Submission of Hôpital Montfort's comments to the Standing Committee on the Legislative Assembly

Bill 41 of the Government of Ontario, an act to amend various  acts in the interest of patient-centred care.

Hôpital Montfort, Ontario’s Francophone academic hospital, subscribes to the principles set out in Bill 41, An act to amend various Acts in the interests of patient-centred care, which seeks to improve access to primary care in the home and in the community, and to facilitate improved integration of Ontario’s health system. 
 

Hôpital Montfort also recognizes the additional powers and jurisdictions that the bill gives Ontario’s Local Health Integration Networks (LHINs) so that they can assume responsibility for planning and delivering primary care as well as home and community care, currently managed by the Community Care Access Centres (CCASs).

Hôpital Montfort welcomes the amendments made to Bill 41 compared with the first version of the bill (known as Bill 210, An act to amend various Acts in the interests of patient-centred care). These amendments recognize, among other things, the competent authority of hospitals to run their operations by exempting them from the LHINs’ directives, and specifically refer to the obligation of the LHINs to respect the French Language Services Act with respect to planning, designing, delivering and evaluating services with the addition of this stipulation in Section 5 of the Local Health System Integration Act, 2006.

Hôpital Montfort remains convinced, however, that Bill 41 can still be improved in order to ensure the right of the Ontario’s Francophone minority community to equitable access to quality health care in French and the obligations under the French Language Services Act.

Hôpital Montfort is a historical reference for the rights of Ontario’s Francophone community and related government responsibilities. Indeed, in Lalonde v. Ontario (Commission de restructuration des services de santé), the Court of Appeal ruled in 2000 on the quasi-constitutional character of the French Language Services Act and on the imperatives to respect and protect language minorities.

Moreover, the designation of Hôpital Montfort as a Group A teaching hospital by the Ontario Ministry of Health and Long-Term Care, in June 2013, stipulates that Montfort must fulfill the following specific objectives:

  • participate in planning and supporting health services in French in communities across Ontario, including clinical support for patients and professionals
  • support the Ontario government in its responsibilities under the French Language Services Act
  • serve as a centre of excellence and a French language training centre for health professionals, including consolidating and coordinating clinical residencies in French
  • establish research and training programs

Given our provincial mandate as Ontario’s Francophone academic hospital requiring us to support the Ontario government in its responsibilities under the French Language Services Act, we are calling on the Standing Committee on the Legislative Assembly to strengthen Bill 41 so that our concerns are taken into account with respect to the rights of Ontario’s Francophone minority community and its access to quality health care in French. 

More specifically, Hôpital Montfort is calling for the following modifications and amendments to Bill 41: 

Public interest and equity in health

The LHINs are mandated to ensure equity in health, which includes respecting the provisions of the French Language Services Act.

Hôpital Montfort is asking that the obligation to serve Francophone populations be specifically included in the concept of public interest, that is, equity in the offer and delivery of health services. 

Designation of LHINs in accordance with the French Language Services Act

Since the bill stipulates that the LHINs become service providers, Hôpital Montfort is asking that these organizations be designated in accordance with the French Language Services Act. In effect, equitable access to quality health services in French can only be achieved if the needs of the Franco-Ontarian community are taken into account in all phases of health services planning, design, offer and evaluation.

The designation of these organizations will require that their boards of directors are representative of the population they serve. Having representatives of the Franco-Ontarian population on their boards will ensure that decisions are made that respect the diversity of Ontario’s population and that the specific needs and characteristics of the Franco-Ontarian community are fully understood and acknowledged. Since the bill provides for amendment of paragraph 7 of the Local Health System Integration Act, 2006, it should also be amended to add a paragraph stipulating that the composition of the board of directors of the LHINs must conform to the provisions of the French Language Services Act so that it can fulfil the requirements of its designation.

Lastly, the designation of these government agencies would allow for an active offer of health services in the patient’s language of choice. Thus, the bill should clearly state that all home care services as well as the Community Care Access Centres (CCACs) that will be transferred to the LHINs will maintain their language rights. Consequently, these services should be subject to the French Language Services Act. Just as there are certain exceptions from Section 34.3 (8) in the application of certain laws in “Part V.1 Transfer of community access corporations to local health integration networks,” it is essential that a paragraph be added specifying that the French Language Services Act applies to agreements with third parties affected by this transfer. 

 

Map of the 14 Local Health Integration Networks of Ontario, or LHIN.   These six LHINs are in non-designated areas: South West, Waterloo Wellington, Central West, South East, Central and Central East.  These five LHINs are in partially designated areas: Erie St. Clair, Hamilton Niagara Haldimand Brant, Mississauga Halton, North Simcoe Muskoka and North West. Finally, these three LHINs are located in designated areas: Toronto Central, Champlain and North East.
  1. Erie St. Clair LHIN
  2. South West LHIN
  3. Waterloo Wellington LHIN
  4. Hamilton Niagara Haldimand Brant LHIN
  5. Central West LHIN
  6. Mississauga Halton LHIN
  7. Toronto Central LHIN
  8. Central LHIN
  9. Central East LHIN
  10. South East LHIN
  11. Champlain LHIN
  12. North Simcoe Muskoka LHIN
  13. North East LHIN
  14. North West LHIN

 

 

 

Legend:

  • Green: Complete designation,
  • Grey: Partial designation,
  • Orange: No designation

Note that at present, eight of the 14 LHINs are in regions that are at least partially designated and only two of the 14 CCACs are designated in accordance with the French Languages Services Act (North East, Champlain).

