The case for local health-care governance
The governance of our local health care is being eroded!
How far from the local community should governance of our health care be?
Should there only be a single Ministry of Health Authority driven by the government elected every four years and controlled by parliament, as is the case in Alberta?
Should there be 14 LHINs or regional authorities as we have in Ontario that act on behalf of the Ministry of Health?
Should we have local community governance? My bias is certainly the latter. I think the closer to home governance is, the better.
As recently as a couple of years ago we had governance structures for the public health unit, the hospital, the access centre, and even an advisory group for our local family health team. These had local representatives serving on boards and bringing a local perspective to policy strategy and practices. While not perfect, they have allowed local citizens to contribute their expertise.
I had the good fortune to be appointed to our local hospital board and serve two terms, or six years. They were not easy times as we had to overcome fiscal challenges, leadership issues, and the many changes facing institutions trying to offer quality health care. But we have an excellent hospital with first-rate leadership and governance.
But what about governance at our other partner institutions? The access centre board has been dismantled and now operationally reports to the regional LHIN. The health unit board is now threatened and most likely will be brought under the LHIN as well.
We have been informed that the province wants the LHINS to now be operational entities. Does this mean they will take over the local family health team groups? Does it mean they will eventually also eliminate local governance of our hospitals? We have been told that the LHINs plan to establish local subgroups but how would they be constituted? I would like to see greater physician involvement in whatever structure is proposed for the future. But physicians are only one of the many stakeholders in our health system. Yes, they are absolutely crucial but in this day and age patients are demanding a greater voice and what better place than in the governance role.
Historically the local communities have valued greatly their local hospitals having local governance. However the hospitals have not historically been so hospitable to other health care providers in their local communities. So there is a real hesitancy to see the local hospital board take over other aspects of health care delivery in the local community. This is understandable given the history but there is new accommodating leadership at PRHC. I believe they are prepared to lead in a collaborative manner or at least in a renewed partnership framework.
So what do the citizens of the greater Peterborough region want? Need?
My experience as a college president tells me we can have excellent governance at the local level. That local governance does not preclude excellence but does instill great pride and commitment. It also allows for our institutions to reflect the nature of our communities. Regional and central control leads to insensitivity. By the way how is that central bargaining going for the college system?
I certainly hope that in 2018 that our community health care leadership will come together to ensure that at the local level governance and advocacy structures are preserved. Perhaps revised and maybe even integrated but local.