Presented to: Regional Family Council Networking Meeting Region 10 Date: Tuesday, May 13, 2008 South East Local Health Integration Network Vision for Health and Health Care in the South East Suzanne McGurn Senior Consultant Planning and Integration South East Local Health Integration Network

2 Overview The Canadian Context The Ontario Context The Local Health Integration Networks (LHINs) The South East LHIN Long Term Care Homes Questions

3 Canada spends $160,000,000,000* on Health Care

4 Canada Health Act The Five Principles Universality Comprehensiveness Accessibility Portability Public Administration Accountability ??

5 Relative Age of Society, 2004

6 The Difference Age Makes

7 Ontario Composition of Revenue 2006/07

8 Ontario Composition of Program Expense 2006/07

9 Ontario Composition of Total Expense 2006/07

10 Ontario Composition of Program Expense 2006/07

11 Developing a New System Key Considerations Canada spends more money on health care than most countries Canada does not receive the best outcomes Canada is the youngest country of the G7 Canada’s population is aging at a fast rate Older countries (e.g. UK) did not see their health systems collapse as they aged All other Provinces devolved health care – moved to some form of regionalization

12 Ontario’s Response 14 Local Health Integration Networks (LHINs) have been set up throughout all of Ontario Somewhat similar to Regional Health Authorities in all other Canadian Provinces, but also very different –Similar characteristics Devolved regionalization, including decision making and funding Focus on system integration –Different characteristics All Boards continue to exist Focus on system management Provincial system and local system linked Local provider boards continue to exist and provide leadership to their organizations LHINs are responsible for managing the system, not operating services

13 Transformation of the Ontario System The New LHIN Environment Province is in controlProvince is steward Acute Care is the hubPrimary Healthcare is the hub System is fragmentedSystem is seamless Accountability focuses on blameAccountability focus on outcomes and improvement

14 Government’s Vision The Hon. George Smitherman, Minister of Health and Long-Term Care: “A health care system that helps people stay healthy, delivers good care to them when they are sick, and will be there for their children and grandchildren.”

15 LHIN Geographic Boundaries LHIN Areas: Erie St. Clair South West Waterloo Wellington Hamilton Niagara Haldimand Brant Central West Mississauga Halton Toronto Central Central Central East South East Champlain North Simcoe Muskoka North East North West

16 Local Health Integration NetworkPopulation Est. (2006) Initial Funding Estimates 1Erie St. Clair647,600853,699,200 2South West931,1001,762,173,900 3Waterloo Wellington708,400774,896,300 4Hamilton Niagara Haldimand Brant1,371,3002,214,490,500 5Central West779,200531,533,600 6Mississauga Halton1,092,200997,387,700 7Toronto Central1,159,4003,773,405,100 8Central1,604,9001,417,156,400 9Central East1,484,3001,665,979,000 10South East482,400853,584,600 11Champlain1,188,8001,945,980,600 12North Simcoe Muskoka431,400520,520,000 13North East567,8001,085,773,900 14North West238,000504,658,400 Provincial Total12,687,00018,901,239,200 Populations and Initial Funding Estimates Local Health Integration Networks (LHINS)

17 The Mandates of LHINs Community Engagement Integrated Health Services Planning Integration Performance and Accountability Agreements Performance Measurement Funding (true devolution of decision making)

18 Local Health Integration Networks LHSIA - Local Health Services Integration Act MLAA – Ministry/LHIN Accountability Agreement IHSP – Integrated Health Services Plan ASP – Annual Services Plan

19 The South East LHIN Where are we…

20 The South East LHIN Where are we…

21 The South East LHIN Where are we…

22 Linking Geography and Population

23 Funding of South East LHIN Health Service Providers by Sector, 2007/08 Total Funding Allocation 2007/08: $861,189,939 Note: Hospital Sector funding total includes one-time and in-year priority program announcements; includes funding for municipal taxes Add 20% for Physicians Services

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25 The Integrated Health Services Plan (IHSP) specific plan for the South East intended to provide an initial perspective –vision, priorities, strategies for enhancing health care through advanced vertical and horizontal integration of services –3 year horizon (2007/08 to 2009/10) involved all sectors –hospitals, home care, long term care, community support services, mental health, addictions, community health centres used both quantitative and qualitative data and analyses community engagement –included 22 communities, 109 meetings, over 1,000 people contributed to the discussions led to seven areas of priority

