The LHIN will be in charge of the funding and accountability agreements with regional hospitals, long term care facilities, homecare and other health service agencies according to their plans and provincial priorities.

There is no public consultation process regarding the radical policy decision to restructure the health system into regions using the LHINs. The LHINs’ Boards of Directors will be appointed by the government, not elected by communities. The ministry has quietly announced "workshops" to be held in the 14 LHIN territories over the next month. These will not be public hearings, rather they are facilitated discussion and question and answer periods. It appears that there are few, if any, ways in which residents have been invited to give input on this policy.

The government is inviting comment on particular questions such as "What are the examples of integration that exist in your community?"

Little information has been released publicly about the LHINs. However, from the information that is public, several concerns and issues have been raised including:

These are processes set up by the controversial Bill 8. Part III of Bill 8 sets out far-reaching powers of the Minister to order individuals and organizations to comply with seemingly unfettered ministerial initiatives. Under the provisions, Health Minister George Smitherman can direct any health resource provider, person, agency or entity to enter into accountability agreements ordered by the Minister those under his direction. The Bill specifically refers to "value for money" and "fiscal responsibility" as well as "transparency", "quality improvement", "public reporting" in the list of matters this section covers. However, it can cover other matters at the Minister’s discretion. Accountability agreements will be negotiated with each hospital, long term care facility, CCAC, and others. These "agreements" allow the Minister to order fundamental changes in the health system with little if any public consultation, procedural safeguards, transparency or other checks and balances. The LHINs will be in charge of these agreements in their areas.