Tag Archives: rationalization

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

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.

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