Bill 41, the Patients First Act, 2016 (formerly known as Bill 210) (the “Act”), was reintroduced in the Ontario Legislative Assembly on October 6, 2016 and received Royal Assent on December 8, 2016, following public hearings held by the Standing Committee on the Legislative Assembly in November.
While some of the provisions came into force on the day the Act received Royal Assent, there are a number of sections that only come into force on a later date to be named by proclamation of the Lieutenant Governor.
The Act amends various legislation in the interests of patient-centred care, including the Commitment to the Future of Medicare Act, Public Hospitals Act (“PHA”), Excellent Care for all Act and Home Care and Community Services Act. The Bill also repeals the Community Care Access Corporations Act. The most significant changes are made to the Local Health System Integration Act (“LHSIA”).
The passing of the Act has not been without controversy, and many health industry organizations and providers are wondering how they will be impacted by the changes. A summary of some of the amendments are provided below. A future Health Communiqué will delve into the significance and implications of the Act.
Local Health System Integration Act, 2006
The current mandate and role of Local Health Integration Networks (“LHINs”) is expanded to include the direct provision of some home and community care services (i.e. primary care programs and services, hospices and Aboriginal health access centres). Corresponding amendments to LHINs’ objects include:
- participating in the development and implementation of health promotion strategies in cooperation with primary health care services, public health services and community-based services to support population health improvement and outcomes;
- providing health and related social services and supplies and equipment for the care of persons in the home, community and other settings and providing goods and services to assist caregivers of such persons; and
- managing the placement of persons into long-term care homes, supportive housing programs, chronic care and rehabilitation beds in hospitals, and other programs and places where community services are provided.
The Act also gives each LHIN increased oversight of health service providers to which it provides funding, including authority to:
- issue operational or policy directives;
- engage in or permit an audit or operational review;
- appoint investigators to report on the quality of the management, care and treatment provided; and
- appoint a supervisor for a health service provider (excluding hospitals and long-term care homes).
LHINs will be required to develop strategic directions and plans for funding and service integration of geographic sub-regions within the LHIN. LHINs must also establish a patient and family advisory committee, although establishing a health professionals advisory committee is now optional. The Act establishes new procedures and requirements when the LHIN enters into a service accountability agreement and revises the LHINs’ authority with respect to integration by health service providers.
The Act also gives the Minister of Health and Long-Term Care (the “Minister”) authority to issue operational and policy directives to LHINs and provincial standards for the provision of health services and to appoint investigators to investigate LHINs.
LHSIA now includes a new Part V.1 to address the transfer of Community Care Access Corporations to LHINs.
Public Hospitals Act
Amendments to the PHA promote increased transparency to the public. Any report resulting from an investigation (ordered by the Lieutenant Governor in Council) into the quality of the management and administration of a hospital, the quality of the care and treatment of patients or of any other matter, where it is considered to be in the public interest, must now be released to the public. Similarly, any reports provided to the Minister by a hospital supervisor or Minister-appointed inspector will also be released to the public. The reports will only be released after personal health information has been redacted.
The Minister is also given authority to issue operational or policy directives to the board of a hospital where it is considered in the public interest to do so. The board must carry out each directive. The Act explicitly states that “a directive shall not unjustifiably as determined under section 1 of the Canadian Charter of Rights and Freedoms require the board of a hospital that is associated with a religious organization to provide a service that is contrary to the religion related to the organization”.