Mandate of French language health services planning entities

Moreover, in order to ensure that the provisions of the French Language Services Act are respected at all times, it is proposed that the mandate of French language health planning entities be reviewed beyond community commitment in order to give them an active role in the decision-making processes of the LHINs in health services planning. 

The Local Health System Integration Act, 2006, and Regulation 515/09 Engagement with the Francophone Community Under Section 16 of the Act should be amended to reflect this broader mandate. 

Note that the French language health planning entities were created as a result of a ministerial directive conferred upon Hôpital Montfort following the Montfort crisis. During the summer of 1997, Ontario’s Health Services Restructuring Commission issued an order calling on Hôpital Montfort to establish a network of French language health services in the Ottawa-Carleton region. The initial mandate of the Réseau des services de santé en français was to facilitate access at all levels to French language health services and ensure that, in the restructured system, Francophones had access to a full range of quality services in French. 

In 2002, the Réseau des services de santé en français de l’Est de l’Ontario became an independent advisory organization on French language health services in Eastern Ontario following a memorandum of understanding with the Ontario Ministry of Health and Long-Term Care.

The successful collaboration between the Réseau and the Ministry, as well as the recognition of the added value of the Réseau in health services planning, influenced the wording of the Local Health System Integration Act, 2006. This new law required the LHINs to involve the Francophone community through the French language health services planning entity in their region. This obligation was reinforced by Regulation 515/09 Engagement with the Francophone Community Under Section 16 of the Act. To this day, the entities have an advisory role among the LHINs on improvements to put in place to ensure quality French language health services. 

The French language health planning entities have fulfilled their mandate perfectly with regards to the consultations held by the Ontario government on Patients First: Action Plan for Health Care. Hôpital Montfort fully supports the entities’ recommendations put forth in the document Réponse du Regroupement des Entités de planification des services de santé en français de l’Ontario. These recommendations seek to improve the principles set out in Bill 41 in order to respond to the realities of Ontario’s Francophone minority community by broadening the entities’ mandate, among other things. 

While Hôpital Montfort recognizes the effectiveness of the French language health planning entities in their advisory role for the community, the LHINs and the health system in order to improve the active offer and access to a continuum of quality health services in French, Hôpital Montfort firmly believes that the improvement of the French language health services system must include a much more direct involvement of French language health planning entities in the LHINs’ decision-making processes. It is only by means of one recognized decision-making authority in the area of French language health services that Ontario’s Francophone community will have the assurances it needs.

Conclusion

Bill 41, An act to amend various Acts in the interests of patient-centred care, seeks to build a solid system of coordination and continuity of quality health care for all Ontarians. Changes at the level of the system must take into account the cultural and linguistic diversity of Ontario’s population if this ambitious mandate is to be fulfilled. The expanded role of Ontario’s local health services integration networks, particularly in primary care, home care and community care, will make it possible to improve and integrate front line service delivery and planning. Local health care planning should, however, be supported by representatives of Ontario’s Francophone minority community in order to ensure that decisions are made with and by those who best understand the needs of their communities. 

About Hôpital Montfort

Hôpital Montfort is Ontario’s Francophone academic hospital, offering exemplary patient-centred care. Montfort serves over 1.2 million people in the Eastern region of Ontario in both official languages. Montfort earned Accreditation with Exemplary Standing, and is recognized as a Best Practice Spotlight Organization by the Registered Nurses Association of Ontario. With its main partners, University of Ottawa and La Cité college, as well as other post-secondary programs, Montfort is preparing the next generation of Francophone health care professionals in French. In 2015, it joined the ranks of Canada’s top 40 research hospitals, through the activities of its research institute. 

In addition to being an exemplary institution in offering health services in French, since its inception, Hôpital Montfort has demonstrated that it is a pillar of Ontario’s Francophone community and plans to continue to fulfil its institutional role in promoting the French language, enriching Francophone culture and supporting solidarity and a flourishing Franco-Ontarian community. 

Summary of recommendations

Recommendation 1:

Specifically include the obligation to serve Francophone populations in terms of the offer and delivery of health services according to the public interest.

Recommendation 2:

Specifically indicate in the bill that the LHINs are required to designate themselves as service providers, in accordance with the French Language Services Act

Recommendation 3:

Add a paragraph that indicates that the composition of the board of directors of the LHINs must conform to the provisions of the French Language Services Act with respect to designation in paragraph 7 of the Local Health System Integration Act, 2006

Recommendation 4:

Add a paragraph to “Part V.1 Transfer of community access corporations to local health integration networks,” which specifies that the French Language Services Act applies to agreements with third parties affected by this transfer.

Recommendation 5:

Amend the Local Health System Integration Act, 2006 to give decision-making power to French health planning entities with respect to LHIN French service planning.

Contact 

Dr. Bernard Leduc
President and Chief Executive Officer
Hôpital Montfort
713 Montreal Road
Ottawa ON K1K 0T2
bernardleduc@montfort.on.ca
Tel.: 613-746-4621, extension 2000

Appendix

Response of the Regroupement des Entités de planification des services de santé en français de l’Ontario