Social Policy in Ontario

Published on Tuesday, Aug. 10, 2010. Last updated on Wednesday, Aug. 11, 2010.   By Christie Blatchford

It doesn’t take long for entitlement and high-handedness – a.k.a. the rot – to set in at a government bureaucracy.

Take the Hamilton Niagara Haldimand Brant Local Health Integration Network, one of 14 little fiefs first announced six years ago by the Dalton McGuinty government, created legislatively in 2005 and up and running only in the few years since.

The paint on the LHINs, as they are tragically called, is barely dry, but as Ontario Ombudsman André Marin said Wednesday of how the Hamilton Niagara Haldimand Brant LHIN greeted his recent investigation, the organization “was defensive and recalcitrant.”

Asked what he thought of being met with that attitude by so new a group of health-care functionaries, Mr. Marin said, “I was floored. I think the LHIN should have been eating a bit of humble pie. I think they should have been responsive.”

The answers he got were either lengthy and legalistic or so full of bafflegab as to be meaningless. The LHIN folks kept talking, he said, “about seeing things at the 10,000-foot level,” and were prone to dropping such word bombs as, “This is a journey, not an event.”

“It sounded more like a trip to Club Med than a democracy,” he snapped.

Mr. Marin was pressed to take on this particular LHIN chiefly because of complaints from the public that it was operating secretively and making big decisions – hospital restructuring, such as the closing of two emergency rooms, the shuffling of services from one place to another, an increased focus on specialization – behind closed doors in direct contravention of its stated claims and the legislation that governs it.

And that, by the way, is precisely what he found – that this LHIN (and all the other 13 too) had passed an improper and flat-out illegal bylaw that allowed the board to have in camera meetings, purportedly for “educational” purposes, but really in order to cram in submissions it didn’t want the public to hear, and that it was paying lip service to the principle of community engagement, which is one of the LHIN raisons d’être.

Yet even now, the Hamilton LHIN blabs endlessly on its website about “community engagement.” Several pages (“Engaging our Communities,” “Our Community Engagement Values,” “Some Examples of Engaging our Community”) would lead the casual reader to believe, lo!, that this sort of stuff matters. Mr. Marin’s investigation has demonstrated that it doesn’t, not in the slightest.

One board member, Jack Brewer, for instance, actually claimed that his chats on his golf course constituted “community engagement.” Given that his club is the private and quite lovely Dundas Valley Golf and Curling Club, where initiation fees are $8,000, this would hardly count as a representative sampling of public opinion.

The original idea underlying the LHINs sounded noble: Services would be better tailored to local needs (though frankly, the notion that Hamilton, Niagara, Haldimand and Brant are all one “local” area strikes me as the arbitrary construct of someone who has never been to any of the locations) and opportunities for integration (that is, intelligent efficiencies) would be easier to spot.

Alas, the LHIN was a brand-new level of middle management, which did not exist before, and which, as Burlington resident Marie Jacobs, one of the original complainants, noted after Mr. Marin’s news conference at Queen’s Park, was established to do a job that to some significant degree had been done previously by volunteers at district health councils.

Mrs. Jacobs and her husband Hans asked that copies of their detailed complaint be sent to every LHIN board member, and were assured it had been done; later, she found out that hadn’t happened. The couple also asked to appear before the board, and were told, “We don’t have those [delegations].”

“Until you can speak and ask questions in public,” she said, you have neither transparency nor consultation.

In five short years, the Hamilton Niagara LHIN has grown to have eight part-time board directors (all with the specifically required accounting/public administration/finance etc. backgrounds, all appointed by cabinet), brand new purpose-built offices in Grimsby, a chief executive officer who last year earned $289,136 and a staff of 31 (two of whom earn more than $180,000 a year, including the senior director of community engagement, the same engagement that, by Mr. Marin’s reckoning, didn’t happen here).

By any reckoning, it’s startling growth – “a massive layer of middle-management,” Conservative Leader Tim Hudak calls it and he’s right – and it’s not like another health-care bureaucracy disappeared to make room for the LHINs.

The Community Care Access Centres, which are fairly Byzantine themselves, still exist, though the Hamilton Niagara’s CCAC CEO earned only about $213,000 last year, poor lamb. All those hospital CEOs are still raking it in. What do any of these people actually do?

The LHINs have simply added to the enormous administrative costs Ontarians pay to have health care delivered unevenly and opaquely – and not one of the people in the new bureaucracy treats patients.

Those who do, like doctors and nurses, or those who are the patients, such as the public, were excluded from discussions as the LHIN met illegally in secret, as Mr. Marin found – all the while simultaneously claiming to be doing the opposite.

As Mrs. Jacobs says, she’d rather have a process that makes no pretence of consultation than a dishonest sham: Better the honest dictatorship than the faux democracy.

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