Social Policy in Ontario

If it wasn’t already before this week, LHIN is now officially a dirty word in Ontario.

Short for Local Health Integration Network, the acronym has become synonymous with bloated, arm’s-length bureaucracy indifferent to Ontarians’ concerns as it rams hospital reforms down their throats. Provincial Ombudsman André Marin made sure of that, with a scathing report – and a somewhat hyperbolic press conference – about the lack of “community engagement” by the Hamilton Niagara Haldimand Brant version.

But getting rid of all 14 LHINs in the province, as opposition leader Tim Hudak has pledged to do, won’t address what’s causing all the friction in places like Niagara. More than anything else, the LHINs are just lightning rods.

All you really need to know about the uproar in places like Fort Erie and Port Colborne is this: They shut the local emergency rooms. And it probably would have happened with or without the existence of a LHIN, and regardless of whether Dalton McGuinty’s Liberals or Mr. Hudak’s Conservatives were in power.

The LHINs, created during Mr. McGuinty’s first term as premier, are merely the Liberals’ method of implementing a broad policy on which the province’s two leading parties have reached a consensus. Health care, they both recognize, has to be shifted to a regional model in which there’s less duplication among hospitals in close proximity to one another, and each hospital stops trying to be all things to all people.

They don’t publicly acknowledge this consensus, because whichever party is out of government has to pretend to be outraged. The Liberals once lambasted Mike Harris’s Health Services Restructuring Commission, which paved the way for many of the reforms they’ve embraced in government; the Tories now pretend they didn’t set most of those reforms in motion.

Emergency room closings are especially a boon to the opposition, because there’s nothing that puts a bigger scare into communities. Fort Erie has become a particular hotbed, since local teenager Reilly Anzovino died last Boxing Day (following a car crash) in an ambulance that had to drive to nearby Welland. So naturally, Mr. Hudak has now promised to reopen that particular ER.

At a news conference this week, however, Mr. Hudak was smart enough to dodge questions about whether he disagrees with the fundamentals of regionalization. Instead he just gave the appearance of disagreeing with it, by returning to the evils of LHINs.

If he does wind up killing the LHINS off, it may be merciful. Their role appears mostly to be rubberstamping decisions made by hospital boards – including, in this case, the closures proposed by the Niagara Health System, which oversees several sites merged under Mr. Harris’s watch – and serving as a buffer between the public and the government. Their mandate, if Mr. Marin’s report is any indication, is too loosely defined even to allow for useful communication of why the reforms are taking place; instead, they make matters worse by acting mysterious.

But the activists who celebrated Mr. Marin’s condemnation of the LHINs are kidding themselves if they think removing that layer of bureaucracy would slow the pace of controversial changes such as closing ERs. If anything, given the need to curb health spending growth, that pace will soon quicken. And rest assured that whichever party is in power will pretend to be mad about it.

< http://www.theglobeandmail.com/news/politics/adam-radwanski/health-care-crisis-a-political-hot-potato/article1670032/ >