Dalton McGuinty's Liberals are set to try once more to breathe life into their health-care regionalization scheme.
Within the next couple of weeks, sources say, the Ontario government will introduce legislation aimed at strengthening the mandates of Local Health Integration Networks. Likely to be most notable among the proposed changes, first hinted at when Health Minister Deb Matthews broadly laid out her policy agenda earlier this year, will be to somehow bring family doctors under the 14 LHINs' purview.
With the LHINs having been labelled by both provincial opposition parties as unaccountable bureaucracies and affronts to local decision-making, the bill may prove too controversial to make it through the province's minority Legislature. But behind the scenes, some Liberals have been pushing to go much further – fearing that being too timid could ultimately spell the end of an experiment aimed at better co-ordinating service delivery and reducing duplication.
In health-policy circles, the concerns about LHINs have less to do with their lack of accountability than with their lack of teeth. Their mandates ambiguous, the LHINs seem mostly just to write cheques to health-care providers, with little real discretion over how the money is spent. That could make them easy targets for future governments looking to shrink the number of provincial agencies, and avoid excessive administrative costs, as Ontario tries to get its finances in order.
Rather than leaving LHINs on the chopping block, a vocal pro-regionalization group within government has been arguing that Community Care Access Centres – agencies that co-ordinate home care and long-term care – should be folded into them, simultaneously reducing bureaucracy and allowing for better integration with other services.
That idea appears to have some support within the Premier's Office. But Ms. Matthews is unconvinced of its merits, as are officials in her department. And Liberal MPPs, including caucus veterans who fought against the previous Progressive Conservative government's attempts to do away with the CCACs, are nervous about the perceptions of the faceless LHINs gaining more power.
With the more cautious side currently prevailing, the foray into planning family medicine is likely to be the most new power the LHINs get. But already, that's leading to speculation that the LHINs will again just be stuck as glorified middlemen, dispensing government funding to family doctors without much say over where or how it's spent.
Meanwhile, the Progressive Conservatives and New Democrats – both of whom have called for the LHINs to be eliminated – can be expected to voice a different complaint. With the legislation, they will likely argue, the Liberals are trying to circumvent a mandated legislative committee review of LHINs, which they have argued since 2010 is overdue.
That alone should give the opposition parties reasonable grounds to deny the bill passage. But truth be told, Liberal strategists may not mind that.
Increasingly, their focus is on making the argument – to voters in the coming by-election in Kitchener-Waterloo, and to a province-wide electorate that could be back at the polls in less than a year – that they need a majority government to get anything done.
This week's posturing by Finance Minister Dwight Duncan and Government House Leader John Milloy, in which they dubiously warned that the passage of this year's budget is again in jeopardy, was part of framing that case. And there are noises from Liberals about following in the footsteps of Prime Minister Stephen Harper, by building a backlog of legislation that shows they want to run an activist government but are encumbered by their minority status.
If so, there's a danger of quantity mattering more than quality. Ruffling too many feathers with the bills themselves might not be worth it if tough decisions aren't really possible anyway.
So for now, it appears, the LHINs will remain on life support – kept alive by a government that still believes in them, but lacks the consensus within and outside its own ranks to really take some risks on them.