Queen’s Park report  AOHC recommends “refresh and reboot” for Ontario’s LHINs

Welcome to the inaugural issue of Voices, a newsletter that offers information about emerging issues, innovative initiatives and an insider’s view into the world of community-governed primary health care.

This Perspectives column will appear regularly in the newsletter to provide views on health and healthcare in this province.  In this edition, we’re bringing you AOHC’s perspective on the future of Ontario’s 14 Local Health Integration Networks. It’s a hot topic. Next week Queen’s Park’s Standing Committee on Social Policy launches province-wide public hearings, an initial step in what will be a year-long review of the Act that governs LHINs’ mandate.

It’s sure the public will have plenty to say at these hearings.  To prepare for all the feedback, late last year the committee conducted initial research, questioning provincial officials and several LHIN CEOs.  The committee also invited presentations from provincial associations, like AOHC, whose members fall under LHIN jurisdiction.  Click here for transcripts. 

In AOHC’s presentation, we laid out a detailed series of changes we believe the Province must take so the LHINs can live up to their potential as regional catalysts for positive system transformation.  And we highlighted how it’s especially important LHINs step up to the plate improving equitable access to Primary Health Care, making sure vulnerable populations get the right kind of services to reduce risks to their health and wellbeing.

The seven years’ experience our member centres working with the LHINsh has guided the development of our recommendations. Although the Province’s Action Plan for Healthcare says Primary Health Care will be integrated into the LHINs, right now Ontario’s 75 Community Health Centres (CHCs) are still the only primary care model that currently falls under the LHIN jurisdiction.

Our recommendations centred around one key message:  while creation of the LHINs in 2007 represented a major step forward in regionalizing the health system, seven years later it’s time for a significant refresh and reboot.

As things now stand, LHINs aren’t equipped to do what we need them to do.  Their mandate, as currently articulated in the current Local Health System Integration Act, doesn’t capture a big enough picture.  What’s more, neither the Act nor the provincial government enable the LHINs to actually plan for local and regional health needs so they can improve population health and advance health equity.

To correct this situation, AOHC proposed the following directions for change:

  1. Build the capacity of the LHINs to serve as strong accountable planning bodies across the full continuum of care.  This means transferring authority for all of Primary Health Care to LHIN jurisdiction as well as for all remaining direct service programs funded by the Ministry of Health and Long-term Care.
  2. Widen the LHINs’ scope to improve population health.  The Act governing the LHINs currently defines their objectives too narrowly with too tight a focus organizing health services and treating sickness.  Moving forward, LHINs should be mandated to prevent more in order to treat less, with a strong focus addressing the root causes of illness and disease.
  3. Require the LHINs to embed a health equity approach in all their initiatives.  Because health disparities in this province are so persistent and pervasive, it’s vital LHINs move from their current ad hoc approach to a more rigorous and systematic strategy to address health equity
  4. Create strong community-based services equipped with the adequate capacity and infrastructure to play a more effective role in Ontario’s health system.  As the province moves forward with its plans to shift services into the community, it must provide appropriate resources for to community based services so they have the capacity to deliver these additional services.
  5.  Require the LHINs to improve their processes for meaningful community engagement.  One of the reasons the LHINs get a lot of criticism is that, for some LHINs, meaningful engagement with the communities they serve is simply not happening.  It appears many LHINs gather general input and share information. In our view this falls far short of meaningfully community engagement. More thorough processes must be implemented so community members clearly understand the decisions LHINs are grappling with and can weigh in with their opinions and perspectives.

Perhaps our most important message to the committee is to keep an eye on future. While it’s important to address current LHIN controversies, it’s equally important to consider long term strategies that will deliver integrated community health and wellbeing systems throughout Ontario. In ten years’ time, where do we want to be and how will the Province, working with the LHINs, lead us there? What parts of the system will be the same?  More importantly, what parts will be different and how do we enable LHINs to deliver these changes at regional levels?

AOHC will continue to pose these questions as the LHIN review continues. Watch for further reports in future editions of “Voices.”

Read AOHC’s presentation on the Local Health System Integration Act review - November 18, 2013

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