26 7 Priorities for Change 1.Access to: –Primary Care –Specialized medical care –Mental health services –Addiction services –Rehabilitation services –Transportation to and from care 2.Improve availability of long term care services 3.Integration of services making it easier for patients and professionals to move between services and service providers 4. Advance engagement with aboriginal communities 5. Advance the availability of French language health services 6. Advance availability and use of e-Health 7. Develop a regional health human resources plan

27 A Vision for Health Care in the South East In March, a new vision for health care was articulated for the South East LHIN region Achieving better health through proactive, integrated and responsive health care in partnership with an informed community.

28 A Vision for Health Care in the South East Breaking down the vision Achieving better health (the end goal for health care consumers)… through proactive (taking the initiative; speaks to a change in provider behaviour and overall system responsiveness),… integrated (speaks to changes in service delivery and the ideal end state)… and responsive health care… (answers and flexibility; speaks to a change in provider behaviour and overall system responsiveness),… in partnership (speaks to the “how;” means change is a collaborative effort)… with an informed community (means communications is key)

29 LHINs & Long Term Care Homes LHINs will be responsible for: –participating as appropriate in preparation and submission of requests related to long-term care homes through the Ministry annual planning cycle –establishing a process to monitor performance of long-term care homes for compliance with service agreements and Service Accountability Agreements –monitoring utilization of long-term care home beds and related funding –monitoring long-term care home performance through pre-established indicators (e.g., occupancy) –adjusting long-term care home funding according to long-term care home performance (e.g., convalescent care program) –identifying operating funds to be recovered from long-term care home operators through the annual reconciliation process and recovering funds as appropriate. –responsible for conducting financial audits

30 Geographic Summary Total # OfLong StayShort Stay HomesBeds Northumberland1490 Quinte West21531 South Hastings45214 Centre Hastings21590 North Hastings11082 Prince Edward53462 Lennox Addington64542 South Frontenac58716 Central Frontenac000 North Frontenac000 Leeds Grenville76930 Lanark33581 Totals

31 MOHLTC & Long Term Care Homes For long-term care homes, the Ministry retains current responsibility for: –compliance inspection, enforcement and sanctions –licensing and approval, including the setting of fees for licensing –approvals of changes of ownership, sale of businesses and amalgamations of providers for purposes of licensing management contracts setting ministry program and long-term care home standards selected funding programs

32 MOHLTC & Long Term Care Homes The mandate of compliance inspection, enforcement and licensing of long-term care homes is in the Compliance Inspection and Enforcement Unit of the Health System Accountability and Performance Division. Their mandate includes: –the development, implementation and management of a comprehensive program that ensures Long-Term Care Homes are in compliance with legislation, regulations, and program standards –safeguarding residents’ rights, safety, security, quality of life and quality of care –inspecting, monitoring and evaluating the performance of all long-term care homes on a regular and ad hoc basis against ministry standards and where necessary, use enforcement measures to achieve compliance Ministry standards

33 MOHLTC & Long Term Care Homes The Ministry will exercise its statutory authority use of enforcement remedies, including use of sanctions, for long-term care homes to achieve compliance. When sanctions are to be applied, MOHLTC will –inform LHINs on proposed actions/ decisions –for financial sanctions, direct LHINs to withhold funds –keep LHINs up-to-date on issues that arise from the application of sanctions Funding –CIEU shall continue to be responsible for ensuring the appropriate management of resident trust funds. In addition, some current Ministry funding programs will continue to be administered by the Ministry (e.g. High Intensity Needs Funds & Lab costs; Exceptional Circumstance Funding)

34 Working Together The LHINs and the Ministry respect each others’ responsibilities in the transformation and management of health care in Ontario, and will ensure that in fulfilling their respective responsibilities Each local CIEU service area office has a Compliance Manager who will be assigned as the point of contact for compliance inspection and enforcement related issues. Regular meetings are held between the CIEU and the LHIN to ensure up-to-date information exchange

35 Moving Forward Focus is on change, integration and improving the current good system... to make it even better !

36 Thank you for your time Questions?