Tag Archives: hospitals

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

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.

Hospital secrecy – changes to Budget Bill fail to protect public interest

The latest amendment to Ontario’s Budget Bill 173 fails to address concerns raised around a change to freedom of information legislation that will permit greater hospital secrecy.

Schedule 15 of Bill 173 enables a hospital CEO to shield from public scrutiny any information about quality of care produced for or by a hospital committee. More than a dozen groups appeared before the legislature’s Standing Committee on Financial and Economic Affairs in April asking the offending schedule be removed.

Instead the McGuinty government has amended the proposed Bill to exempt “information provided in confidence to, or records prepared with the expectation of confidentiality by, a hospital committee to assess or evaluate the quality of healthcare and directly related programs and services provided by a hospital, if the assessment or evaluation is for the purpose of improving that care and the programs and services.”

Ontario hospitals are the last in Canada to come under Freedom of Information legislation. After introducing a public sector accountability bill last fall that would open up hospitals to freedom of information requests beginning January 2012, the McGuinty government recently caved-in to a lobby by the Ontario Hospital Association, the Ontario Medical Association and a private insurance company to narrow what would be accessible.

“The government’s amendment allows hospital executives to make some documents secret by simply stamping ‘confidential’ on them or retroactively suggesting that the records were intended to be private,” says Cybele Sack of Impatient for Change, a patient advocacy group. “Our freedom of information laws are meant to increase transparency and this amendment undermines that spirit.”

The final act is expected to be passed by the majority Liberal government this Thursday (May 5).

SE LHIN looking to rationalize surgeries to as few as one regional hospital

Surgical services may end at Perth-Smiths Falls and Napanee Hospitals as part of a new clinical services roadmap in the South East region of the province.

The South East LHIN is now consulting the public on the issue. A series of “workbooks” are on-line, some putting forward ideas for change, others broadly hinting at them.

Unlike other such exercises, the SE LHIN is placing the emphasis of this new plan on financial sustainability.

“Our existing hospital system was built on a model that is decades old, that doesn’t reflect the economic realities we face today,” the LHIN web site states.

Despite the fact that core hospital budgets are going up by less than 1.5 per cent, the LHIN erroneously claims the cost of hospital care is increasing at twice the rate of inflation.

April 19th staff of the Perth and Smiths Falls District Hospital were given an unvarnished version of the options for surgeries.

They were told at a general meeting the LHIN is looking at everything from the status quo to providing all regional surgeries in Kingston. It’s clear from the ordering of the potential rationalization of surgeries that Napanee and Perth-Smiths Falls are the most vulnerable to these changes.

“If you ask the general public if they’re going to get hip surgery in six weeks or two weeks, I can guarantee you they’ll take the two weeks if they have to go to Brockville,” Georgina Thompson, Chair of SE LHIN told the Belleville Intelligencer.

The irony is Perth and Smiths Falls District Hospital presently has among the shortest wait times for hip replacement in the province. The wait is 71 days compared to 79 days in Brockville, 141 days at Kingston General Hospital and 192 days at Kingston’s Hotel Dieu.

Two weeks wait for hip surgery may sound good to the uninformed, but the LHIN hasn’t explained how rationalizing services from hospitals with short waits to hospitals with longer waits is somehow going to accomplish this. Presently the shortest wait for hip replacement is 49 days, not two weeks. For that you would have to travel to Brantford.

When the government introduced the idea of Local Health Integration Networks, OPSEU had argued it was paving the way for rationalization of services. At the time the union was accused of fearmongering. Now it appears to be happening.

All of this is also taking place as a provincial panel is looking at the question of what is the role of small and rural hospitals. That question may be answered before they get a chance to make their recommendations.

Thompson says such rationalization will streamline the way area hospitals work together, promising no hospital would close, but services may substantially change.

“We have seven hospital sites today. We will have seven hospital sites tomorrow,” she told the newspaper.

A committee from the Perth and Smiths Falls District Hospital has been meeting with the SE LHIN to demonstrate what the outcome of such choices would be on population health, including the impracticality of concentrating surgeries in a handful of regional hospitals.

The SE LHIN defines itself on-line as “an organization based in Belleville.”

Feedback on the roadmap will be accepted until May 15. To access the on-line workbooks, go to http://www.southeastlhin.on.ca/HealthCareRoadmap

Hospitals warned to ‘cleanse’ files before 2012

There are further signs that by the time hospitals are subject to Freedom of Information legislation in 2012, what’s left to get won’t be worth the effort.

