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LHINs require radical surgery

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Did Ombudsman André Marin’s scathing report on LHINs last week sound the death knell for this disgraced and unaccountable public health body?

Not likely – at least not in the short term. The Premier and his health minister Deb Matthews have too much invested in Local Health Integration Networks to admit the obvious: These anti-democratic decision-making agencies have strayed from their mandate. LHINs were, after all, introduced by the McGuinty team five years ago and according to government spin in the aftermath of the Ombudsman’s bombshell, they’re still working out kinks in the system.

That’s not good enough, as the Marin report painfully described. In language seldom heard coming from the parlour room calm of Queen’s Park, the Ombudsman called the LHINs consultative process “meaningless;” their meetings, “clandestine …. (and) illegal;” and their decision-making process “sneaky.”

The temptation is to tell the government, ‘We told you so.’

OPSEU was the first to challenge LHIN secrecy in court. In 2008 we took the Central East LHIN to Ontario Superior Court over the absence of public consultation in the transfer of acute care mental health beds from the Ajax to Scarborough hospitals. At the time government lawyers argued that the LHINs only had an obligation to consult on high level planning, not on specific service changes. While the judicial review failed to support our challenge, it exposed how flawed the legislation was with regards to meaningful public consultation.

For years, local municipal leaders, MPPs, professional health care providers, public health advocates and organized labour have pleaded with the health minister to reform the way LHINs operate by lifting the curtain on their decision-making process thereby allowing the public a meaningful role in consultation.

How did the LHINs respond? By passing bylaws that make their operations even more secretive and shrouded in mystery – all the while ordering program cuts, emergency room shutdowns and restructuring plans to go ahead in the absence of any input from those for whom they exist to serve – the public.

As we said in our news release last week, the genie is out of the bottle and there’s no way LHINs can ever go back to their old cloak-and-dagger ways of doing business. A thorough house cleaning is in order and the Premier can make good on this by moving ahead with a review of LHINs as is legislatively required under the laws used to set them up in the first place. Incredibly, the Premier has put off any review until July 2012 – eight months after the next provincial election.

(As an aside, don’t be fooled by Conservative leader Tim Hudak’s pledge to scrap LHINs altogether if he’s elected to power. LHINs were an outgrowth of the Conservative’s own Health Services Restructuring Commission under Mike Harris which, of course, the Liberals of the day opposed but which, since 2003, they have implemented in several key ways).

What makes the conduct of Ontario’s 14 LHINs even more incendiary is the fact that they control $21 billion in annual health care spending. That’s $21 billion in spending without any meaningful public oversight or accountability.

It’s time to stop the rot that the LHINs have come to represent. Nobody realistically expects the government to scrap them tomorrow, although that would be a step in the right direction in the view of many.

What we need to hear from the Premier is an admission that his model of regional-based health care planning is seriously flawed and that his government is willing to consider alternative models – one that puts the interests of communities, first.

Ontario was the last province to go to a regional health care model. It did so despite a total absence of any evidence to suggest such a model provided any benefit. Since then other provinces have either dismantled or reduced in number their regional health authorities. Rumours have been swirling for months that Ontario is considering reducing the number of LHINs.

We could do worse than a move to publicly-elected, local health care boards where members would be directly responsible to the public. Ontario once exercised this model of democratic decision-making and other jurisdictions in North America still operate similar bodies.

In the aftermath of the Ombudsman’s report, one thing is clear: the status quo as represented by the current LHINs model doesn’t work. It’s time to take out the knife and scalpel.

In solidarity,

Warren (Smokey) Thomas, President

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