Bill 36Bill 36Local Health Local Health

System Integration ActSystem Integration Act

“…“…most of the debate over Bill 36 most of the debate over Bill 36 involved arcane language and, involved arcane language and, accordingly, did not appear on the accordingly, did not appear on the public radar screen. In the past year, public radar screen. In the past year, for example, LHINs have been for example, LHINs have been mentioned just eight times in stories in mentioned just eight times in stories in the Toronto Star compared to 736 the Toronto Star compared to 736 mentions for the Gomery inquiry. mentions for the Gomery inquiry.

- Ian Urquhart, Toronto Star, Wednesday, March 1, 2006- Ian Urquhart, Toronto Star, Wednesday, March 1, 2006

"We haven't defined every aspect "We haven't defined every aspect of our engagement with the of our engagement with the public. We just know the days public. We just know the days of town hall meetings are over."of town hall meetings are over."

- South East LHIN CEO Paul Huras, Brockville Recorder - South East LHIN CEO Paul Huras, Brockville Recorder & Times, February 14, 2006& Times, February 14, 2006

What are Local Health Integration What are Local Health Integration Networks (LHINs)?Networks (LHINs)?

Agencies to allocate health service Agencies to allocate health service funding and delivery within 14 funding and delivery within 14 designated regions.designated regions.

Agencies run by 9-member boards Agencies run by 9-member boards appointed by government and appointed by government and accountable only to government. This accountable only to government. This is is not local controlnot local control..

Their mandateTheir mandate The LHINs have a legal requirement to The LHINs have a legal requirement to

continuallycontinually restructure health care restructure health care within each region. This means within each region. This means permanent instability permanent instability for patients and for patients and workers. workers.

Continual restructuring includes Continual restructuring includes forced mergers, transfers, and forced mergers, transfers, and contracting out of health services.contracting out of health services.

What’s included…What’s included… Effects both clinical & non-clinical servicesEffects both clinical & non-clinical services Hospitals (including hospital labs)Hospitals (including hospital labs) Long Term Care Facilities Long Term Care Facilities Community Care Access CentresCommunity Care Access Centres Community Support ServicesCommunity Support Services Community Health CentresCommunity Health Centres Mental Health and Addiction Services*Mental Health and Addiction Services* University of Ottawa Heart InstituteUniversity of Ottawa Heart Institute Anything the Minister wants to addAnything the Minister wants to add

What’s not… for now…What’s not… for now…

PhysiciansPhysicians AmbulanceAmbulance LaboratoriesLaboratories & &

specimen collectionspecimen collection (outside of hospitals)(outside of hospitals)

Independent Health Independent Health FacilitiesFacilities

Homes for Special Homes for Special CareCare

Public HealthPublic Health Provincial Drug Provincial Drug

ProgramsPrograms Psych. Hospitals still Psych. Hospitals still

under direct control of under direct control of Ministry of Health*Ministry of Health*

Defined specialistsDefined specialists (ie podiatrists, optometrists)(ie podiatrists, optometrists)

Not LocalNot Local LHINs cover large regions.LHINs cover large regions. Five LHINs serve populations larger than five Five LHINs serve populations larger than five

Canadian Provinces.Canadian Provinces. Sample distances/drive time within same LHIN:Sample distances/drive time within same LHIN:

Scarborough to Haliburton = 203 km / 2.5 hoursScarborough to Haliburton = 203 km / 2.5 hours Cornwall to Pembroke = 248 km / 3 hoursCornwall to Pembroke = 248 km / 3 hours Parry Sound to Timmins = 468 km / 6 hoursParry Sound to Timmins = 468 km / 6 hours Kenora to Thunder Bay = 491 km / 6.5 hoursKenora to Thunder Bay = 491 km / 6.5 hours

(Times weather permitting)(Times weather permitting)

Southwest LHINSouthwest LHIN Covers distance from Tobermory in the North, Covers distance from Tobermory in the North,

to Lake Erie in the South, from Long Point to to Lake Erie in the South, from Long Point to Port GlasgowPort Glasgow

Includes counties of Grey, Bruce, Huron, Includes counties of Grey, Bruce, Huron, Norfolk, Elgin, Middlesex, Oxford and PerthNorfolk, Elgin, Middlesex, Oxford and Perth

Area includes 30 hospitals, 49 long term care Area includes 30 hospitals, 49 long term care homes and 6 CCACshomes and 6 CCACs

Office located in LondonOffice located in London Population Served: 871,000Population Served: 871,000

Southwest LHINSouthwest LHIN

Identified priorities:Identified priorities: E-Health top integration priorityE-Health top integration priority Other priorities include “needs-Other priorities include “needs-

based funding, rural administrative based funding, rural administrative networks and primary care.”networks and primary care.”