 The London Free Press reports that hospitals are being warned to “cleanse” their files of anything that might embarrass them before the public gets the right to access it come January 2012.

The warnings come from Toronto-based law firm Osler, Hoskin & Harcourt. Many hospitals across Ontarioare on OH&H’s client list.

“I was astounded at the language,” Ann Cavoukian,Ontario’s Information and Privacy Commissioner, told the newspaper. “Just using the word ‘cleansing’ is highly inappropriate. It suggests shredding, eliminating, hiding – getting rid of material before the end of the year.”

 Health Minister Deb Matthews said she expects hospitals to “embrace the spirit” of the legislation.

 However, while this is taking place, the province itself has slipped an amendment into the budget bill that will exclude hospitals form divulging “information provided to, or records prepared by, a hospital committee for the purposes of evaluating the quality of health care and directly related programs and services provided by the hospital.”

Federal campaign health care platforms: Conservative, Liberals, NDP and Greens

Health care was supposed to be the number one issue for Canadians coming into the Federal election. Within days, all the parties had committed to some level of renewal of the Health Accord, set to expire in 2014. Under that accord provinces have been receiving a so-called “escalator” that automatically increases Federal transfers to the provinces for health care by six per cent per year. By the last year of the accord that transfer should amount to about $30 billion. This was part of what officials once called an agreement to fix health care for a generation. Given the concerns that Canadians have been expressing during the election, they haven’t exactly met that expectation.

The Federal party platforms vary considerably, from the 98-page Liberal Red Book, to the 66-page Conservative “Here For Canada” platform, to the 12-page Green Party Platform. While the NDP features a brief point-form platform on their web site, there is no book.


In his opening message to the Conservative platform, Stephen Harper doesn’t actually use the word health, although one of the top five priorities, to support families, includes a promise of more support for seniors and caregivers.

That reference is to a $2,000 Family Caregiver Tax Credit for those who care for “infirm loved ones at home.” The tax credit would apply to those caring for an infirm spouse, common-law partner, and children of minority age.

The Conservatives have said they will work collaboratively with the provinces and territories to renew the Health Accord and to continue reducing wait times. A separate agreement would be negotiated with Quebec.

With little accountability embedded in the first Accord, the Conservatives say in their “discussions” they will “emphasize the importance of accountability and results for Canada.” However, they also state in the next paragraph that they “will respect the fact that health care is an area of provincial jurisdiction and respect limits on the federal spending power.”

During the leaders’ debate, Stephen Harper said he had a different definition of privatization than Jack Layton. Harper did not include private delivery of publicly-insured health services as privatization, which he refers to as “alternate delivery.”

In a CBC radio debate earlier in same day as the leader’s debate, Colin Carrie (PC MP-Oshawa) said he rejected David Dodge’s four solutions (see story on Diablogue) for health care, suggesting it was not an either/or scenario. The Conservatives are often criticized for not holding up the Canada Health Act (particularly around private clinics). Carrie said “it was the law of the land.”

Carrie said the government is working on programs to keep Canadians well, including doubling the children’s fitness tax credit to $1,000 and establishing an adult fitness tax credit of $500. Neither would be implemented until the federal budget is balanced — according to their plan, that would be 2014-15.

Many in the media have questioned how the Harper government could reduce taxes and escalate health care spending faster than growth in the economy.

Prior to the election call, MP Maxime Bernier had suggested in 2010 the Federal government get out of health care and transfer tax points to the provinces instead. A tax point transfer effectively means the Federal government would reduce taxes to the equivalent of what the provinces need to raise them by, leaving the tax rate the same for individuals. There are several obvious risks to this.

  • The provinces could use the tax points to implement their own tax cuts.
  • We would lose any semblance of consistent health care delivery across Canada.
  • The Federal government would lose any leverage by which to enforce the Canada Health Act, allowing provinces to further privatize and delist services.
  •  Charges for hospital services and extra billing would be allowed to thrive.

Bernier claimed it would allow the provinces to experiment more with different delivery models. The Canada Health Transfer is expected to hit $30 billion by 2013. At the time the PMs office said Bernier was not speaking for the government.

However, Harper himself said as much back in 2001 in the now famous “fire wall” letter to Alberta Premier Ralph Klein. In the letter, Harper, then President of the anti-Medicare National Citizens’ Coalition, argued that “each province should raise its own revenue for health care — ie., replace Canada Health and Social Transfer cash with tax points as Quebec has argued for many years.”

