August 2016

While the ‘Dog Days of Summer’ are often referred to as “the sultry part of the summer...marked by lethargy, inactivity, or indolence”, I can assure you that the 2016 Dog Days of Summer are anything but inactive at the Hamilton Niagara Haldimand Brant LHIN! As I mentioned in the postscript of my June blog, Bill 210, which includes the Patients First Act, 2016, was introduced in the Ontario Legislature on June 2 and we’ve be going full-tilt ever since.

This month, I want to provide a brief summary of what the proposed legislation includes and how we as a LHIN are proceeding in preparation for these potential changes should Bill 210 be passed by the legislature.

The introduction of Bill 210 followed an extensive public and stakeholder consultation process that was initiated after the December 2015 release of Patients First: A Proposal to Strengthen Patient-Centred Health Care in Ontario. I am very proud to report that our LHIN, which accounts for approximately 10 per cent of the province’s population, played a prominent role in soliciting feedback on the Proposal. Of the approximately 6,000 patients, caregivers and providers from across Ontario that provided their feedback, 1,274 people, or roughly a quarter, were engaged as part of consultation sessions organized right here in the Hamilton Niagara Haldimand Brant region.

Bill 210 is the next step in delivering on the commitments outlined in Patients First: Action Plan for Health Care - Ontario's blueprint for health system transformation. The legislation, if passed, would improve access to health care services by giving patients and their families faster and better access to care and putting them at the centre of a truly integrated health system.

The changes proposed in the bill represent an expansion of the mandate of LHINs and a significant increase in the scope of our work. LHINs are currently mandated under the Local Health System Integration Act, 2006 (LHSIA) to plan, fund and integrate health services for defined geographic areas. As non-profit corporations and Crown agents, LHINs may only carry out or do what is outlined in LHSIA.

In her Report on LHINs, the Auditor General noted that while LHINs were charged with integrating services, in certain areas, including Primary Care, they have not been provided with mandate or tools to hold other parts of their local health systems accountable. Legislative amendments are required to provide LHINs with the authority to plan and implement better integration of primary care, home and community care and to better incorporate population and public health into local health planning.

Bill 210 proposes amendments to LHSIA as well as amendments to several other Acts. Key legislative changes proposed under Bill 210 include:
  • Amendments to LHSIA to expand the mandate and oversight powers of LHINs
  • Amendments to the Home Care and Community Services Act, 1994, allowing the Minister of Health and Long-Term Care to approve LHINs to deliver home and community services.
  • Repeal the Community Care Access Corporations Act, 2001, to reflect the transfer of functions from Community Care Access Centres (CCACs) to LHINs.
  • Amendments to the Health Protection and Promotion Act, 1990, to establish engagement requirements for LHINS and local boards of health.
These changes link directly back to the four overarching themes identified in the Patients First Proposal, which are:
  1. More effective integration of health services and greater equity - The mandate of LHINs would be extended to play a greater role in health service planning and performance management at every step in the patient’s journey including primary care, home and community care, and public health. LHINs would identify smaller geographic sub-regions to serve as the focal point for integrated service planning and delivery.
  2. Timely Access to, and better integration of Primary Care - LHINs would take on responsibility for primary care planning and performance improvement, in partnership with local clinical leaders. 
  3. More consistent and accessible Home and Community Care - Direct responsibility for service management and delivery would be transferred from CCACs to the LHINs
  4. Stronger links to Population and Public Health - Linkages between LHINs and boards of health would be formalized to integrate a population health approach into local planning and service delivery across the continuum of health care.
Bill 210 is an important part of legislation that will continue to move health care and the role of LHINs forward; however, the HNHB LHIN has been continuing our work and progress related to our 5-year Strategic Health System Plan (SHSP) and we are seeing clear alignment with Bill 210. You may recall in our SHSP we discussed the creation of ‘zones’ across our LHIN. This concept aligns with Bill 210’s reference to ‘sub-regions’ so our LHIN has been focusing on this theme identified in Bill 210.

Locally, we have been hosting a series of webinars, which began in July and extend into August, to share details related to the provincial government’s Patients First: Action Plan for Health Care including the development of sub-regions and the proposed legislation Bill 210. These engagement sessions are open to the public, health service providers, primary care providers (including physicians), and interested individuals. Two face-to-face symposiums for health service providers are also planned for August.

Upcoming Webinars (All welcome) Upcoming Symposiums (Health Service Providers and Physicians) The HNHB LHIN will be providing recommendations on LHIN sub-regions to the Ministry by September 16 taking into consideration population characteristics, patterns of health service usage, geographic boundaries and an appropriate mix of health service providers.

While much work is taking place at the provincial level to address the changes within Bill 210, deliverables related to the transfer of all CCAC programs, staff and assets to the LHIN must also be reviewed and addressed at the local level should the Bill pass.

The HNHB LHIN and HNHB CCAC have started discussions and planning together including the creation of an Implementation Working Group comprised of LHIN and CCAC leadership.
In addition to the Implementation Working Group, additional LHIN and CCAC leadership and staff are working together to understand the current state and design the future for home and community care under the proposed new mandate.

We have also begun to have conversations with local physician groups and clinical leaders around planning and performance improvement in Primary Care, as well as meetings with the Medical Officers of Health from the five Public Health Boards in our region to formalize links and identify opportunities to integrate population health with health system planning.

As we undertake these initiatives, our commitments to our staff, our health system partners and most importantly to patients and clients are our primary concern. I look forward to continuing to keep you updated on our progress and encourage you to visit the Bill 210 page on our website for more information, engagement opportunities or to submit your thoughts and feedback.


If you or your organization would like to be featured in a future blog or share a patient story in one of our Voices in the Community videos you can reach us through our office, or if you’re on social media via our Twitter handle -@HNHB_LHINgage. Your feedback and questions are always welcome.