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Will a post-election, post-LHIN world bring even more health care restructuring?

A new piece on Local Health Integration Networks (LHINs) and the governance of health care has come out, this time from Terrence Sullivan (a long time top leader in Ontario health care and former boss of Cancer Care Ontario) and Karen Born (a researcher-writer with the Li Ka Shing Knowledge Institute at St Michael's Hospital Toronto). 

While the piece comes  to no definitive conclusions, it is clear that they are raising the idea of stronger regional governance of health care to speed change and restructuring in health care. Such changes would likely change bargaining unit structure and have other far reaching impacts on CUPE members.  The piece can be found here, but I’ve also copied some notable points below (with my added emphasis). 

We feared that LHINs would regionalize, centralize, privatize, and cut health care services.  But from this perspective, LHINs have not brought about enough radical change  and the province needs to find new ways to achieve this.  

Correctly, this article suggests that democratic and community power is a barrier to this sort of change. There has been significant opposition in local communities to the sort of regionalization and reduction of services that we were concerned LHINs would encourage.  

Clearly the debate about how to restructure health care in a post-LHIN world is on and CUPE health care workers have a major stake in this. 
  

As the cost and complexity of health care delivery systems have increased, there has been a movement across Canada to develop regional structures for the governance and administration of health care provider organizations, to better integrate services. By the end of the 1990s all provinces in Canada, with the exception of Ontario, had created regional health care authorities....

Many argue that LHINs were not given sufficient authority to meaningfully fulfill their mandate. A recent commentary  argued that “the LHINs have been and are set up to fail” as they only have about 30 employees each, compared to the nearly 4000 Ministry of Health and Long-Term Care employees.

Ontario has taken a cautious approach to regionalization....

LHINs technically have authority over more than $20 billion in funding to health care organizations such as hospitals and community care access centers. In reality, however, LHIN administrators have little say in how these funds are distributed, and the money itself flows directly from the government to hospitals and other health care providers. In other provinces, health authorities receive money based on the population they serve and have the authority to make decisions on how and where to direct funding. 

Unlike other provinces, when the LHINs were established, Ontario chose to retain boards for individual hospitals and other local health organizations. Some see this as a major impediment to change, because powerful hospital administrators and boards sometimes work against LHIN efforts to rationalize and integrate services. Chris Carruthers, a retired Ottawa orthopaedic surgeon and former Chief of Staff of the Ottawa Hospital says that “Ontario is unique in Canada for leaving hospital boards in place” in a regionalized system, and that strong hospital governance has “been an impediment to quick decision making and collective integrated care” by the LHINs. Carruthers says that retaining hospital boards means “LHINs don’t have the power to improve services across their regions,” depriving them of the ability “to make tough decisions about integrating care.”....

LHINs have legislative authority to restructure, merge, and close facilities within their regions. However their ability to make major changes to the health system has been limited.  Restructuring decisions can be highly unpopular with communities and are politically charged.

Keon says that political interference with health system governance is “the price we pay for democracy”, but that it has created “a stop and go system” where changes are made based on politics, without sufficient consideration for the performance of the health care system. ....

So, while it may sound appealing to suggest LHIN budgets should be converted to “front line care”, Ontario’s delivery system currently is short on strong management at the regional level.


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