Southwest LHINSouthwest LHIN

CEO Tony WoolgarCEO Tony Woolgar President Salary: $230,000 President Salary: $230,000 Former Chief Executive of North Bristol NHS Former Chief Executive of North Bristol NHS

Trust was paid £70,961 upon resigning after Trust was paid £70,961 upon resigning after the North Bristol trust ran up a £44m deficitthe North Bristol trust ran up a £44m deficit

Southwest LHINSouthwest LHIN

The trust's executive group "was, for long The trust's executive group "was, for long periods, conducting its business in a periods, conducting its business in a dysfunctional, uncoordinated manner", the dysfunctional, uncoordinated manner", the report said, adding that the management report said, adding that the management culture at the trust - particularly under Mr culture at the trust - particularly under Mr Woolgar - was "not conducive to effective Woolgar - was "not conducive to effective team working at executive level". team working at executive level".

- SocietyGuardian UK reporting on a Deloitte Touche - SocietyGuardian UK reporting on a Deloitte Touche investigation into the North Bristol Trustinvestigation into the North Bristol Trust

““Individuals are reported to have concentrated Individuals are reported to have concentrated their energies on saving their personal positions their energies on saving their personal positions rather than sharing problems as a corporate rather than sharing problems as a corporate executive group.”executive group.”

Some staff “perceived a culture of fear operating Some staff “perceived a culture of fear operating at executive board level” at executive board level”

““Serious doubts as to the accuracy and Serious doubts as to the accuracy and robustness” of the budget setting process and that robustness” of the budget setting process and that the content and style of budget reports to the trust the content and style of budget reports to the trust board made them “difficult to interpret”. This was board made them “difficult to interpret”. This was despite finance staff having been “aware for some despite finance staff having been “aware for some time” that there was a cash-flow crisis and that a time” that there was a cash-flow crisis and that a large deficit was likely.large deficit was likely.

DistanceDistance

LHINs will lead to health services being LHINs will lead to health services being concentrated in fewer locations, meaning concentrated in fewer locations, meaning patients will have to travel further to patients will have to travel further to receive routine procedures.receive routine procedures.

Travel costs will effectively create two-tier Travel costs will effectively create two-tier medicine – those who can afford to travel medicine – those who can afford to travel will receive more timely health care.will receive more timely health care.

Ministry retains control…Ministry retains control… LHINs required to sign accountability LHINs required to sign accountability

“agreement” with ministry*“agreement” with ministry* LHINs must follow ministry strategic LHINs must follow ministry strategic

plan and seek approval for their plan and seek approval for their individual strategic planindividual strategic plan

Minister determines funding levelsMinister determines funding levels Minister can veto or order “integrations”Minister can veto or order “integrations” Minister approves bylaws, sets salary Minister approves bylaws, sets salary

ranges, changes objectives, etc.ranges, changes objectives, etc.

*Ministry can dictate “agreement” in absence of one

LHINs powersLHINs powers

LHINs will sign “accountability LHINs will sign “accountability agreements” with health care providers, agreements” with health care providers, similar to the contracts between CCACs similar to the contracts between CCACs and Home Care providers.and Home Care providers.

Bill 36 allows the Minister to give any of Bill 36 allows the Minister to give any of his/her powers to the LHINs at any point, his/her powers to the LHINs at any point, reducing accountability to the government reducing accountability to the government and the public.and the public.

Purchaser / Provider SplitPurchaser / Provider Split

LHINs a bureaucracy intended to purchase LHINs a bureaucracy intended to purchase health services, like the Community Care health services, like the Community Care Access Centres (CCACs)Access Centres (CCACs)

Legislation does not specify how LHINs will Legislation does not specify how LHINs will make their “purchasing” decisions, but make their “purchasing” decisions, but language strongly suggests language strongly suggests competitive competitive bidding bidding will be used.will be used.

