The Local Health Integration Networks (LHINs) were supposed to bring health service decision-making much closer to the communities.
At the core of that decision-making is the integration process. As we stated last week, “integration” can mean a variety of things. The Act that created the LHINs defines “integration” as
(a) to co-ordinate services and interactions between different persons and entities,
(b) to partner with another person or entity in providing services or in operating,
(c) to transfer, merge or amalgamate services, operations, persons or entities,
(d) to start or cease providing services,
(e) to cease to operate or to dissolve or wind up the operations of a person or entity.
In theory the LHIN integration process is to include the posting of integration proposals and the public is to be given 30 days to respond to that proposal before a decision can be made. In reality, it is far more confusing, inconsistent and complex than that.
Despite the clear definition, many of these “integrations” take place without ever being considered “integration decisions” for the purposes of public disclosure and response.
Last year the CEO of The Ottawa Hospital announced that his corporation was going to perform 4,000 fewer endoscopies, telling the media low risk patients could safely access this service at one of many private endoscopy clinics in the community (the majority, incidentally, run on a for-profit basis). That’s a big change for an entire class of health care user, yet there was virtually no opportunity for input even after the proposal became public.
One might argue that this would normally constitute an integration decision as it involves the wind up of a service, even if the general inferred concept is one of service transfer. An integration decision only requires one of the two parties to be a health provider under the jurisdiction of the LHIN, however, the LHIN cannot make any decisions regarding specific transfers to entities it cannot also fund. It can make a decision around a proposal that involves a situation where the hospital will cease providing services, which does apply in this situation.