Lead or follow

County health care advocates propose Rural Healthcare Hub as model for remake of LHINs

The way healthcare is planned, administered and funded in Ontario is changing. Again. A decade ago, the province created 14 Local Health Integration Networks (LHIN) as a means of extracting greater efficiency and accountability from the many and varied moving parts that make up the healthcare system.

At the time, then- MPP Ernie Parsons greeted the news with unfiltered incredulity.

“Who knew the solution to health care in Ontario, was another layer of administration,” quipped Parsons. His comments likely didn’t endear him to his Liberal party colleagues, yet they reflected— still reflect—a wide-spread skepticism with the direction of health care, particularly in this region.

Ten years have passed and the LHINs are an entrenched force in the healthcare landscape. Increasingly, the LHIN is the organization locally called upon to explain or justify decisions affecting healthcare and hospital services in Prince Edward County.

The LHINs’ profile has expanded even after Provincial Auditor Bonnie Lysyk noted that performance gaps continue to widen and the mandate is unnecessarily vague and ragged.

Among her chief concerns was with the province’s network of Community Care Access Centres (CCAC) and its 6,000 employees. She found that the home and nursing home care co-ordinating agency spent too much on administration and not enough on care. Further, she found the LHINs were hamstrung in their ability to influence the CCAC.

Last month, the Liberal government introduced the Patients First legislation that, among other things, will scrap the CCACs, putting these functions under the direction of the LHINs. This, and other changes, are intended give the LHINs more direct control to reduce duplication and streamline the delivery of services in the region for which is it is responsible. Public hearings for the new legislation are set for this fall and with passage expected next spring.

Health Minister Eric Hoskins has said he expects administrative savings of between 5 and 10 per cent annually.

Part of the overhaul includes the creation of smaller planning spheres within each LHIN— recognizing that some processes and services work better, and efficiency is best realized, in a local ecosystem rather than the regional LHIN—especially one that stretches from Trenton to Brockville, from Smiths Falls to the edge of Algonquin Park.

“The needs of the people in the Bancroft area are different than those in the Kingston area,” explained Paul Huras, CEO of the South East LHIN. “Their access to services is different. You have to plan differently.”

Sensing that a rare window may have opened in which local ideas and successes might pass through and perhaps infect the large, slow-moving and otherwise impermeable healthcare policy bureaucracy, a team of local healthcare professionals, residents and municipal council representatives is hoping to shape the conversation.

Rather than wait to be thrust into a sub-LHIN defined by bureaucrats unfamiliar with the unique and highly evolved healthcare relationships in Prince Edward County, the County’s Health Care Advisory Committee is seeking to shape the transformation.

Specifically, the group has developed a blueprint for a Rural Health Hub encompassing the highly integrated services and collaborative relationships that make healthcare in Prince Edward County work well. They believe the experience here can be used to derive the same benefits in other rural communities.

Ron Lirette heads the Prince Edward Family Health Team, and spoke on behalf of the County’s Health Care Advisory Committee before a council meeting last week, looking for its support.

“This has been created by us, for us,” said Lirette. “We are looking to get ahead of events before we are simply told what will happen. We want to control what we can control.”

Lirette pointed to long list of achievements borne of the close collaboration and cooperation between health care providers in Prince Edward County. He observed that the County’s primary care model is a recognized success story.

He noted the innovation in the sharing of electronic medical records as a means to improve collaboration for the benefit of patient care.

Lirette added that the near-seamless connectivity between the hospice, community care, primary care and hospital care in Prince Edward County is a model that should be preserved.

Lirette cautioned, too, that an ill-considered reorganization could bake-in inefficiencies.

“Patient flow from the County is just as likely to flow back and forth from Kingston as Belleville,” said Lirette, suggesting a Rural Health Hub would more nimbly improve productivity and find savings.

What is the likelihood the South East LHIN will be receptive to a Rural Health Hub? Lirette says the objectives of the proposal and the Patients First initiative are identical.

“When you look at the key ingredients of enhanced integration, enhanced communication and enhanced outcomes for patients and families, those are all core outcomes,” said Lirette. “That is already what we do in Prince Edward County.”

Council members were generally supportive, yet they’ve learned to be wary of change in the healthcare system, as it has historically meant diminished services in this community.

Some, like Athol councillor Jamie Forrester, wanted some assurance that control over healthcare would be maintained in the County.

While Lirette could not offer this assurance, he suggested it was better to be part of the discussion than not, especially in the early stages.

“We can choose to stand back and allow this to happen,” said Lirette. “But this is our attempt to shape the transformation. This is our community response.”

Some councillors wanted the local hospital to play a larger role in the Rural Health Hub proposal. Lirette countered that the plan was more of a system response rather than a discussion about bricks and mortar.

But Councillor Bill Roberts pressed for a more direct inclusion of Prince Edward County Memorial Hospital.

“It is important to demonstrate that our aspirations for a new hospital align well with the Patients First proposal,” said Roberts.

Notwithstanding the wariness, council heartily endorsed the Rural Health Hub proposal