(To get a full history of Stephen Harper’s attacks on Medicare, journalist Murray Dobbin has a detailed chronicle at http://murraydobbin.ca/2011/04/16/dr-harpers-new-and-improved-medicare/  The Star’s Thomas Walkom also looks at Harper’s record, including lack of enforcement of the Canada Health Act, at http://www.thestar.com/news/canada/politics/article/977249–walkom-harper-and-the-subtle-erosion-of-medicare )

Ujjal Dosinjh, the former Liberal Minister of Health, told CBC radio the Tories pushed the health accord into the Senate “to wash their hands of responsibility.” He raised Bernier’s comments and said the Harper government had a “shrinking view” of the Federal role in health care. Megan Leslie, an NDP candidate from Halifax, said the PM had started no conversations with the provinces on the next health accord.

To read the Conservative’s “Here For Canada” platform, go to http://www.conservative.ca/media/ConservativePlatform2011_ENs.pdf


Unlike the Prime Minister, Liberal leader Michael Ignatieff places considerable emphasis on health care in his opening message. Stating the Liberal platform is about equal opportunity, he says Liberal governments have built up the foundations of equality, including establishing universal Medicare. The Liberals have one of the more developed health care platforms among the four major parties. Ignatieff has also promised a Federal-Provincial summit on health care with the Premiers within 60 days of taking office. The Liberals have pointed out that the Harper government has never convened a first minister’s meeting on health care.

While much attention has been spent on their pledge to renew the Health Accord and provide $1 billion for home care, less attention has been paid to their promise to scrap the Harper government’s Public Private Partnership Fund, which the Liberals claim has only delivered 8 per cent of the funds allocated to it. The Liberals would instead use the money for public housing.

P3s have been a feature of much of the recent debate over the Provincial Liberal plans to build new hospitals in Ontario.

The Family Care Plan is similar to the Tory plan – instead of providing funding for professionally-delivered home care services, the money is aimed at supporting families to provide care themselves. One half of the Liberal plan would include an extension of the six-week EI benefit for those who have to take time off of work to care for a “gravely ill” family member. To be eligible, the family member must be “gravely ill with a significant risk of death within 26 weeks.” The Liberals would thereby extend the current six week period to six months (26 weeks).

A new Family Care Tax Benefit would assist low and middle-income family caregivers who provide “essential care” to a family member at home up to a year.  The maximum is relatively modest at $1,350 per year. The Liberals estimate 600,000 family caregivers could take advantage of the benefit at a cost of $750 million per year.

The Liberals feature numerous initiatives on health promotion, including investments in sport and the establishment of a national food policy:

  • Working with the provinces to set national targets for physical activity in primary and secondary schools;
  • A Healthy Choices program to educate Canadians on health eating;
  • Progressive labelling regulations for food, including improving the regulatory process for new health claims;
  • Standards on transfats and salt;
  • $40 million annually for a healthy start program to help children from low-income families to access healthy home-grown foods;
  • A comprehensive review of the Canadian Food Inspection Agency;
  • An increase of $50 million over four years to improve food inspection;
  • Using athletes as role models, the Liberals would commit to stable and sustained funding for “Own The Podium” and Sport Canada.

The Liberals also commit to a Canadian Brain Health Strategy to assist Canadians coping with diseases such as Alzheimer’s, Multiple Sclerosis, and Parkinson’s Disease. The strategy includes public education on prevention, $100 million over two years for research, a sharing of best practices, and a more vague promise to look into potential economic supports for families coping with brain disorders and legislation to prevent discrimination against people showing symptoms.

The Liberals say they will work with the provinces to ensure all Canadians have coverage for catastrophic drug costs for illnesses such as cancer, diabetes, or arthritis.

The Red Book also makes several vague promises to work with the provinces and territories to bolster innovation in the health and bioscience field, improve rural health care, bring down prescription drug costs, improve home care, and address priority areas such as mental health and palliative care.

During a CBC-radio three-party panel on health care, former Liberal Health Minister Ujjal Dosanjh identified new technology and drugs as the largest drivers of health care costs, but said it was something a Liberal government could handle.

To see the full Liberal plan, go to: http://www.liberal.ca/issues/

New Democrats

The NDP have also committed to renewing the Health Accord for another decade, including a six per cent escalator. The NDP would put strings on the money – including “a clear, monitored and enforced commitment to respect the principles of the Canada Health Act.”

The NDP say they will work with the provinces to promote a clear commitment to the single-payer system, make progress on primary care, take steps to replace “fee-for-service” delivery, and take the first steps to reduce the cost of prescription drugs.

