Defend Public Healthcare

The litany of health care problems identified by the Auditor General  in her 2015 report is frightening. Here's thirty-seven of them dealing with LHINs, LTC, EMS, Rehab Hospitals, Health Infrastructure, Home Care, and Health Human Resources. Local Health Integration Networks (LHINs): A Lot of Problems LHINs have not met performance expectations. "Most LHINs performed below expected levels in the year ending March 31, 2015. In that year, LHINs on average achieved their respective local targets for six of the 15 performance areas".  Also: "Based on the provincial results that include all 14 LHINs, only four of the 11 provincial targets that measure long-term goals for LHINs were met." Performance has not improved. "While province-wide performance in six of the 15 areas measured has improved between the time the LHINs were created and 2015, in the remaining nine areas, performance has either stayed relatively consistent or deteriorated since 2010 or...

Another LHIN-based  initiative to restructure   " non-urgent patient transfers"  is underway.  Non-urgent transfers are ambulance-like transfers for patients from hospital to hospital, from hospital to long-term care, or from hospital to home. While the cost of these transfers often simply come out of the hospital budget, austerity has made this more difficult.   The latest restructuring project is in the North East  -- and is funded by the North East LHIN. Earlier this year , the government strongly endorsed a LHIN-wide plan for the South West.   As in the South West LHIN, t he North East project is supposed to develop a standardized approach to the delivery of non-urgent transportation services throughout the LHIN.   While EMS had provided much of the inter-facility transfers in the past, over the last 14 years that has changed, after the Mike Harris Progressive Conservative government introduced legislation in 2000 allowing...

Below is the recent submission of OCHU to the Standing Committee on Social Policy of the Ontario Legislature: The Ontario Council of Hospital Workers (OCHU/CUPE) represents 30,000 hospital and long-term care workers in 65 hospitals across Ontario. We represent food service workers, maintenance workers, housekeepers, Registered Practical Nurses, Personal Support Workers, administrative and office workers, and many more classifications. When Local Health Integration Networks (LHINs) were established, we feared that they would provide cover for the government as they proceeded to regionalize, centralize, privatize, and cut health care services. Unfortunately, this has proven accurate. A number of problems have arisen with the LHINs, but two stand out. First, they have been charged with centralizing, privatizing, and cutting local hospital services and, second, they have distanced elected government officials from decisions to reduce, privatize or centralize local health care ser...

From time to time there are rumors that EMS (ambulance services) and municipal public health services may move over to the tender mercies of the Local Health Integration Networks (LHINs), which fund hospitals, home care, long term care, and other health services. Fortunately-- for these services -- that has not happened yet.   The government is starving the LHINs.  According to the recently released Budget Estimates , the LHINs are going to get $300 million less than what they got two years ago. In contrast, public health services (provided by municipalities but funded to a considerable extent by the province) are  budgeted to get about a 6.4% increase from the provincial coffers this year.   Over the last two years the increase is 12.2%.  Not too bad. "Emergency Health Services" (aka EMS) are also largely provided by municipalities but funded almost 50% by the province.  And EMS has also done okay, with a 3.8% increase this yea...

The Local Health Integration Networks (LHINs) are getting stuck again.   According to the newly released Budget Estimates, the government is cutting their funding.  The cut is, at least, small ($3.25 million out of a total LHIN funding of $23 billion). LHINs are the primary funders of hospitals, long term care homes, and home care.  Last year, at least they got a little bit of an increase -- 0.9% (based on the scope of services the LHINs are currently supposed to cover).  That gives the LHINs a whopping $64 million extra to play with compared with two years ago.  That might sound like something until you consider they provide $23 billion in services.   In effect, the government is making the LHINs the bad news bearers.  With no new money, they are going to have to squeeze the providers.  Health care consultants who dreamed that LHINs would become powerful agents for change will be disappointed.  At most, the LHINs will have...

