is the idea of keeping the work in place but cooperating as a system, as HICL has done.

To be fair, many of the integrations we are now seeing are more along these lines. At the Central East LHIN a proposal was looked at that would merge the two cardiac rehab programs in Durham with the goal of expanding the program and filling in gaps. The program – which involves weekly sessions with those at risk for heart disease, stroke and diabetes – can only be successful if they are delivered within a 30-minute radius of the patient.

Expanding the program would be a huge benefit to the region. Not only does it improve the chances of survival for a high-risk group, but it also improves quality of life, including a measureable reduction in anxiety and depression.

This week the Central East LHIN also spent time on a strategy that would bring together service providers to improve specialized geriatric services. That strategy includes a CEO-level committee to plan an entire system of care for frail seniors. By involving the CEOs, it ensures greater buy-in within the organizations. The proposal for an umbrella organization for frail seniors is timely – growth in the seniors population is expected to grow 19 per cent by 2019, at which time 47 per cent will be over the age of 85. There is desperate need for a more coherent approach to these services.

When Dr. Alex Hukowich left the board of the Central East LHIN, he made it clear that he was unsure whether the parts the LHIN was taking out of the system or putting into the system were of value.

Maybe that’s part of the problem – the need to pluck pieces out and put pieces back in is probably limited. Getting the various pieces to work as a system is likely the greater challenge.

To deal with that, the Ministry and the LHINs have to overcome a lot of history, including addressing some of our longstanding grievances prior to when the LHIN was even here.

1 Comment

Posted in Health System, Local Health Integration Networks

Tagged , , ,

The trouble with LHINs Part II – How do you integrate half a system?

Posted on May 11, 2011 | 2 comments

One of the key problems with the Local Health Integration Networks was evident from the start: they were given responsibility to better integrate our health system, but couldn’t address key parts of that system.

How do you integrate health care without the ability to better coordinate primary care? Physicians have always remained outside of system planning, and it could be argued that much of our system is defined by the agreement between the Ontario Medical Association and the Ministry of Health. This is totally outside the LHINs.

Oddly, while Family Health Teams remain outside the LHINs, Community Health Centres are in.

OPSEU has argued for years that the health system would be more efficient and cost-effective if hospital medical labs also conducted community-based work. Funding for community-based volumes would allow hospitals to increase staffing in their labs, expand scope of testing, and assist in the purchase of new equipment. For community doctors, it would result in faster turnaround of medical laboratory testing and give local physicians a direct lab contact in the community. In a comparison with some of the smallest hospital labs in the province, consultants RPO discovered that these labs were performing the same testing at two-thirds the cost of private labs. Once the hospital loses community-based work (there are only a handful left that still perform community-based testing) it is totally out of the jurisdiction of the LHINs. The North Simcoe Muskoka LHIN washed its hands of this issue when we raised it at the time Bracebridge and Huntsville hospital labs were losing their community volumes.

In Owen Sound the hospital is attempting to divest speech language therapy for preschoolers to the health unit. Once it is gone, the LHIN will no longer be able to address that service given health units are out of its jurisdiction. Who will monitor outcomes once that service is transferred? What happens if it turns out the hospital was the better host for the service, or perhaps another community-based agency? Who hold the health unit to account?

Within the LHIN jurisdiction, integrations are often about moving services around rather than facilitating strong links between health providers.

Integration shouldn’t just be about moving services from provider A to provider B and C.

As the Central East LHIN recently recognized, two addictions services don’t need to merge in order to cooperate on strategic goal setting. While it has been orthodoxy to move services out of hospital, the LHIN recognized the role of Lakeridge Health in maintaining one of these two addiction services.

The LHINs have consistently drawn a line between hospitals and community-based agencies, but hospitals do exist within communities. If a hospital is to provide community-based services, would it not by its very nature integrate well with other in-hospital services?

What role does prevention play? Not only is health promotion outside the jurisdiction of the LHINs, it is completely outside the Ministry of Health and Long Term Care.

We know, for example, that a more active population would dramatically reduce diabetes costs. One estimate suggests that if we were to bring diabetes down to the same level of northern European countries Canada could save $6 billion a year in health costs.

It’s true the LHINs do have contact with health providers outside their jurisdiction. But it has no ability to evaluate the quality of the work done by these providers, or whether the services they provide might be better delivered somewhere else. Nor does a friendly contact necessarily compel these providers to work more closely with hospitals, mental health agencies, home care or long term care homes.

The idea behind the LHINs was to make our health system just that – a system.

Some say five years is not long enough to get the job done. But what significant changes have the LHINs really made to date?

How long will it take to see a system emerge from the disparate entities that presently deliver public healthcare?

Are we expecting too much from bodies appointed to manage when what we really need are signs of bold leadership? Is this even possible within a LHIN model?

And where does the accountability lie? At present everything leads to the Minister of Health. Should it not also lead back to the communities?

