Frequently Asked Questions
Frequently Asked Questions About the Local Health Integration Networks (LHINs)
- What is the purpose of the Local Health System Integration Act?
- What are Local Health Integration Networks (LHINs)? What will they do?
- What programs/services will LHINs be responsible for?
- What programs/services will the ministry be responsible for?
- Why does the government need to organize the health system by LHINs?
- Are LHINs expected to reduce health service costs?
- What does a LHIN-organized health system mean to patients and what are the benefits for patients?
- How will LHINs make health care better in communities across Ontario?
- What authority will LHINs have to integrate services in their local areas? How will they improve service delivery?
- Why are the LHINs being given this authority?
- The Ministry of Health and Long-Term Care is handing nearly two-thirds of the ministry's budget to LHINs. What checks and balances are in the legislation to ensure that LHINs do not overstep the wishes of government, or take the health system in a direction counter to the government's strategic direction?
- How can communities be sure that LHINs will include them in local decision making?
- Will meetings of LHIN boards be open to the public?
- Will LHINs be able to make decisions to close hospitals?
- Does this mean that services will move from hospitals in smaller communities to hospitals in major centres?
- Do I have to get health services from the LHIN in which I live?
- How independent will LHINs really be? Do they have to report back to the ministry?
- Are LHINs an expensive and additional level of bureaucracy? Shouldn't we spend more energy on increasing the numbers of doctors and nurses?
- Does the legislation give LHINs the power to override collective agreements?
- Are LHINs a move to expand privatization in health care?
- What impact does this legislation have on French language services in the province?
1. What is the purpose of the Local Health System Integration Act?
The legislation, gives the LHINs the legislative power and authority they will need to effectively plan, coordinate, and fund their local health systems to make it easier for patients to access the care they need.
2. What are Local Health Integration Networks (LHINs)? What will they do?
LHINs are not-for-profit organizations that will be responsible for planning, integrating and funding local health services in 14 different geographic areas of the province. LHINs are intended to be the managers for health services that are delivered in hospitals, long-term care facilities, community health centres, community support services and mental health agencies.
LHINs are based on a principle that community-based care is best planned, coordinated and funded in an integrated manner within the local community because local people are best able to determine their health service needs and priorities.
LHINs will determine the health service priorities required in their local community. LHINs will work with local health providers and community members to develop an integrated health service plan for their local area. They will eventually be responsible for funding and ensuring accountability of local health services providers.
3. What programs/services will LHINs be responsible for?
LHINs will have responsibility for:
- Public and private hospitals (including divested Provincial Psychiatric Hospitals)
- Community Care Access Centres
- Community Support Service Organizations
- Mental Health and Addiction Agencies
- Community Health Centres
- Long-Term Services Homes
4. What programs/services will the ministry be responsible for?
The government will retain control for:
- Individual practitioners and Family Health Teams
- Ambulance Services
- Provincial drug programs
- Provincial programs
- Independent Health Facilities
- Public Health
5. Why does the government need to organize the health system by LHINs?
Through improved integration and the coordination of services, it is expected that LHINs will create a more efficient and accountable health care system that ensure people get the access to care they need.
6. Are LHINs expected to reduce health service costs?
LHINs will improve the way health services are planned and delivered at the local level across the province so that patients get the services they need. LHINs will also lead to a more efficient and accountable health system and provide better value for investments in health services.
7. What does a LHIN-organized health system mean to patients and what are the benefits for patients?
Patients will benefit from having health service decisions affecting them made by people in their community, who understand the needs of the community and the people who live there.
LHINs are specifically mandated to engage people and providers in their communities about their needs and priorities. They will develop ways to improve access to health services, respond to concerns people have about those services and look for ways for service providers to improve the quality of care.
LHINs will play an important role by ensuring that patients have better access to coordinated and integrated services through proper planning, and by building on the strength of local health organizations to improve communication among providers.
8. How will LHINs make health care better in communities across Ontario?
LHINs will be responsible for managing the local health system to ensure that services are integrated and coordinated. LHINs are expected to ease the flow of patients across the health care system and improve their access to services in their community. They are also expected to plan and allocate resources more efficiently to ensure better access to health care across the system.
LHINs will allow for more community input into local health care decisions, improving health care experiences for patients in every part of the province.
9. What authority will LHINs have to integrate services in their local areas? How will they improve service delivery?
LHINs have the authority to integrate local health services and programs. LHINs will not make integration decisions in isolation, but will work with local health service providers to identify ways to reduce duplication in the health system and to improve health services in Ontario.
10. Why are the LHINs being given this authority?
Community needs are best determined at the local level. By devolving responsibility for health services to LHINs, the ministry will play a more strategic role in the health system by concentrating on setting overall strategic directions and provincial priorities for the health care system.
