LHINs and Health Service Providers Status
There are major deficiencies when it comes to access to health services in French by Francophone patients:
- Francophone patients do not know where health services in French are located;
- There are insufficient health service providers that offer services in French;
- Because a majority of health service providers have no legal obligation to offer services in French, the quality and availability of services may suffer.
The point where these issues converge is the LHIN. Under the Local Health System Integration Act, 2006, LHINs have an obligation to ensure the adequate provision of health services in their zone, in both English and French. For health services in French, this is obviously more difficult: LHINs will probably have trouble understanding the needs of Francophone communities and finding appropriate health service providers.
The legislature anticipated this issue, and it therefore created French Language Health Planning Entities. Their role is to assist the LHINs and actively and fully participate in the planning and coordination of the health system in French. The Entities must also support the LHINs in identifying service providers that should offer services in French. Doing otherwise would result in higher risks and costs for the LHINs.
Although the Entities are not involved with service delivery, they play a key role in identifying providers of health services in French and making that information available to francophone patients. In other words, when a patient is looking for a francophone health specialist, they should be able to find that information easily from the Entity in collaboration with the LHIN. However, the Entity may reply that there are no service providers capable of providing the patient with care in French.
The Ministry and the LHINs advise that there are four categories of health service providers:
- Health service providers designated under the FLSA
- Pre-designated (or identified) health service providers
- Third parties
- Health service providers that have no obligation
Categories 1, 3, and 4 are less problematic. A designated health service provider is subject to the FLSA, and the LHIN retains responsibility for the quality of the services. The LHINs acknowledge that health service providers that deliver in-home health care are actually third parties under Regulation 284/11; however, there are not many of these providers, since the majority of health service providers funded by the LHINs belong to Category 2. Providers that have no obligation to provide services in French are ordinarily located in areas that are not designated under the Act.
The central issue lies in Category 2. According to the LHINs and the Ministry, although these providers have been identified as offering health services in French and have entered into service accountability agreements, they are not third parties under Regulation 284/11, and so the LHINs have no legal verification obligation. That interpretation is problematic: when looked at from that angle, the obligation to offer services in French is not subject to any legislation — neither the Act nor the LHSIA. These providers therefore do not deliver services on behalf of the LHIN and the Ministry of Health. That argument strays significantly from the spirit of the Act.
The nature of the problem actually lies in a vague semantic distinction whereby the majority of providers, such as hospitals, receive funding from the LHIN and do not receive funds paid under a contract. That difference apparently explains the position taken by the LHINs that they cannot impose obligations on providers to offer services in French — a position shared by the Ministry. The interpretation adopted by the LHINs and the Ministry is contrary to both the letter and the spirit of the LHSIA and the FLSA. The Commissioner has criticized that legal interpretation in several annual reports. This situation is similar to the auditor general, for example, refusing to investigate a hospital if its funding came from the LHIN and not under a contract. It makes no sense. The funds involved are the same public funds that come from the same taxpayers and are meant to cover services offered under a government program.
The consequences of this two-tier concept for clients and patients of the health care system are real.
The concept may be cause for concern: if Category 2 providers become third parties under Regulation 284/11, the LHINs will have to make improvements to their agreements for health services in French and verify the quality of the services delivered by providers. In addition, questions concerning capacity and quality of service are important. It may therefore seem like a daunting task.
However, not all health service providers have an obligation to offer services in French. The LHIN must decide, in cooperation with the Entity, which providers are necessary for Francophone communities. By taking a pragmatic and evidence-based approach, supported by the Entities’ expertise, the LHINs will be able to coordinate the delivery of services in French through a range of providers that have been specifically selected to offer their services in French.
Recommendation 7
The Commissioner recommends that the Minister of Health and Long-Term Care issue a clear directive requiring LHINs to:
(a) monitor the delivery of health services by health service providers who offer specific services targeted to be offered in French; and
(b) ensure that service contracts and service accountability agreements entered into with those providers contain clear obligations in respect to French-language services.