Bill 36 Local Health System Integration Act

1. Bill 36Local Health System Integration Act

2. “…most of the debate over Bill 36 involved arcane language and, accordingly, did not appear on the public radar screen. In the past year, for example, LHINs have been mentioned just eight times in stories in the Toronto Star compared to 736 mentions for the Gomery inquiry. • - Ian Urquhart, Toronto Star, Wednesday, March 1, 2006

3. "We haven't defined every aspect of our engagement with the public. We just know the days of town hall meetings are over." • - South East LHIN CEO Paul Huras, Brockville Recorder & Times, February 14, 2006

4. What are Local Health Integration Networks (LHINs)? • Agencies to allocate health service funding and delivery within 14 designated regions. • Agencies run by 9-member boards appointed by government and accountable only to government. This is not local control.

5. Their mandate • The LHINs have a legal requirement to continually restructure health care within each region. This means permanent instability for patients and workers. • Continual restructuring includes forced mergers, transfers, and contracting out of health services.

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

7. Physicians Ambulance Laboratories & specimen collection (outside of hospitals) Independent Health Facilities Homes for Special Care Public Health Provincial Drug Programs Psych. Hospitals still under direct control of Ministry of Health* Defined specialists (ie podiatrists, optometrists) What’s not… for now…

8. Not Local • LHINs cover large regions. • Five LHINs serve populations larger than five Canadian Provinces. • Sample distances/drive time within same LHIN: • Scarborough to Haliburton = 203 km / 2.5 hours • Cornwall to Pembroke = 248 km / 3 hours • Parry Sound to Timmins = 468 km / 6 hours • Kenora to Thunder Bay = 491 km / 6.5 hours (Times weather permitting)

9. Southwest LHIN • Covers distance from Tobermory in the North, to Lake Erie in the South, from Long Point to Port Glasgow • Includes counties of Grey, Bruce, Huron, Norfolk, Elgin, Middlesex, Oxford and Perth • Area includes 30 hospitals, 49 long term care homes and 6 CCACs • Office located in London • Population Served: 871,000

10. Southwest LHIN • Identified priorities: • E-Health top integration priority • Other priorities include “needs-based funding, rural administrative networks and primary care.”

11. Southwest LHIN • CEO Tony Woolgar • President Salary: $230,000 • Former Chief Executive of North Bristol NHS Trust was paid £70,961 upon resigning after the North Bristol trust ran up a £44m deficit

12. Southwest LHIN • The trust's executive group "was, for long periods, conducting its business in a dysfunctional, uncoordinated manner", the report said, adding that the management culture at the trust - particularly under Mr Woolgar - was "not conducive to effective team working at executive level". - SocietyGuardian UK reporting on a Deloitte Touche investigation into the North Bristol Trust

13. “Individuals are reported to have concentrated their energies on saving their personal positions rather than sharing problems as a corporate executive group.” • Some staff “perceived a culture of fear operating at executive board level” • “Serious doubts as to the accuracy and robustness” of the budget setting process and that the content and style of budget reports to the trust board made them “difficult to interpret”. This was despite finance staff having been “aware for some time” that there was a cash-flow crisis and that a large deficit was likely.

14. Distance • LHINs will lead to health services being concentrated in fewer locations, meaning patients will have to travel further to receive routine procedures. • Travel costs will effectively create two-tier medicine – those who can afford to travel will receive more timely health care.

15. Ministry retains control… • LHINs required to sign accountability “agreement” with ministry* • LHINs must follow ministry strategic plan and seek approval for their individual strategic plan • Minister determines funding levels • Minister can veto or order “integrations” • Minister approves bylaws, sets salary ranges, changes objectives, etc. *Ministry can dictate “agreement” in absence of one

16. LHINs powers • LHINs will sign “accountability agreements” with health care providers, similar to the contracts between CCACs and Home Care providers. • Bill 36 allows the Minister to give any of his/her powers to the LHINs at any point, reducing accountability to the government and the public.

17. Purchaser / Provider Split • LHINs a bureaucracy intended to purchase health services, like the Community Care Access Centres (CCACs) • Legislation does not specify how LHINs will make their “purchasing” decisions, but language strongly suggests competitive bidding will be used.

18. Competitive Bidding • Services are bid on by health care providers, both profit and non-profit. • Results include constant turnover, lack of continuity of care, low wages, shortages of skilled workers, high cost, and shift to for-profit delivery.

19. Labour • Will likely lead to downward pressure on wages and benefits. • Legislation aimed at creating divisions with the labour community through run off votes (Bill 136). • Will create an environment of constant turnover, discouraging new workers from entering into health professions.

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

21. CCACs • CCACs will merge to match the LHINs boundaries, 42 CCACs amalgamated to 14. • More chaos for the home care sector. • Decision-making much further from communities served.

22. Cost • Estimated to cost $55 million annually to maintain LHINs bureaucracy (minimum estimate: 25 staff x 14 regions = 350 staff) • $20 million to dismantle District Health Councils. • About $21 billion of annual health budget to be spent by LHINs.

23. Timelines • Introduced in November, passed by beginning of March, Royal Assent given March 28 • Boards were supposed to be appointed by January 2006, but appointments continue • Local health system planning expected to be complete by September, 2006. • Funding and allocation in 2007.

24. Amendments • Public access to the accountability agreements between the LHINs and the Service Providers • Meeting access better defined • Principles of the Canada Health Act added to preamble

25. Summary • LHINs will take services (mostly from hospitals) and have them delivered at a handful of sites located over huge geographic regions • LHINs will not align critical parts of the system not presently covered. • LHINs will sharpen regional inequalities. • LHINs fail to address the real drivers of health care costs.

26. LHINs will create a large new bureaucracy. • LHINs mean institutionalized chaos – no end to mergers, amalgamations, rationalization. • LHINs open the door to more private sector for-profit delivery of health care. • The ability of communities to influence which services are offered locally is diminished. • LHINs threaten job security and put downward pressure on wages and benefits through competitive bidding.

27. Ian Urquhart, Toronto Star: • “What the government has in mind here is the consolidation of services now being offered in many hospitals in a region — say, cataract removals or hip replacements — into just one hospital or even a doctor-owned clinic… All this is fine, provided you are not neither a hospital employee forcibly transferred, or a patient who has to travel 100 kilometers for a routine procedure.”