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Understanding Lhins: a Review of the Health System Integration Act and the Integrated Health Services

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Understanding Lhins: a Review of the Health System Integration Act and the Integrated Health Services Understanding LHINs: A Review of the Health System Integration Act and the Integrated Health Services Komal Bhasin MSW, MHSC (HA), CHE A. Paul Williams, PhD. Professor, Department of Health Policy, Management and Evaluation, University of Toronto and CRNCC Co‐Chair Produced for the Canadian Research Network for Care in the Community (www.CRNCC.ca) and The Ontario Community Support Association (www.OCSA.on.ca) May 2007 UNDERSTANDING LHINS: A REVIEW OF THE HEALTH SYSTEM INTEGRATION ACT AND THE INTEGRATED HEALTH SERVICES PLANS 1.0 PURPOSE This report provides background information about Ontario’s 14 Local Health Integration Networks (LHINs). This includes an overview of Bill 36 (the Local Health System Integration Act, 2006) and a summary of the contents of each LHIN’s Integrated Health Services Plan (IHSP) particularly as it relates to community support services (CSS) and community support service agencies (CSSAs). It concludes with a discussion of key issues for consideration by CSSAs as the rollout of the LHINs continues. 2.1 BACKGROUND Ongoing concerns about the sustainability of publicly‐funded health care, in the face of changing demographics, economic pressures, and shortages of health human resources, set the context for the Ministry of Health and Long Term Care’s (MOHLTC) transformation agenda. In 2004 the MOHLTC announced its intention to transform Ontario’s health care system in an effort to achieve its vision of “(a) healthcare system that helps people stay healthy, delivers good care to them when they get sick and will be there for their children and grandchildren”. The transformation agenda included four key components: 1. Improving access to primary care; 2. Reducing wait times for high‐demand surgical and diagnostic procedures; 3. Developing an information management system, including an electronic health (e‐health) record; 4. Creating Local Health Integration Networks (LHINs) in 14 geographical regions across the Province. As detailed below, LHINs are organizations that will take over key responsibilities from the MOHLTC to oversee and manage the delivery of health care at the “local” level. LHINs will be responsible for planning, funding and monitoring hospitals, home care (Community Care Access Centres (CCACs)), community support services, community mental health and addictions services, and long‐term care (LTC) facilities (albeit not doctors, drugs or public health). The stated principle underlying the creation of the LHINs is that health care services are best managed at the local level where they can be delivered in an integrated manner, and with input from community members. LHINs are seen to be a mechanism for overcoming existing health care “silos”, and improving integration and coordination of services that will hopefully lead to a more efficient, accountable and sustainable health care system in Ontario. According to the MOHLTC, “LHINs are a critical part of the evolution of health care in Ontario from a collection of services to a true system that is patient‐focused, results‐driven, integrated, and sustainable.” KOMAL BHASIN, A. PAUL WILLIAMS PAGE 1 UNDERSTANDING LHINS: A REVIEW OF THE HEALTH SYSTEM INTEGRATION ACT AND THE INTEGRATED HEALTH SERVICES PLANS Unlike regional health authorities in other Canadian jurisdictions, LHINs will not be direct service providers; they will fund services provided by existing and/or new provider organizations that will maintain their own governance. LHINs will enter into contracts called “service accountability agreements” with local service providers that will set expectations regarding the scope, nature and volume of services to be provided under LHIN funding. The relationship between the MOHLTC and each LHIN will also be governed by an accountability agreement, as well as a memorandum of understanding that will detail funding, services and standards to be maintained by the LHIN, a plan for spending within a budget allocated by the province, and expected health service and system outcomes. As of April 1st, 2007, all LHINs are required to have accountability agreements with the Ministry. Although considerable responsibility has thus been devolved to the LHINs, the government will continue to act as “steward” of Ontario's health system by retaining control of strategic policy‐making, direction and standard‐setting, and also continue to deliver province‐wide programs and services. LHIN budgets will be determined by the MOHLTC, with LHINs having no ability to raise additional funds. A visual diagram of the MOHLTC’s stewardship activities can be found at: http://www.health.gov.on.ca/english/providers/transition/pdf/dep_memo_011806.pdf Under the Local Health System Integration Act (Bill 36) each LHIN was required to develop an Integrated Health Services Plan (IHSP) for the three‐year period starting in 2007. IHSPs are strategic plans that include a vision, strategic priorities and directions, as well as subsequent actions for providing integrated services. Key elements of these plans are summarized below. 