Rad­i­cal health unit cuts pro­posed

The Beacon Herald - - LOCAL NEWS - JONATHAN SHER THE LON­DON FREE PRESS On­tario health units

On­tario has qui­etly pro­posed sweep­ing changes to pub­lic health units that could make them less nim­ble re­spond­ing to emer­gen­cies such as SARS, an ex­pert and op­po­si­tion health critic warn.

An ex­pert panel con­vened by On­tario’s Lib­eral gov­ern­ment has rec­om­mended scrap­ping the prov­ince’s 36 health units and re­plac­ing them with 14 much larger bu­reau­cra­cies that repli­cate the ge­o­graphic bound­aries of agen­cies over­see­ing health care spend­ing, called lo­cal health in­te­gra­tion net­works (LHINs).

In the Lon­don re­gion alone, that would mean re­plac­ing seven lo­cal health units with a sin­gle be­he­moth cov­er­ing com­mu­ni­ties from Owen Sound to St. Thomas, and that could make them less re­spon­sive to lo­cal needs, in­clud­ing pub­lic health emer­gen­cies.

“(The pro­pos­als) are a leap of faith. (The panel) didn’t pro­vide any ev­i­dence,” said Joseph Lyons, di­rec­tor of the lo­cal gov­ern­ment program at West­ern Univer­sity.

It’s true that there could be bet­ter in­te­gra­tion be­tween pub­lic health and health ser­vices gen­er­ally, Lyons said. It’s also true some of On­tario’s small­est health units have strug­gled for lack of re­sources, he said, but that is not a good rea­son to scrap the en­tire sys­tem.

“Smaller health units can be fixed with­out turn­ing whole sys­tems on their heads,” he said.

The ex­pert panel re­leased its re­port in the sum­mer with­out much pub­lic no­tice but its rec­om­men­da­tions alarm Pro­gres­sive Con­ser­va­tive health critic Jeff Yurek. Gi­ant health units “would de­lay a timely re­sponse” to health crises, the El­gin-Mid­dle­sexLon­don MPP said Tues­day.

Lyons and Yurek high­lighted a num­ber of con­cerns about the pro­pos­als:

• While health units now have board mem­bers from com­mu­ni­ties they serve, many com­mu­ni­ties would have to go with­out rep­re­sen­ta­tives on LHIN-sized units.

• The ex­pert panel as­sumes larger bu­reau­cra­cies will be more ef­fec­tive and ef­fi­cient, but his­tory has proven oth­er­wise: past com­mu­nity and hos­pi­tal amal­ga­ma­tion did not pro­duce sav­ings and may have added to costs.

• Pub­lic health needs in down­town Lon­don are noth­ing like needs in ru­ral Grey and Bruce coun­ties, but a pro­posed, mas­sive health unit for the re­gion would have to man­age both.

• Un­der the pro­posed changes, lo­cal med­i­cal of­fi­cers of health would have to an­swer to a chief ex­ec­u­tive, adding an­other level of bu­reau­cracy.

The sci­ence be­hind pub­lic health is driven by ev­i­dence but the panel’s pro­pos­als lack that vigour, Lyons said. “These are pretty sweep­ing (changes). I’m not sure I’d be com­fort­able ac­cept­ing the claims of the ex­pert panel on face value,” he said. jsher@post­media.com

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• 36 across the prov­ince Small­est serves 34,000 peo­ple spread over an area the size of France Largest serves nearly 2.8M peo­ple



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