However, the minister is also ultimately accountable for the health care system and will ensure that there are appropriate checks and balances in place to hold LHINs accountable for the performance of the local health system and the services Ontarians receive.
11. The Ministry of Health and Long-Term Care is handing nearly two-thirds of the ministry's budget to LHINs. What checks and balances are in the legislation to ensure that LHINs do not overstep the wishes of government, or take the health system in a direction counter to the government's strategic direction?
The legislation ensures that there is an appropriate balance between granting LHINs the authority they need to effectively and efficiently manage the local health system while retaining the ability to hold LHINs accountable for their performance.
The relationship between LHINs and the ministry will be governed by a Memorandum of Understanding (MOU) between each LHIN and the ministry, and an accountability agreement between each LHIN and the ministry. The accountability agreements will include performance goals and objectives for the LHINs, performance standards, targets and measures, and a plan for spending the money the LHINs receive.
The legislation requires LHINs to provide the minister with annual reports, including audited financial statements. The Auditor General will also have the authority to audit any aspect of the operations of a LHIN.
12. How can communities be sure that LHINs will include them in local decision making?
Community engagement is a core function of LHINs aimed at reaching out to communities for a variety of reasons, including assessing local needs and planning for local health services. The legislation requires LHINs to engage their communities. Each LHIN will determine the process, format, and frequency of community engagement activities based on the unique characteristics and needs of the local community.
The ministry will provide guidelines and direction to the LHINs and could make a regulation setting out additional requirements.
13. Will meetings of LHIN boards be open to the public?
Most board meetings will be open to the public. However, the legislation allows the board to go in camera to discuss matters in certain circumstances such as human resources advice and information from legal counsel.
14. Will LHINs be able to make decisions to close hospitals?
The legislation stipulates that LHINs will not have the authority to direct amalgamations, to direct changes to provider boards or to direct service providers to close or cease their corporate operations. LHINs cannot order the closure of a hospital.
15. Does this mean that services will move from hospitals in smaller communities to hospitals in major centres?
Services provided in each LHIN will depend on the local characteristics and needs of the community. LHINs will have the flexibility to address unique local population health needs and priorities, without compromising the quality, access, or the efficiency of health services.
16. Do I have to get health services from the LHIN in which I live?
No. LHIN boundaries are for management and administrative purposes only.
17. How independent will LHINs really be? Do they have to report back to the ministry?
The government will always be ultimately responsible for providing Ontarians with high quality, accessible health care services. LHINs will work in partnership with the ministry to ensure that unique local health care needs and priorities are addressed.
The ministry will continue to set the principles, goals, and baseline requirements for all LHINs to ensure that all Ontarians have access to a consistent set of health care services when they need them, regardless of what LHIN they reside in. At the same time, it is intended that LHINs will have the flexibility to address unique local population health needs and priorities.
As Crown agencies, the LHINs are subject to Ministry of Government Service accountability policies and directives. The LHIN/ministry relationship is subject to the new legislation, the Memorandum of Understanding, accountability as well as regular, ongoing dialogue between the ministry, LHIN CEOs and chairs of the LHIN Boards.
18. Are LHINs an expensive and additional level of bureaucracy? Shouldn't we spend more energy on increasing the numbers of doctors and nurses?
LHINs are an important vehicle that will be responsible for creating a true health care system at the local level. One that can assess the health needs of the community and resource these needs better - including providing advice about the numbers of doctors and nurses. LHINs are intended to change the fragmented approach to health service delivery and create an integrated and coordinated local health care system. LHINs are expected to reduce duplication, not increase it.
19. Does the legislation give LHINs the power to override collective agreements?
The legislation provides for the application of a special labour law to deal with labour relations issues that arise following any integration. This will give employees, and their representatives, rights at the new employer and it will establish processes for resolving any issues.
20. Are LHINs a move to expand privatization in health care?
This initiative is about providing better health care to the people of Ontario by doing some things differently than in the past - like involving communities in important health care decision. LHINs will play an important role to ensure that patients have better access to coordinated and integrated services through proper planning, and by building on the strength of local health organizations to improve communication among providers. In fact, the legislation prohibits private payments for services that result from an integration decision, unless the payment is permitted by law. Moreover, the Commitment to the future of Medicare Act preserves the public health care system in Ontario.
21. What impact does this legislation have on French language services in the province?
Under the French Language Services Act, (FLSA) any head or central office of a government agency must provide services in French. The FLSA also indicates that members of the public have the right to receive services in French from the Government of Ontario in 25 designated areas. Each LHIN will provide services to the public in French in accordance with the FLSA. Although 2 of the 14 LHINs are not within designated areas, there will be no difference in French-language services provided to the public by these LHIN offices.
Although LHINs will not be providers of clinical services, LHINs will plan services, fund and integrate the delivery of health care services. In these roles, LHINs will need to assess and plan for French-language services in their areas, and provide the appropriate funding and allocation of resources. In doing so, the LHINs will be required to engage a French language health planning entity for their geographic area.