2.2 BILL 36: LOCAL HEALTH SYSTEM INTEGRATION ACT, 2006 Bill 36, the Local Health System Integration Act, was passed by the Government of Ontario in March 2006. It sets out the legal framework for the establishment and functioning of the LHINs. The complete Act can be found at: http://www.e‐laws.gov.on.ca/DBLaws/Statutes/English/06l04_e.htm 2.2.1 PURPOSE OF THE ACT The purpose of the Act is “to provide for an integrated health system to improve the health of Ontarians through better access to health services, coordinated health care in local health systems and across the province and effective and efficient management of the health system at the local level by local health integration networks”. 2006, c. 4, s. 1 [1]. KOMAL BHASIN, A. PAUL WILLIAMS PAGE 2 UNDERSTANDING LHINS: A REVIEW OF THE HEALTH SYSTEM INTEGRATION ACT AND THE INTEGRATED HEALTH SERVICES PLANS 2.2.2 LHIN GOVERNANCE LHINs are Crown Agents. The Lieutenant Governor in Council (ie. Cabinet) will appoint their members and their Board of Directors (sections 3‐4). Each LHIN must have a Board of Directors with no more than nine members (appointed by Order in Council) that may hold their position for up to three years, with the possibility of re‐appointment for one additional year. LHIN boards have the power to pass by‐laws and resolutions, though certain by‐laws may require the Minister’s approval (specific conditions not given in the Act). LHIN boards are required to meet at least four times per year with meetings open to the public, however there are also provisions within the regulations for meetings to be held “in camera” (closed sessions). The LHINs are required to act honestly and in good faith for the best interests of the LHIN. To this end, they are required to conduct an annual audit, and submit an annual report to the MOHLTC (including audited financial statements) that will be tabled in the Legislature. The legislation also requires that the LHINs work collaboratively with the Ontario Health Quality Council, an independent body that monitors the quality of publicly funded health care in the province, and to provide it with information as requested. More information about the Ontario Health Quality Council can be found at: http://www.ohqc.ca/en/index.php 2.2.3 LHIN RESPONSIBILITIES LHINs will: • promote the integration of the local health system • identify, plan for and make recommendations to the Minister about health service needs and funding needs • engage the community in planning and setting priorities for that system • respond to concerns that people raise about the services that they receive • evaluate, monitor and report on the performance of the local health system and its health services • assist in the development of the provincial strategic plan • improve the integration of the provincial and local health systems and improve the coordination of health services • improve access to health services and enhance continuity of health care • disseminate information on best practices and promote knowledge transfer • bring economic efficiencies to the delivery of health services • fund health service providers for services and equipment • enter into agreements to establish performance standards and ensure the achievement of performance standards by health service providers that receive funding from the network KOMAL BHASIN, A. PAUL WILLIAMS PAGE 3 UNDERSTANDING LHINS: A REVIEW OF THE HEALTH SYSTEM INTEGRATION ACT AND THE INTEGRATED HEALTH SERVICES PLANS • ensure the effective and efficient management of resources • do anything else the Minister specifies by regulation (section 5) 2.2.4 HEALTH SERVICE PROVIDERS (HSPs) UNDER THE LHINS Under section 2 of the Act, many, but not all publicly funded HSPs, will fall under the auspices of the LHINs including: • Public hospitals • Divested psychiatric facilities • Community Care Access Centres • Community mental health and addictions agencies • Community support services organizations • Community health centres • Long term care facilities (charitable homes for the aged; municipalities that maintain homes for the aged; nursing homes) Note that the LHINs will not have responsibility for: • Physicians, dentists, chiropodists, optometrists and corporations of these health professionals • Public health • Ambulance services (both emergency and non emergency) • Laboratories • Provincial networks and programs 2.2.5 FUNDING AND ACCOUNTABILITY As agents of the Crown, LHINs will be funded by the MOHLTC based on terms and conditions that it deems appropriate. The Minister will enter into an accountability agreement with each LHIN for a minimum of one year at a time. Accountability agreements will contain: • Funding amounts for the LHIN • Services, standards and targets that must be achieved • A plan for spending of allocated funds • Expected health care and system outcomes In the event that the Minister and LHIN are not able to reach an agreement, the Minister retains the power to unilaterally set the terms of the agreement for the LHIN. Section 17 of the Act contains a provision that gives authority to the Minister to allow LHINs that have retained savings due to efficiencies to reinvest portions of their savings back into their local health system.
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