Bill 36
Local Health
System Integration Act
“…most of the debate over Bill 36
involved arcane language and,
accordingly, did not appear on the
public radar screen. In the past year,
for example, LHINs have been
mentioned just eight times in stories in
the Toronto Star compared to 736
mentions for the Gomery inquiry.
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- Ian Urquhart, Toronto Star, Wednesday, March 1, 2006
"We haven't defined every aspect
of our engagement with the
public. We just know the days
of town hall meetings are over."
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- South East LHIN CEO Paul Huras, Brockville Recorder
& Times, February 14, 2006
What are Local Health Integration
Networks (LHINs)?
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Agencies to allocate health service
funding and delivery within 14
designated regions.
Agencies run by 9-member boards
appointed by government and
accountable only to government. This
is not local control.
Their mandate
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The LHINs have a legal requirement to
continually restructure health care
within each region. This means
permanent instability for patients and
workers.
Continual restructuring includes
forced mergers, transfers, and
contracting out of health services.
What’s included…
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Effects both clinical & non-clinical services
Hospitals (including hospital labs)
Long Term Care Facilities
Community Care Access Centres
Community Support Services
Community Health Centres
Mental Health and Addiction Services*
University of Ottawa Heart Institute
Anything the Minister wants to add
What’s not… for now…
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Physicians
Ambulance
Laboratories &
specimen collection
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(outside of hospitals)
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Independent Health
Facilities
Homes for Special
Care
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Public Health
Provincial Drug
Programs
Psych. Hospitals still
under direct control of
Ministry of Health*
Defined specialists
(ie podiatrists, optometrists)
Not Local
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LHINs cover large regions.
Five LHINs serve populations larger than five
Canadian Provinces.
Sample distances/drive time within same LHIN:
 Scarborough to Haliburton = 203 km / 2.5 hours
 Cornwall to Pembroke = 248 km / 3 hours
 Parry Sound to Timmins = 468 km / 6 hours
 Kenora to Thunder Bay = 491 km / 6.5 hours
(Times weather permitting)
Southwest LHIN
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Covers distance from Tobermory in the North,
to Lake Erie in the South, from Long Point to
Port Glasgow
Includes counties of Grey, Bruce, Huron,
Norfolk, Elgin, Middlesex, Oxford and Perth
Area includes 30 hospitals, 49 long term care
homes and 6 CCACs
Office located in London
Population Served: 871,000
Southwest LHIN
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Identified priorities:
 E-Health top integration priority
 Other priorities include “needsbased funding, rural administrative
networks and primary care.”
Southwest LHIN
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CEO Tony Woolgar
President Salary: $230,000
Former Chief Executive of North Bristol NHS
Trust was paid £70,961 upon resigning after
the North Bristol trust ran up a £44m deficit
Southwest LHIN
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The trust's executive group "was, for long
periods, conducting its business in a
dysfunctional, uncoordinated manner", the
report said, adding that the management
culture at the trust - particularly under Mr
Woolgar - was "not conducive to effective
team working at executive level".
- SocietyGuardian UK reporting on a Deloitte Touche
investigation into the North Bristol Trust
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“Individuals are reported to have concentrated
their energies on saving their personal positions
rather than sharing problems as a corporate
executive group.”
Some staff “perceived a culture of fear operating
at executive board level”
“Serious doubts as to the accuracy and
robustness” of the budget setting process and that
the content and style of budget reports to the trust
board made them “difficult to interpret”. This was
despite finance staff having been “aware for some
time” that there was a cash-flow crisis and that a
large deficit was likely.
Distance
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LHINs will lead to health services being
concentrated in fewer locations, meaning
patients will have to travel further to receive
routine procedures.
Travel costs will effectively create two-tier
medicine – those who can afford to travel
will receive more timely health care.
Ministry retains control…
LHINs required to sign accountability
“agreement” with ministry*
 LHINs must follow ministry strategic
plan and seek approval for their
individual strategic plan
 Minister determines funding levels
 Minister can veto or order “integrations”
 Minister approves bylaws, sets salary
ranges, changes objectives, etc.
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*Ministry can dictate “agreement” in absence of one
LHINs powers
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LHINs will sign “accountability
agreements” with health care providers,
similar to the contracts between CCACs
and Home Care providers.
Bill 36 allows the Minister to give any of
his/her powers to the LHINs at any point,
reducing accountability to the government
and the public.
Purchaser / Provider Split
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LHINs a bureaucracy intended to purchase
health services, like the Community Care
Access Centres (CCACs)
Legislation does not specify how LHINs will
make their “purchasing” decisions, but
language strongly suggests competitive
bidding will be used.
Competitive Bidding
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Services are bid on by health care
providers, both profit and non-profit.
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Results include constant turnover, lack
of continuity of care, low wages,
shortages of skilled workers, high cost,
and shift to for-profit delivery.
Labour
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Will likely lead to downward pressure
on wages and benefits.
Legislation aimed at creating divisions
with the labour community through
run off votes (Bill 136).
Will create an environment of constant
turnover, discouraging new workers
from entering into health professions.
Community Input
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Bill calls on LHINs to provide formal
channels for community input, but sets
no minimum level of engagement.
CCACs
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CCACs will merge to match the LHINs
boundaries, 42 CCACs amalgamated
to 14.
More chaos for the home care sector.
Decision-making much further from
communities served.
Cost
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Estimated to cost $55 million annually
to maintain LHINs bureaucracy
(minimum estimate: 25 staff x 14 regions = 350 staff)
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$20 million to dismantle District
Health Councils.
About $21 billion of annual health
budget to be spent by LHINs.
Timelines
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Introduced in November, passed by
beginning of March, Royal Assent given
March 28
Boards were supposed to be appointed by
January 2006, but appointments continue
Local health system planning expected to be
complete by September, 2006.
Funding and allocation in 2007.
Amendments
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Public access to the accountability agreements
between the LHINs and the Service Providers
Meeting access better defined
Principles of the Canada Health Act added to
preamble
Summary
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LHINs will take services (mostly from
hospitals) and have them delivered at a
handful of sites located over huge
geographic regions
LHINs will not align critical parts of the
system not presently covered.
LHINs will sharpen regional inequalities.
LHINs fail to address the real drivers of
health care costs.
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LHINs will create a large new bureaucracy.
LHINs mean institutionalized chaos – no end to
mergers, amalgamations, rationalization.
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LHINs open the door to more private sector forprofit delivery of health care.
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The ability of communities to influence which
services are offered locally is diminished.
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LHINs threaten job security and put downward
pressure on wages and benefits through competitive
bidding.
Ian Urquhart, Toronto Star:
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“What the government has in mind here is the
consolidation of services now being offered in
many hospitals in a region — say, cataract
removals or hip replacements — into just one
hospital or even a doctor-owned clinic…
All this is fine, provided you are not neither a
hospital employee forcibly transferred, or a
patient who has to travel 100 kilometers for a
routine procedure.”