Everybody has a shopping list of how we could do better. While our system is in the middle of the pack with regards to cost, there is no question that we could do better from an organizational point of view.

Our LHIN discussion series continues.

2 Comments

Posted in Local Health Integration Networks

Tagged , , , , ,

The trouble with LHINs

Posted on May 10, 2011 | 2 comments

Local Health Integration Networks (LHINs) have become lightning rods in many communities.

The Hamilton Niagara Haldimand Brant LHIN was the focus of a scathing Ontario Ombudsman report “The LHIN Spin” which suggested public engagement was no more than lip service.

The South East LHIN recently sent their local communities into a panic after it floated the idea of concentrating all surgeries in Kingston.

The Erie St. Clair LHIN generated headlines last year when it unveiled plans to bring in a Disney speaker at a cost of close to $10,000. The speaking engagement was cancelled, although not the cost.

Aside from a horrible name, the LHINs have made many blunders to turn Ontarians against them – at least among the citizens that are even aware they exist.

68 per cent of PC supporters oppose plan to kill the LHINs

In a February 2011 Vector Poll, only 22 per cent of respondents claim to have either heard or read something about LHINs. Vector has been polling this question since 2006 with barely a change in results. After a brief description of what the LHINs do, 77 per cent of Ontarians opposed shutting them down. More troublesome to PC leader Tim Hudak, 68 per cent of PC voters are opposed to his promise to kill the LHINs.

It’s like that old song, “I can’t live with you, but I can’t get along without you.”

If the LHINs are likely here to stay, how do we fix them?

For starters, it’s about time the province come up with its overall strategic plan. It was supposed to be the guide for the LHINs to develop their own regional integrated health service plans. Instead, the province has been flighty in its priorities, often changing from Minister to Minister. George Smitherman was all about aging at home. David Caplan was about mental health. Deb Matthews is focused on getting alternate level of care patients out of hospitals.

Secondly, the LHINs are likely too small and have too few professional staff to effectively carry out their work. They like to crow about how small their administrative costs are relative to funding they shell out to hospitals, long term care homes, home care and other health providers, but it may be unreasonable. The Ministry has added to the workload with additional performance indicators and a broadened scope of oversight, but it refuses to allow the LHINs to hire appropriate staff to get the job done.

This may have something to do with point three – the LHINs have been very focused on reigning in costs, mostly at hospitals. It would be political folly to add to the LHIN administration while front line health professionals are being cut. This was supposed to be an exercise about quality, but clearly the focus has been on cost. One hospital CEO showed up at a LHIN board meeting to discuss progress on his hospital’s improvement plan. Missing from his presentation was information about the hospital’s performance on the LHIN’s quality indicators. To their credit, Ontario hospitals are in a far better place financially today, but it may be at a cost in quality.

The LHINs were supposed to take their strength from the communities they served, but no community has really warmed up to them. A few years ago OPSEU was invited to participate in a panel discussion on the LHINs by the Rural Ontario Municipal Association (ROMA). When the floor opened for questions, Mayors and Councillors of small towns lined up at the microphone to vent their frustration with the LHINs. The mayors felt the LHINs were unaccountable and were carrying out a hatchet operation on their local hospitals.

When a matter of concern comes up on the LHIN board’s agenda, often communities show up in considerable numbers. The LHINs lack any mechanism for representatives of these communities to address their concerns directly to the board. Recently two LHINs opened up their board meetings to deputations, although the process at Central East may be far too onerous and controlling to ever work.

When the LHINs did hold events for public consultation, these events often involved round tables with facilitators and set question lists. Many who have attended these events found the process manipulative.

When OPSEU took the Central East LHIN before judicial review in 2008, the lawyers for the government argued the LHINs were only responsible for high-level consultation, not on specific changes. In other words, the LHINs could ask what kind of health services a community might want, not on whether 20 mental health beds should be shut down at their local hospital and moved to another community.

It’s these specific initiatives when the public is most engaged, and it is these moments when the LHIN shuts them out of the process.

There are signs the LHINs are beginning to learn from their mistakes. At a recent Central East LHIN meeting they said they looked at integration between two addiction services and realized that while cooperation between the two of them was encouraged, it didn’t make sense for them to merge. The LHIN also acknowledged that Lakeridge Health was a good place to host one of these two services – a radical departure from the LHIN’s early days when it seemed they couldn’t move services out of hospital fast enough nor convince enough providers to integrate. This is the same LHIN than asked hospitals to set aside 1 per cent of their budget to allocate to a community-based health provider while trying to maintain it was making evidence-based decision-making.

There is a value to have a process by which health care providers must justify changes in service delivery.

The Southwest LHIN recently put the breaks on a plan by Grey Bruce Health Services to jettison speech language therapy for preschoolers. The hospital made the announcement under a hope and a prayer that the Health Unit would be able to pick up the work. The LHIN has since written to the hospital asking them to submit a formal integration proposal. Such a proposal will require more than a hope and prayer in the transfer of a service — it will need a HR transition plan.