Competitive BiddingCompetitive Bidding

Services are bid on by health care Services are bid on by health care providers, both profit and non-profit.providers, both profit and non-profit.

Results include constant turnover, lack Results include constant turnover, lack of continuity of care, low wages, of continuity of care, low wages, shortages of skilled workers, high cost, shortages of skilled workers, high cost, and shift to for-profit delivery.and shift to for-profit delivery.

LabourLabour

Will likely lead to downward pressure Will likely lead to downward pressure on wages and benefits.on wages and benefits.

Legislation aimed at creating divisions Legislation aimed at creating divisions with the labour community through with the labour community through run off votes (Bill 136).run off votes (Bill 136).

Will create an environment of constant Will create an environment of constant turnover, discouraging new workers turnover, discouraging new workers from entering into health professions.from entering into health professions.

Community InputCommunity Input

Bill calls on LHINs to provide formal Bill calls on LHINs to provide formal channels for community input, but sets channels for community input, but sets no minimum level of engagement.no minimum level of engagement.

CCACsCCACs

CCACs will merge to match the LHINs CCACs will merge to match the LHINs boundaries, 42 CCACs amalgamated boundaries, 42 CCACs amalgamated to 14.to 14.

More chaos for the home care sector.More chaos for the home care sector. Decision-making much further from Decision-making much further from

communities served.communities served.

CostCost

Estimated to cost $55 million annually Estimated to cost $55 million annually to maintain LHINs bureaucracy to maintain LHINs bureaucracy (minimum estimate: 25 staff x 14 regions = 350 staff)(minimum estimate: 25 staff x 14 regions = 350 staff)

$20 million to dismantle District Health $20 million to dismantle District Health Councils.Councils.

About $21 billion of annual health About $21 billion of annual health budget to be spent by LHINs.budget to be spent by LHINs.

TimelinesTimelines

Introduced in November, passed by Introduced in November, passed by beginning of March, Royal Assent given beginning of March, Royal Assent given March 28March 28

Boards were supposed to be appointed by Boards were supposed to be appointed by January 2006, but appointments continueJanuary 2006, but appointments continue

Local health system planning expected to be Local health system planning expected to be complete by September, 2006.complete by September, 2006.

Funding and allocation in 2007.Funding and allocation in 2007.

AmendmentsAmendments

Public access to the accountability agreements Public access to the accountability agreements between the LHINs and the Service Providersbetween the LHINs and the Service Providers

Meeting access better definedMeeting access better defined Principles of the Canada Health Act added to Principles of the Canada Health Act added to

preamblepreamble

SummarySummary

LHINs will take services (mostly from LHINs will take services (mostly from hospitals) and have them delivered at a hospitals) and have them delivered at a handful of sites located over huge handful of sites located over huge geographic regionsgeographic regions

LHINs will not align critical parts of the LHINs will not align critical parts of the system not presently covered.system not presently covered.

LHINs will sharpen regional inequalities.LHINs will sharpen regional inequalities. LHINs fail to address the real drivers of LHINs fail to address the real drivers of

health care costs.health care costs.

LHINs will create a large new bureaucracy.LHINs will create a large new bureaucracy.

LHINs mean institutionalized chaos – no end to LHINs mean institutionalized chaos – no end to mergers, amalgamations, rationalization.mergers, amalgamations, rationalization.

LHINs open the door to more private sector for-LHINs open the door to more private sector for-profit delivery of health care.profit delivery of health care.

The ability of communities to influence which The ability of communities to influence which services are offered locally is diminished.services are offered locally is diminished.

LHINs threaten job security and put downward LHINs threaten job security and put downward pressure on wages and benefits through competitive pressure on wages and benefits through competitive bidding.bidding.

Ian Urquhart, Toronto Star:Ian Urquhart, Toronto Star:

““What the government has in mind here is the What the government has in mind here is the consolidation of services now being offered in consolidation of services now being offered in

many hospitals in a region — say, cataract many hospitals in a region — say, cataract removals or hip replacements — into just one removals or hip replacements — into just one

hospital or even a doctor-owned clinic… hospital or even a doctor-owned clinic… All this is fine, provided you are not neither a All this is fine, provided you are not neither a

hospital employee forcibly transferred, or a hospital employee forcibly transferred, or a patient who has to travel 100 kilometers for a patient who has to travel 100 kilometers for a

routine procedure.”routine procedure.”