Bill 210, the Patients First Act, proposes to change significantly how Ontario’s health care system is regulated and overseen. Most importantly, it significantly expands the mandate and powers of Local Health Integration Networks (“LHINs”). The Bill was introduced by Minister Hoskins on June 2, 2016.
The Ontario Government established LHINs in 2006 under the Local Health System Integration Act, 2006 (“LHSIA”), creating 14 geographic LHINs throughout the Province. The LHINs were set up to fund and oversee a finite list of “health service providers”, including hospitals, psychiatric facilities, long-term care homes, and community care access centres. The LHINs were originally given the power to:
- review and refuse voluntary integrations between health service providers; and
- order integrations between health service providers.
Bill 210 proposes to give the LHINs an expanded role by adding to the list of health service providers under the LHIN’s jurisdiction. These additional are primarily primary care health providers, such as family health teams, nurse practitioner-led clinics, aboriginal health access centres, and primary care nursing services. Palliative care services (including hospices) and physiotherapy services in a clinic setting are also added to the list of health service providers.
The Bill puts in place the mechanics by which the LHINs will take over the community care access centres (“CCACs”). CCACs are currently responsible for providing health and social services in home and community settings and managing the placement of individuals into long-term care homes, supportive housing programs, and chronic care and rehab beds. This major policy change was announced in December 2015 through a discussion paper focused on changes to primary care in Ontario. This is a sizable change in the LHINs’ mandate – they are evolving from a regulator and funder to a service provider themselves. The transition of the CCACs to the LHINs will be seamless, as the LHINs inherit the assets, liabilities and staff of the CCACs through Ministerial order.
Bill 210 also gives the LHINs considerable new powers over the expanded list of health service providers, some of which raised eyebrows across the sector. The most commented on new power is the ability of the LHIN to issue (provided it is “in the public interest” to do so) “operational or policy directives”, which when issued are mandatory for health service providers. There was serious concern expressed that Bill 210 was a first step in eroding self-governance (volunteer local boards) of Ontario’s health service providers. The Ontario Hospital Association was particularly vocal about the overly broad power given to LHINs to issue these directives, on virtually any possible subject matter, without any need for consultation or prior notice.
LHINs will also have the power to appoint an investigator over health service providers, with broad powers to investigate and report on the quality of the management of a health service provider, the quality of care provided by a health service provider, or any other matter that the LHIN considers in the public interest. Investigators may enter premises, require the production of records, and question people on matters relevant to the investigation. Investigators must prepare a report that will be made public.
Bill 210 also gives LHINs the power to appoint a “supervisor” over any health service provider (other than long-term care homes or hospitals). A supervisor is appointed at the pleasure of the LHIN for an indeterminate period of time and has the exclusive right to exercise all of the powers of the health service provider’s board, its directors, officers and members or shareholders. The Minister of Health and Long-Term Care has similar powers under the Public Hospitals Act, but the actual appointment of an investigator or supervisor must be made by Cabinet (the Lieutenant Governor in Council). Under Bill 210, the LHIN would have this power directly, without needing to involve Cabinet.