Integration network proponents defend transparency, public access

Print

Text

On May 16, a plan to slash costs at Rouge Valley Health System will land before Ontario Superior Court.

While the scope of the legal case is narrow - the Ontario Public Service Employees Union (OPSEU) is seeking an injunction to prevent the hospital from transferring psychiatric beds from its Ajax-Pickering campus to the Centenary Health Centre in Scarborough - there could be much broader implications for Ontario's health-care system.

At least, that's what Warren (Smokey) Thomas is keeping his fingers crossed for.

Thomas, president of OPSEU, is hoping the injunction hearing will serve as something of a trial for Local Health Integration Networks (LHINs).

"The injunction is about mental health but if you can stop the plan in one area you can stop it in others," he said.

"We may be able to create an accountability mechanism (for all LHINs) by doing this."

Ontario has 14 LHINs, new community-based organizations set up by the province a year ago to plan, integrate and fund local health-care services in hospitals and other health agencies.

The LHINs say they consulted with thousands of people in their communities putting together integrated health service plans for their areas.

They also boast there are a variety of ways for the public to get involved, from contacting the LHINs directly with concerns and suggestions to collaboratives, advisory panels made up of local volunteers.

But critics dispute the premise that LHINs are benevolent bodies forging local health strategies based on open consultations with communities.

LHIN board members are non-elected and non-accountable to taxpayers, Thomas said.

And with the Ministry of Health transferring nearly two-thirds of its $37.9 billion dollar budget to LHINs, the organizations have tremendous power over health dollars, he added.

"These guys are invested with huge amounts of power and that's why I say they should be elected. I'll never get off my soap box that these LHINs should be elected," said Thomas, who fears LHINs' primary goal is to cut and consolidate health-care services.

He accused the Central East LHIN, which is overseeing cutbacks at Rouge Valley, for making its decisions without proper consultation as required under provincial legislation.

"They didn't consult beforehand. I know the unions weren't consulted," he said, complaining the LHIN began a 30-day public consultation period following the announced cuts.

"If you have already made your mind up and you are just presenting your plan, that is not consultation, it's just telling people what you're doing."

Thomas also said he believes the LHINs are a way for Health Minister George Smitherman to distance himself from unpopular decisions.

He's not the only one worried.

Rouge Valley nurse Carol Oates, who is also the hospital's bargaining unit president for Ontario Nurses Association Local 24, said she has "significant concerns".

"The general public doesn't understand LHINs. But even the most medical-experienced person (on the front lines) doesn't completely understand LHINs. If they don't, do you really think new Canadians or the elderly woman needing cataract surgery does?" she said.

Oates has a hard time believing proper public consultation took place before the LHIN settled on cutbacks at Rouge Valley.

She also said she believes LHINs were put in place to make cuts to health care, which now consumes almost half the provincial budget.

"They have an agenda. They were appointed into this position by the government. I think they were appointed for a reason."

James Meloche, senior director for planning, integration and community engagement for the Central East LHIN, which is responsible for an area stretching from Scarborough to Peterborough, doesn't understand the criticisms.

"The charge we're not elected and therefore not accountable... we are governed by a board that has an agreement with the ministry of health and the minister of health," he said. "It stipulates what we're accountable for access and accountability and sustainability of health services in the area."

LHINs, which must consult extensively with the public, are making the decisions that for years have been made behind closed doors by nameless, faceless ministry bureaucrats, Meloche said.

"While we're not elected, we have a very transparent process that is open to the public," said Meloche, a former ministry official.

"We're much more in the public in a way that was never done before."

That doesn't mean LHINs are supposed to act as Santa Claus for the public's wish list of health services, Meloche said.

While the cuts at Rouge Valley hospital are a lightning rod for frustration with LHINs, Central East is not the only area where discontent has been voiced.

At a March press conference by the Toronto Central LHIN to announce $5 million in new funding for 16 programs within the organization's catchment area of York, part of North York, East York and Beach, some wondered whether the LHIN was channelling money to the highest priority areas.

For example, Gillian Chernets, an advocate for people with disabilities who also sits on the LHIN's rehabilitation advisory panel, questioned why funding wasn't going to services that allow young people with disabilities to live meaningful lives at home.

Her attempts to get answers from the ministry of health had been stonewalled, she added.

Meanwhile, a man complained about the lack of funding for personal care workers.

Sandra Fawcett, communications specialist for the Toronto Central LHIN, said the organization spoke to more than 7,000 individuals before mapping out its service plan.

"The Toronto Central LHIN has made a concerted effort to engage the public. The feedback we have had is the plan at the Central Toronto LHIN reflected accurately what we were told," she said.

Fawcett referred further questions to the ministry.

Ministry spokesperson John Yoannou disputed claims the LHINs are not accountable, saying the province has a memorandum of understanding with each organization spelling out requirements such as public consultation.

He provided an April 16 letter from Smitherman addressing concerns about LHINs.

"We expect LHINs will create the conditions to allow for more community dialogue about the future direction of our health-care system. The government has always and continues to be responsible for health care," Smitherman wrote.

"I made this point very clearly in the legislature in March 2007 when I said: 'Let no one mistake this system transformation for an exercise in shirking of responsibility at the government level.'"

If that were not enough, Yoannou pointed out the provincial auditor can investigate any aspect of the LHINs.

But those assurance aren't good enough for the growing list of critics.

In addition to Thomas and Oates, count Conservative health critic Elizabeth Witmer and NDP health critic France Gelinas among those with nagging doubts.

"I think people are questioning the effectiveness of the LHINs. Certainly those who consider this another layer of bureaucracy created by the minister of health (and) the ministry of health to deflect responsibility to the LHINs," Witmer said.

"I think they are still taking their marching orders from the minister. The minister says 'Go talk to the LHINs. It's not my problem'."

Witmer admitted the Tories appointed non-elected District Health Councils to oversee local health decisions when they were in power a decade ago but argued they couldn't make funding decisions.

"I think, at the end of the day, the verdict is still out if (LHINs) will play an effective role in the delivery of health care in Ontario," Witmer added.

"We have to see how they use their power and see how satisfied the local communities are with their decisions."

Gelinas isn't taking the same wait-and-see approach.

While she supports the LHINs' role of making health decisions at the community level, Gelinas admitted she is nervous about their power and the ability of the government to use them as puppets to implement cutbacks.

"When people say they (LHINs) have a lot of powers, they are right. LHINs can force integration of programs. They can force agencies, whatever they decide, to integrate as they see fit. There are rules they have to follow but they do have the power," she said.

"What is happening at Rouge Valley is an integration order. It was a greatly missed opportunity because it was the first time to get it right."

Other communities facing stretched-to-the-limit health-care budgets should brace for similar orders from their LHINs, Gelinas said.

"There are lots of hospitals having problems balancing their books," she said.