Ontario’s local health networks must go, opposition says
Published On Mon Aug 16 2010. By Tanya Talaga, Queen’s Park Bureau
Former health minister George Smitherman drove the idea to carve up Ontario into 14 local health networks nearly four years ago.
Faced with a bloated nearly $40 billion health system widely criticized by being too centrally controlled, Smitherman decided to follow British Columbia and Alberta’s lead by taking decision-making power out of the hands of the provincial government and giving it to local health groups.
But instead of the decentralized dream, some say what Smitherman created was just another bureaucratic layer — one the Star has learned spent $80 million in 2009/10 on operation expenses such as wages, office rent and equipment.
There are nearly 300 employees at Ontario’s 14 local health integration networks (LHINs) — community-led decision-making bodies that decide how to most wisely spend scant-health care dollars.
The networks came under fire last week after Ombudsman André Marin revealed one of the LHINs passed a secret “illegal” bylaw enabling it to forgo public consultation and hold closed-door meetings on hospital restructuring and closing emergency rooms.
In Ontario, political opposition and many health care pundits say if the McGuinty government really wants to save money, it should simply get rid of the LHINs because they are essentially toothless bodies controlled by the health ministry.
Alberta scrapped their 12-body system in 2008 and reverted back to one single entity: Alberta Health Services.
Those around when Smitherman developed the LHINs recall a less altruistic reason for their creation — Smitherman knew too well the punishment the former Mike Harris government took when they restructured health care. But if responsibility was transferred to 14 groups, the Liberal government could deflect criticism away from themselves and onto the LHINs especially as they battled rising health costs.
Ontario’s health system is bleeding money. Canada’s most populous province spends 46 per cent of its budget on health care and it is projected health costs will consume 70 per cent of the budget in 12 years. How to curb those costs is on Premier Dalton McGuinty’s radar.
The LHIN system was brought on Ontarians by McGuinty and Smitherman with scant public consultation, said NDP MPP Peter Kormos (Welland).
“It was flawed from the get-go,” Kormos said.
This is just one of a series of missives Smitherman made as health minister that Ontario is left to deal with, said Kormos, who added Smitherman was also a key player in the $1 billion electronic health record attempt.
“Here you have Smitherman tarred with eHealth and that scandal and now not only is he tarred but feathered with the LHIN scandal,” Kormos said. “Mr. Smitherman has some explaining to do to the voters of Toronto in this current mayoralty race.”
But the Liberals are not the only ones responsible for the LHINs creation, according to one former health insider. There were discussions going on within the health ministry among senior officials left over from the previous Progressive Conservative government before Smitherman arrived in 2003.
And, there were a number of senior bureaucrats — such as former deputy minister of health Phil Hassen — who came from out west and had experience with the regional system. Hassen was president of the Vancouver Coastal Health Authority.
In Ontario, the Liberal networks came into being in 2007 to hand out $21.5 billion in scant health dollars. At the time, Smitherman called them a “made in Ontario” solution that would break down health care silos. Each network is made up of hospitals, community care access centres or home-care providers, long-term care homes and mental health and addiction agencies.
Overarching the LHINs, the province was supposed to develop an overall strategic health plan that would help guide the networks. That long-term plan is yet to be unveiled.
Health Minister Deb Matthews defends the model of the LHIN, but, like the premier admitted on Thursday, said they are still young entities learning how to run.
“I am firmly committed to the regional model,” she said. “I have complete confidence local decision-making is worth protecting.”
Just how public and consultative the networks are came under scrutiny last week after Marin released his investigation entitled the “LHIN Spin” on Tuesday. Marin revealed the Hamilton Niagara Haldimand Brant Local Health Integration Network created an “illegal” bylaw that allowed them to conduct secret meetings that have no public record.
That “educational” bylaw was then adopted by at least eight of the other networks. Last week Matthews ordered that all networks remove the questionable bylaw. However, Marin charged the ministry was aware of the secret bylaw for a year before they acted on it.
The provincial Tories say the networks should be completely scrapped and the savings put back into frontline care.
“Dalton McGuinty and his health minister have been covering the tracks of their scandal plagued LHIN for too long,” said PC MPP Christine Elliott (Whitby-Oshawa). Just like the eco-tax fiasco, ultimate responsibility with the LHIN scandal lies at the feet of the premier, she said.
On Friday, the Tories charged it is hard to know how the networks are doing financially with the public’s money as Matthews is suppressing the public release of the LHINs annual reports.
By law, the reports should be filed once a year and made public, Elliott said. However, the reports have not been publicly released since 2008. “There must be a lot of information in those reports they don’t want people to see,” she said.
Matthews denied she is holding back the reports.
“We are going to release those reports very quickly,” she told the Star.
Still, all this is further fodder for the Tories and the NDP who feel the networks in their current form should just be scrapped.
PC Leader Tim Hudak “doesn’t know when he is talking about” when he says the networks should be abolished, Matthews said.
“The future of health care is about integration,” she said. It isn’t just about hospitals. “I do not want to see us going back to the days where we had two additional layers of bureaucracies with the regional offices and district health councils but decisions were made in the minister’s office. I want those decisions made as close to the ground as possible.”
But the NDP argues the governments claim that the LHINs provide local planning is simply not true — the LHINs are too big.
The Hamilton-Niagara network, points out Kormos, stretches from Fort Erie through Hamilton and into Brantford. These are “areas of a huge amount of acreage that have nothing in common,” he said.
Those appointed to the LHINs are also “government appointees,” Kormos added.
“The LHINs were designed — and both the Conservatives and the NDP criticized this in the legislative process — to create a firewall between the ministry of health or the government that is really calling the shots at the end of the day.”
The government uses the LHIN as a buffer, he said.
“Well the emperor has been exposed now as having no clothes,” said Kormos. “It isn’t time for firings or resignations. It is time for the whole kit and caboodle to be tossed.”
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