Registed Nurses' Association of Ontario

Bill 36: The Local Health System Integration Act

Bill 36: The Local Health System Integration Act

February 6, 2006
Submission to Standing Committee on Social Policy

Recommendation 1:
a) Amend the preamble to the Act to include references to the government’s commitment to the Canada Health Act and to the Commitment to the Future of Medicare Act.
b) Amend the objects of the LHINs to include upholding the principles and conditions of the Canada Health Act and strengthening not-for-profit delivery.

Recommendation 2:
a) Amend Bill 36 to require that any integration decisions that provide for a transfer of services must, in the first instance, be to not-for-profit providers (provide right of first refusal). Only if not-for-profit providers are unwilling or unable to accept the transfer of health services should transfer to for-profit providers occur.
b) Amend Section 25 of the Bill to ensure that integration between a for-profit provider and a not-for-profit provider would only be allowed if the resulting health service provider operates on a not-for-profit basis.
c) Amend Section 28 of the Bill to provide the Minister with powers to order for-profit providers to cease operating, amalgamate, or transfer services. This will provide the Minister with identical powers with respect to for-profit providers and not-for-profit providers.

Recommendation 3:
Amend Bill 36 to prohibit LHINs from using competitive bidding as a method of allocating funding to health service providers.

Recommendation 4:
a) Amend Bill 36 to prohibit LHINs from issuing decisions that facilitate or order contracting out of any hospital or residential care facilities services that provide direct clinical and non-clinical patient services.
b) Amend Bill 36 to prohibit Cabinet from ordering contracting out of any hospital services that provide non-clinical patient services.

Recommendation 5:
Address nursing health human resources issues in the legislation to move toward equity in remuneration and terms of employment across all sectors, including institutional and community care settings.

Recommendation 6:
a) Amend Bill 36 to strengthen the independence of LHIN boards by providing for fixed terms and providing an automatic renewal for a second term unless there is cause.
b) Amend Bill 36 to provide for a dispute resolution process when LHINs and the Ministry cannot agree on an accountability agreement.

Recommendation 7:
a) Amend Bill 36 to include explicit parameters for public engagement including the requirement to engage equality seeking groups.
b) Amend Bill 36 to allow the community to appeal decisions by the LHINs.

The Registered Nurses’ Association of Ontario (RNAO) is the professional organization for registered nurses who practice in all roles and sectors across this province. Our mandate is to advocate for healthy public policy and for the role of registered nurses in enhancing the health of Ontario residents. We welcome this opportunity to convey the views and recommendations of Ontario’s registered nurses on Bill 36, the Local Health System Integration Act.
RNAO supports the government’s health care transformation agenda. We believe that Medicare will be strengthened by reforms that improve population health and improve access to care by the right provider, at the right time, and in the right place. We support the following principles in the preamble to the bill:

Achieving an integrated health system and enabling local communities to make decisions about their local health system;

The need to coordinate health service delivery to make it easier for people to access health care;

Health system should be guided by a commitment to equity and respect for diversity and the requirements of the French Language Services Act;

The role of First Nations and Aboriginal peoples in the planning and delivery of health services in their communities;

Public accountability and transparency; and,

Envisioning an integrated health system that delivers the health services that people need now and in the future.

Despite our support for the health care transformation process, RNAO has some profound concerns about this proposed legislation. These concerns are outlined below.

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Bill 36 Submission56.07 Ko
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