The centerpiece of the NDP platform is a plan to work with the provinces to increase the number of doctors, nurses and other health professionals, although the document only sets specific targets for the doctors (1,200 over the next 10 years) and nurses (6,000 new training spaces over six years). To put this modest promise in perspective, 120 new doctors per year would be added to the already existing 65,000 doctors in Canada — an increase of about 1.8 per cent over a decade. Likewise, there are about a quarter of a million nurses, of which the NDP would add an averge of 1,000 per year. 

While the NDP are pledging $165 million to create these new training spaces for doctors and nurses, they are also promising to increase the number of doctors and nurses (no mention of other health professionals) as a priority within the first 100 days.

Jack Layton said “we can’t wait three more years for the government to hire doctors and nurses for families who need them now.” Given the length of time it takes to become a doctor or a nurse, the training spots are not going to fulfill this promise. No detail is in the NDP platform on how many or where this immediate supply of doctors and nurses will come from. 

The NDP would also establish programs aimed at recruiting and supporting low-income, rural and aboriginal medical students.

Unlike the Tories and Liberals, the NDP would designate funding to guarantee a basic level of home care services. They would also include a federal transfer to increase long term care “spaces” and double funding for forgivable loans under the Home Adaption for Seniors’ Independence Program, a program intended to help seniors remain in their own homes. They would help up to 200,000 families a year to retrofit their homes to create self-contained secondary residences for senior family members. The “forgivable loan” would cover 50 per cent of the costs of a renovation up to a maximum of $35,000.

The NDP’s promises on pharmaceuticals include improved assessment to ensure the quality, safety and health effectiveness of prescription drugs, savings through bulk purchasing, a more aggressive price review, and the elimination of kickbacks from drug companies to pharmacists.

In the way of prevention, the NDP offer a Children’s Nutrition Initiative to expand provincial and local programs that provide healthy meals to school children. They would also introduce a National Strategy for Serious Injury Reduction in Amateur Sport Act – a plan to reduce concussions through a variety of strategies.

To review the NDP platform, go to:  http://www.ndp.ca/platform


Elizabeth May says the Green are not a one-issue party. Their 130-page “Vision Green” document is the most comprehensive of the four parties. However, there is very little in their posted 12-page election platform specific to health care. Her platform introduction makes a reference to living in healthy communities and enjoying a life-giving, healthy natural world, but nothing specific to improving health care delivery or prevention.

Vision Green, on the other hand, makes a strong commitment to upholding the Canada Health Act, including measuring the extent of two-tier health care in Canada and striving for its elimination.

It advocates not only the education and hiring of more medical staff, but also re-opening many of the beds that have been closed, better utilizing operating rooms, and purchasing new diagnostic equipment. Unfortunately, while they do talk about needing more health professionals in their preamble, the platform only talks about providing funds to train more doctors and nurses. They call for the fast-tracking and on-the-job mentoring of foreign trained health care professionals.

The Greens call for forgiveness of student loans for graduating doctors, nurses, paramedics, and other health professionals who agree to staff rural facilities and family practice clinics where recruitment is currently a problem.

The Greens also call for expansion of public coverage to proven alternative therapies such as chiropractic, massage and acupuncture. Their health plan also includes a national pharmacare program, accepting the principle that Canadians should spend no more than three per cent of total after tax earnings on necessary prescribed medications. Like the NDP, they would put emphasis on the effectiveness of drugs covered under the formulary.

Vision Green plans to expand home support, home care programs and assisted living services. At a time when seniors are being threatened with illegal hospital charges if they don’t take the first available long term care bed, the Green’s promise to enshrine a policy that seniors’ care must be provided in the communities where they or their families live.

The Greens would also transfer more money to the provinces to open more long term care beds.

The Greens have an extensive prevention platform, including $500 million over five years to aggressively address inactivity and youth obesity.

For mental health, the Greens would transfer funding for non-institutionalized mental health agencies.

While Vision Green sounds great, the budget numbers put forward in the other document – the election platform – certain does not include the wide sweep of Vision Green. The budget does include $300 million a year for national pharmacare and $43 million for a national campaign to discourage marijuana use after the Greens legalize and tax it. Canadians spend about $25 billion per year on pharmaceuticals, which leaves the Green’s $300 million rather limited in its ability to provide universal coverage.

To read the full Vision Green document, go to: http://greenparty.ca/files/attachments/vision_green_april_2011.pdf

To read the Green election platform, go to: http://greenparty.ca/files/attachments/green-book-2011-en.pdf