The South West also responded to complaints that the Regional Mental Health Centre in London and St. Thomas was cutting beds without providing appropriate alternate services in the community. The LHIN allocated another $2.9 million for community delivery of mental health as a result. It won’t be nearly enough, but at least there was evidence they are listening.

It is far more productive to start talking about what the LHINs or their replacement might look like rather than take an axe to it all as Tim Hudak proposes. Diablogue will write more on this in the weeks to come.

2 Comments

Posted in Local Health Integration Networks

Tagged , , , , , , , ,

What’s beyond the LHINs? Hudak says he’d replace them with nothing

Posted on May 9, 2011 | 1 comment

There is no question the Local Health Integration Networks have had their share of problems.

When they were first proposed in 2005, OPSEU warned that it would lead to a rationalization of health care services and shield the politicians from unpopular decisions. To a degree, both concerns have turned out to be true.

One of the few promises provincial Tory leader Tim Hudak has made is to scrap the LHINs. The Tories say it would save $250 million, however, that is the total cost of the LHINs since 2006, not the annual cost. At present the LHINs take about $70 million per year to administer. On a $47 billion health budget (about half of which is within the jurisdiction of the LHINs) that’s a very small percentage allocated for administration.

If Hudak were to scrap the LHINs, he would not even save the $70 million. The LHINs replaced seven regional Ministry offices and 16 District Health Councils which previously cost $48 million. With inflation, the costs would likely remain equivalent to the LHINs if Hudak were to turn the clock back.

But Hudak says he would not replace the LHINs, he would simply cut them. We’re not sure how that would work, and likely neither does Hudak.

Dismantling the LHINs would not be free, as we discovered in the transition from District Health Councils and Regional Offices to LHINs. Costs ranging from broken leases to severance costs would be borne by government. Then there is the cost of transitioning the work.

Hudak doesn’t say what existing infrastructure would absorb the LHIN work, from planning and accountability to public engagement and integration. Is he actually suggesting we don’t need these functions?

The recommendations of the Health Restructuring Commission once dominated Ontario’s health care policy-making. Those recommendations are now more than a decade old. The data by which they came to their conclusions is closer to two decades old. There is a need to gather new evidence and make sound decisions around the future of our health system.

If we are to move forward we really have two choices – reinvent the existing LHINs, or come up with a new structure altogether. Both have their pros and cons.

Unfortunately the McGuinty government never followed-through on the requirement in the Local Health System Integration Act to conduct a review of the LHINs after five years. That would be now.

Neither did McGuinty ever produce the provincial plan that was supposed to be the guiding direction for the LHINs. Instead the LHINs scramble to fulfill whatever priority whim is the flavour of the day at Queen’s Park. Nowhere was this clearer than in the province’s focus on alternate level of care.

While the LHINs were making plans to utilize their aging at home funding, the Ministry changed its mind and suggested that at least half that money be devoted to getting ALC patients out of hospital.

Regardless of who gets elected, it is likely the LHINs will look very different after the October provincial election.

1 Comment

Posted in Local Health Integration Networks

Tagged , , , ,

LHINs grapple with data to make decisions

Posted on April 28, 2011 | 1 comment

What is sufficient data to make effective decisions about the health system? What is the quality of that data?

Two issues came up at Wednesday’s Central East LHIN board meeting to illustrate both questions.

The LHINs across Ontario are balking at a lengthy list of performance indicators from the province they claim are “too many and too detailed.” The CE LHIN says it would need additional staff to keep up with the data stream the province is asking for.

James Meloche, a Senior Director with the CE LHIN, said the list of indicators was not strategic, leading departing board member Ron Francis to suggest the LHIN should be asking the province what they are planning to do with the data generated by these indicators.

Three different bodies are presently generating lists of indicators without any coordination between them. The LHIN says Hospitals are “maxed out” by the requirement for an every increasing stream of data.

For all the data that is presently collected, the veracity of it came into question in an exchange between Meloche and CE LHIN board member Samantha Singh.

Singh had questioned CE Community Care Access Centre CEO Don Ford on the large number of children awaiting speech-language therapy in the LHIN. Ford confirmed that the wait list for speech language therapy was between two and three years.

Meloche chimed in that the LHIN had previously only had 70 people on the wait list for speech language therapy– including both children and adults. After a recent blitz, he said that list was now down to 10.

Singh was incredulous; saying one school she visited had eight children waiting for speech language therapy.

The LHIN board also had a lengthy discussion about delays in getting data. At the April meeting the board was just getting results from the third quarter of last year. Paul Barker, a senior director of the LHIN, said reporting periods were “all over the map.” The third quarter data showed two hospitals in deficit, whereas in fact he said only one – Peterborough – would finish the year in the red.

With delays in getting data, the board is sometimes left making decisions on information that is six months old.

1 Comment

Posted in Local Health Integration Networks

Tagged , , , , , , , , , ,