In the mid-2000s, the Ontario Liberals under Premier Dalton McGuinty, awash with federal cash for health care, ushered in the 14 Local Health Integration Networks, or LHINs. The LHINs were intended to organize and administer the province's health care services at the a regional level, or local level in the case of the biggest cities. It was a good thought. The Ministry of Health staff are legendary for being cloistered in their Toronto office building, wholly out of touch with health care struggles on the proverbial ground. Regional health authorities have been employed with various degrees of success for years across Canada, so why not Ontario?
Except that LHINs were not granted the power to merge or close hospitals. Nor reshape or dissolve Boards. Nor oversee Public Health. Nor control the supply or remuneration of doctors. Nor make decisions on drug procurement. Nor set or monitor or enforce standards of long-term care (LTC). Nor control the delivery of home care (at first).
What do you call a regional health authority that has no actual authority? A LHIN.
These LHINs, and their equally ill-conceived Community Care Access Centres (CCACs), have been in operation for over a decade with very little to show for the time or money spent. The CCACs, having wasted millions and millions of public dollars lobbying the government to showcase their own worth and lavishing executives with fat salaries, are now in the process of being shuttered. But the very same people that made a shambles of home care (minus the CEOs) - the managers, the Boards - have now been stuffed under the LHIN umbrella, along with the CCAC's many millions in liabilities such as unpaid sick and vacation days.
Of course, with its convoluted and yet-to-be implemented Patients First plan, the Liberal government wants to put the LHINs at the forefront of health care delivery, through yet another layer of bureaucracy colloquially labelled a "sub-LHIN". At the forefront of health care, except, that is, in the delivery of home care - the key service for which the LHINs were empowered by Patients First to begin with! Home care administration will now be divided between the LHINs and a Ministry-controlled agency that might be nothing more than a gift to the Liberal-friendly SEIU union.
Enough.
Health care in Ontario is in a near-shambles. A predictable seasonal flu has overcrowded hospitals past their breaking point, and we are now seeing cancelled surgeries and deaths directly attributable to that overcrowding. While the most devastating of these stories - the death of a five-week infant - happened in New Brunswick, it's dumb luck that a similar death hasn't happened yet in Ontario. Worst of all, rather than take a shred of responsibility for the problem, the (now former) Health Minister has skipped town for the greener pastures of a federal advisory committee.
While the LHINs aren't responsible for the miseries in Ontario's health care system, and good people are doing good (or at least harmless) work at the LHINs, on the whole they're a dud...a bad idea with bad execution and bad results. How long should Ontario continue to flush money down this drain?
So it's time for the Ontario government - whoever forms it after the next election - to scrap the LHINs. Give what little authority they once had back to the Ministry or download it to hospitals, and reinvest every dime in an urgent expansion of hospital capacity, home care, LTC space, and mental health services. There is no other justifiable way forward.
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Tuesday, March 6, 2018
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accountability,
health policy,
home care,
hospitals,
Ontario,
overcrowding,
politics
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