Frequently Asked Questions about LHIN Boards
- What is the composition of LHIN boards?
- How can I apply to be on a LHIN board?
- How are board members selected?
- Will there be municipal representation on LHIN boards (as there was with District Health Councils)?
- How long will LHIN board members serve?
- How will the board be set up to protect against undue influence from more powerful members?
- Some of the appointed board members come from the private health care sector - is this what LHINs are all about, creeping privatization in health care? With the movement toward LHINs, will services that are now being delivered publicly be privatized?
- What kind of conflict of interest provisions has the government put in place for the appointed LHIN boards?
- How much will LHIN board members be paid?
- Why are LHIN Board members paid when hospital board members are not?
- Why are LHIN Board members appointed, not elected?
1. What is the composition of LHIN boards?
Each Local Health Integration Network (LHIN) is governed by a members-only board of directors of up to nine members. These board members are appointed by Order-In-Council for a term of one to three years, subject to renewal. For the initial appointments, three directors on each board were recommended to the Minister's Office through the community-based nomination process established by LHIN boards. Board members are required to live within the geographic area served by their LHIN.
2. How can I apply to be on a LHIN board?
Information about LHIN boards, director requirements and downloadable application forms are available on the Public Appointments web site at www.pas.gov.on.ca
3. How are board members selected?
LHINs are governed by boards of directors selected by the Lieutenant Governor in Council and appointed through Order in Council. For the initial appointments, three positions on each board were recommended to the Minister's Office through the community-based nomination process established by the LHIN boards.
The current appointment process has been transparent and consistent. Board positions were advertised in national and local newspapers as well as government websites. As part of their community-based nomination process to recruit board members, LHIN chairs hosted 59 public information sessions in 46 cities in the fall of 2005.
Board member selection is a merit-based process. All candidates are being assessed for fit between skills and abilities, and the needs of each LHIN As leaders within their communities, LHIN board members are expected to possess relevant expertise, experience and leadership skills as well as an understanding of local health issues, needs and priorities.
4. Will there be municipal representation on LHIN boards (as there was with District Health Councils)?
The LHIN boards are intended to be skills-based and not representative of specific groups or areas. One of the first responsibilities of LHINs will be to engage the stakeholders or their respective geographic area to ensure that all relevant stakeholders, including municipalities, have the opportunity to provide input into their local health planning initiatives.
5. How long will LHIN board members serve?
The first three directors will serve three-year terms that are renewable up to a maximum of six years. The next six directors will serve from one to three-year terms that are also renewable for up to six years. The terms will be staggered so that they do not expire at the same time.
6. How will the board be set up to protect against undue influence from more powerful members?
All board members will be voting members and will be able to exercise their responsibilities equally. Each director is required to act with honesty and integrity, in the best interest of the LHIN corporation and in compliance with the conflict of interest guidelines.
7. Some of the appointed board members come from the private health care sector - is this what LHINs are all about, creeping privatization in health care? With the movement toward LHINs, will services that are now being delivered publicly be privatized?
We are absolutely committed to the principles of universal Medicare, and so are all of our founding LHIN leaders. LHINs are part of our plan to improve and strengthen Medicare.
8. What kind of conflict of interest provisions has the government put in place for the appointed LHIN boards?
Because of the unique mandate of LHINs, the government has stipulated that LHIN board members must avoid conflicts of interest so that they cannot have overlapping responsibilities or influences between LHINs and other health care organizations.
The government has ensured that members resign from being a board member or officer of a regulated health professional college, an organization in the health care system that advocates for its members, or an organization in the geographic area of the LHIN that may receive funding from the ministry or the LHIN. In addition, conflict of interest guidelines are being developed for LHIN boards and their employees.
9. How much will LHIN board members be paid?
The LHIN board chair, vice-chair and directors will receive a per diem for their time spent on LHIN activities consistent with the Government Appointees Directives as follows:
Members - up to $200 per day
Vice-Chair - up to $250 per day
Chair - up to $350 per day
10. Why are LHIN Board members paid when hospital board members are not?
The per diems for LHIN board members were decided in accordance with the Management Board Directives for government appointees to government agencies. Hospitals are charities and are not allowed to remunerate board members.
11. Why are LHIN Board members appointed, not elected?
This decision was made based on the experience of other provinces that have already introduced some form of regional health authorities. Also, the LHINs boards are skills-based, not representational and include community leaders from across the province.
The 2005 community-based nomination process to recruit three board members for each LHIN was extensive, with 59 meetings in 46 cities and towns. Members of the public were invited to attend the information sessions and encouraged to submit applications.
For more information about Local Health Integration Networks visit the Ministry web site at http://www.health.gov.on.ca or the LHINs web site at www.lhins.on.ca
Ministry of Health and Long Term Care FAQs