Health Minister Deb Matthews signalled that the LHINs would decide which surgeries and tests should be shifted from hospitals to clinics, the Ottawa Citizen reports.  "We will expect the LHINs to do the work to determine what, if any, procedures there are that could be better delivered in the community," Matthews said. Moving work out of hospitals is a major policy direction for the Ontario Liberal government. LHINs are, of course, supposed to integrate health care (their full name is Local Health Integration Network) so it is amusing that they are now supposed to fragment health care by moving work to new providers.  (Oh what a tangled web we weave...) The Citizen also reports Matthews hinted that she would be open to having the Ottawa Hospital's cataract clinic spun off as a stand-alone corporation, if health officials can demonstrate that such a move "would provide high-quality care at a lower price."  Currently, the Ottawa Hospital clinic provides ...

A lot has been made about the announcement in the Ontario Health Action Plan that the Local Health Integration Networks (LHINs) would expand their role to include the doctors. But in the fine print, the government did not actually promise to hand over funding responsibilities for the family doctors to the LHINs. Au contraire, they specifically promised  that the government would continue to have a funding role for the doctors. The government only promised to 'integrate' family health care into the LHINs, and then mumbled something about identifying some model that brings planning and accountability "for the full patient journey" under the LHINs. Well, as the LHINs have done not too much planning for any health sector, this may not amount to much.  The LHINS most powerful tool has been money.  The government has kept the major portion of the new health care cash for itself and passed on only scraps for the LHINs to dish out to the hospitals and other health sect...

One interesting line in the Ontario government's new "Action Plan": "In addition to integrating family health care into LHINs, we will introduce further reforms to promote more seamless local integration, with fewer layers of administration, to ensure we have a system truly structured around the complex needs of an aging population." What might "fewer layers of administration" mean?  That is unknown, at least to this writer.  But some have pointed to the oddity of the Ministry of Health and LTC funding the LHINs, the LHINs then funding the CCACs, and the CCACs then funding the contracted home care providers. Especially as the CCACs have been restructured so their boundaries coincide with the LHIN boundaries. Other thoughts?

Nine of the province's 14 Community Care Access Centres (CCACs) are in deficit, the Chatham Daily News reports.  The local Erie St. Clair CCAC has asked for $5.2 million to tide it over this year.  The Local Health Integration Network (LHIN) is only handing over $1.5 million for now and refused its request to let its deficit run over to next year.   Gary Switzer, the LHIN CEO, said the CCAC may end up needing that money, "we just don't have enough data to determine what the real need is." But Betty Kuchta, the CEO of the Erie St. Clair CCAC,  replied that the CCAC may have to put hospital patients looking for home care on waiting lists.  Kuchta said waiting lists mean more frail, elderly people will stay in hospital when they could be cared for at home.   The costs of the province's 'Home First' program, designed to get patients out of hospital, are driving up CCAC costs across the province, it seems.   The 14 LHIN CEOs are meeting in J...

Now that  bothersome provincial election is over with, the powers that be are talking more frankly about health care restructuring. There was, of course, the musings from Don Drummond (the Bay Street advisor to the provincial government on public sector reform) about health care "structural redesign".  But we have also gotten this call to strengthen the power of regional health authorities (either LHINs or a some new form of regional health authority) to make changes and consolidate.  Strengthen and empower regional healthcare - whatever the structure. Government should strengthen Local Health Integration Networks (LHINs), or their next iteration, by giving them the autonomy and discretionary funds - in short, the power - to do the work they are mandated to do. That means letting them shift funding to meet the particular needs of the population they serve. That means consolidating agencies, but with respect and assurance for local input. This was the first ...

An Ottawa Citizen story  suggests a new, low-tech way of dealing with aging patients in hospitals: restorative care.   Here, through a modest increase in hospital and home care resources, the Champlain LHIN is finding that more patients can return home and that wait lists for long term care can be reduced. Officials point to the new approach - from rehab to home - as a sign that Eastern Ontario hospitals are finally moving away from a well meaning but paternalistic attitude that assumes all older patients decline irreversibly, when some of them just need a little extra support to help them recover their day-to-day function. Queensway Carleton officials view the restorative-care program as a better, more cost-effective way to treat seniors, who make up more than half of all the hospital's patients.... Under the program, a specially trained nurse patrols the hospital looking for elderly patients who have been given no obvious plans for discharge, but are considered medi...

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 ne...