Tag Archives: Central East LHIN

“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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Unintended Consequences – Northumberland Hills CEO says replacing ALC patients comes at a cost

Reducing the number of “alternative level of care” (ALC) patients in a hospital may have unintended consequences.

Robert Biron, CEO of the Cobourg’s Northumberland Hills Hospital, told the Central East LHIN yesterday that his current operating deficit may be partially linked to the hospital’s success in reducing the number of ALC patients from a high of 36.8 per cent in December 2010 to a low of 2 per cent in June of this year.

Alternate level of care patients are those who have completed their acute care treatment at the hospital but are not well enough to return home. Wait lists for long-term care beds and home care services have left many hospitals without an ability to responsibly discharge these patients.

Biron says filling the former ALC beds with high acuity patients requires more resources, not less, including advanced nursing care. These are additional costs to the hospital in a year when base budgets are frozen.

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Did The Scarborough Hospital hide its near insolvency from the LHIN?

The merger between the Scarborough and Toronto East General hospitals may be off, but the Central East Local Health Integration Network certainly took note of one of the report’s statements – The Scarborough Hospital is near financial insolvency.

This may be the main reason why the Toronto East General Hospital backed off from a proposed merger, or as the consultant’s report states, was a “potential show stopper.”

The LHIN has since released a statement March 1st that suggest The Scarborough Hospital’s financial predicament may have been previously misrepresented.

“The report makes a number of observations related to the financial sustainability of The Scarborough Hospital that are not substantiated by evidence or data previously submitted by the hospital to the LHIN which will require some clarification by the hospital,” the LHIN release states.

Or in more common parlance, TSH CEO Dr. John Wright may have some explaining to do.

The LHIN also raised issues about how the merger talks had evolved, noting that the process lacked a transparent explanation of the vision, aims and scope of an integration, a clear understanding of the benefits to the community, nor an appropriate community engagement plan.

The Scarborough Hospital is expected before the LHIN on March 28th to outline its plan on how it will “move forward.”

LHIN warns merger of two Toronto hospitals could undermine access and quality

As The Scarborough Hospital (TSH) openly advocates for a merger with the Toronto East General, CEO Dr. John Wright may have difficulty persuading the Central East Local Health Integration Network of the merits of bringing the two hospitals together.

In a preliminary report recently posted online, the Central East LHIN raises a number of concerns, including the fact that such a merger does not align with their clinical services plan.

The CE LHIN states there is no evidence that “this will improve quality or access,” suggesting that it may possibly undermine it.

The LHIN states that the current activity is not client-focused, lacks a clear engagement strategy, and has not garnered physician support.

They further state there is no evidence to suggest a merger would assist in addressing population health challenges within Scarborough.

The LHIN suggests that if TSH is interested in an alliance, that it would make more sense to look towards “integration” with the Scarborough Centenary Hospital, which is part of the Rouge Valley Health System.

This is not the first time that suggestion has been made. Community groups in Ajax, who have never been happy having their hospital linked to Scarborough Centenary, have long advocated that Centenary should join TSH, leaving the Ajax-Pickering Hospital to link to Durham’s Lakeridge Health.

No application has yet been made by the two hospitals to proceed with a formal merger.

CEO says he wants to increase power base through Toronto hospital mergers

After all the talk about system integration it’s notable that the CEO of a Ontario public hospital should argue for a merger on the basis of enhancing the institution’s power base.

This hardly strikes us as being in sync with the present evidence-based narratives emerging from the Drummond Report or the Minister of Health’s new action plan. Isn’t health planning supposed to be about providing care in the right place at the right time by most appropriate provider? The “power” scenario suggests the province may be making decisions on a different basis.

It is even more surprising given one of the two potential dance partners in the merger is Rob Devitt, CEO of the Toronto East General Hospital.

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Turning around the Titanic?

Many of the LHINs are now seeing turnover of their original board chairs as their terms expire.

This week Foster Loucks, Chair of the Central East LHIN, conducted his final board meeting in Ajax.

Reflecting on the long and difficult process of transforming the health care system, Loucks told the meeting “whenever you turn the Titanic around it’s going to take some time.”

There may have been one or two puzzled looks in the room – did the departing chair not remember that the Titanic actually sank?

Loucks was probably the first Chair we had contact with from OPSEU. While we didn’t always agree with his board’s decisions, there is no question that Loucks was always focused on the mission of improving health care delivery within the region. He was usually quick to address our concerns and treated our members with respect. He will be missed.

We offer him our best wishes – and Foster, if you are planning any cruises in the next little while, be careful which ship you get on.

The trouble with LHINs

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.

LHINs grapple with data to make decisions

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.