JFAAP response to the Provincial “Patient First discussion paper”

Patients Ignored

To: The Board of the Central Local Health Integrated Network and other interested parties.

From: Jane Finch Action Against Poverty

Re: A response to the Province’s Patients First Discussion Paper

Date: 2016-02-17


On Tuesday February 2, 2015, the Central LHIN held a “community consultation” in response to the Province’s Patients First initiative.

Many of us residents at the meeting did not have a clear idea of what a LHIN was before the meeting nor did the presenter give us a clear explanation of its role in our community’s health. She continually made the LHIN sound like a collector of reports from service providers hiding its true mandate: “to plan, fund and integrate health care services for more efficient care in (our) region.”[1] She had to be corrected by an audience member.

The room was badly set up with no PA system.

Introductions to the PowerPoint questions were biased and condescending.

The impression of many of the participants was that full information was not being provided. This disrespectful tone continued until the end of the meeting when some decided to leave after an hour and a half of frustration.

It became clear that the LHIN wanted the community to rubberstamp the LHIN’s role in carrying out the Province’s Patient First changes.

It is strange that the LHIN is trying to look like it is consulting with the community at this time because when the LHIN was planning to move the Finch branch of our hospital out of the community it held no consultative meetings. We were not privy to the backroom negotiations that led to one of the largest health care assaults that Jane and Finch has ever suffered. We wonder, therefore why the LHIN appeared to wish to listen to us at this juncture?

Jane Finch Action Against Poverty would like to present our contribution to this ‘consultation’ after an actual reading of the discussion paper.

In the paper three changes that were presented 1. Primary Care Management, 2. Home Care Administration and 3. Public Health Planning And Funding.

1.     Primary Care Management

According to the Province’s discussion paper Patients First,  A Proposal To Strengthen Patient-Centred Health Care In Ontario, LHINs,” in partnership with local clinical leaders, would take responsibility for primary care planning and performance management.” (italics added) While this may seem like a good idea on paper, its major flaw will be in its implementation.

Presently LHINs do this kind of thing for other health providers such as hospitals; but unlike hospitals which are funded through the LHIN, doctors’ “compensation and primary care contracts would continue to be negotiated by the government and administered centrally.”[2]

By this, we understand that the only role of the LHIN would be to increase the administration duties of doctors without controlling the financial side.

It was clear that your staff wanted participants at the meeting to agree with this idea in order to feel comfortable telling doctors that this change had community support.

We understand that the OMA is a powerful force and that you will need all the help you can get but please be clear the Jane and Finch community neither understands the reasons for nor supports this change.

2.       Home Care Administration

The concerns that most people have with the CCAC is the level of services that they are able to provide within their funding levels. Home nursing, assistive devices, physiotherapy, caregiver relief, etc. are important in keeping patients at home instead of in very expensive hospital beds but the CCACs are underfunded and cannot support caregivers any more than they already do.

According to the Province’s discussion paper, the LHINs would completely take over the duties of the CCACs which would then be dissolved.

By the time you introduced this issue at the meeting, you had already lost a large part of your audience.

JFAAP finds that this move disturbing and problematic.

As it stands now, the LHINs never have directly administer any health care; they only plan and fund. What would lead us to conclude that the LHIN would succeed where the CCACs have not? Clearly, the structure and administration of both bureaucracies are equally unrepresentative of and unaccountable to the population they serve.

The only way to improve home care is to put more resources into it. Patients and caregivers do not care what acronym administers the service as long as they get what they need.

JFAAP sees no reason to make this change because the LHIN is inexperienced as a service provider unless it comes with dramatically more funding for home care services.

          3.       Taking over public health

The discussion paper indicates that the province wants to “transfer the dedicated provincial funding for public health units to the LHINs for allocation to public health units. The LHINs would ensure that all transferred funds would be used for public health purposes.

JFAAP asks why?

Public health services improve the lives of our area more than the all the hospitals and doctors combined. They deal with nutrition, vaccinations, sexual health, mental health and much more

These services need to be rooted in the social determinants of health of which LHIN has indicated little or no understanding or interest.  For example, during the meeting, when some youth and other residents brought up issues of police brutality which affects mental health of our community, your staff were clearly dismissive.

JFAAP recommends that the LHIN should not have a role in  planning public health because it has no understanding of our community.


The LHIN’s understanding of our community is limited. It hampers its ability to make plans for our health care.

The Central LHINs board is made up provincially appointed members who are lawyers, bankers, an associate professor, college and a long-term care administrators. None of them have any understanding at all about the social determinants of health in Jane and Finch or in rural Ontario for that matter. The token community advisory board of the LHIN carries no weight in terms of their responsibility to our community or as actors for change.

In contrast, the members of the Board of the Black Creek Community Health Center Board, who hosted you meeting, are elected by residents of the area that the clinic serves.

LHINs have the word “Local” in their names but there is nothing local about them when all of them have developed identical  priorities in tune with Province after some token ‘consulting’ with interested parties. Clearly LHINS are just another layer of administration for the Ministry.

JFAAP believes that the Central LHIN is unaccountable to our community and ignorant of its needs. It is incapable of service delivery and should not be granted any more planning or administrative powers until it is restructured into a transparent and socially responsible agency.

JFAAP recommens that both the CCACs and LHINs be reorganized to create organizations that are truly representative and responsive to our communities.

Please feel free to contact us at info@jfaap.com or Errol Young at 416-571-0042.


  1. MPP Mario Sergio,

Hon. Dr. Eric Hoskins, Minister of Health and Long Term Care,

MPP Gélinas France, NDP Health Care Critic,

MPP Bill Walker PC Health Care Critic,

Cheryl Prescod Executive Director Black Cree Community Health Clinic,

Patients First feedback  health.feedback@ontario.ca

Ontario Medical Association, info@oma.org

Ontario Health Coalition OHC@sympatico.ca, c.egan@sympatico.ca



[1]                    http://healthydebate.ca/2011/06/topic/cost-of-care/lhins-2

[2]                    http://www.health.gov.on.ca/en/news/bulletin/2015/docs/discussion_paper_20151217.pdf