Niagara’s new centralized health agency that will eventually govern all health care in the region was finally approved by the provincial government Thursday after its 45 member agencies settled on key a conflict resolution framework.

However, questions about how Niagara’s Ontario Health Team (OHT) will create and implement a “24/7” health-care navigation record for residents that will allow them the move to easily between health-care agencies, along with how publicly responsive and transparent the agency will be, remain unanswered.

Announced in a Thursday morning Ontario Health news release and then again at an afternoon press conference outside St. Catharines hospital by Niagara West MPP Sam Oosterhoff and Niagara Health president Lynn Guerriero, the approval of the local OHT came eight months after the provincial government rejected the initial plan to create the agency.

The health teams are a key element of the ongoing health-care restructuring plan and will replace the LHINs as the regional health agencies.

Last December, Ontario Health — the province’s new health-care super agency — did not approve the Niagara team comprising Niagara Health, Hotel Dieu Shaver Health and Rehabilitation Centre and dozens of other local health agencies, big and small, due to unanswered questions about how the organization would make decisions and how it would resolve conflicts among 45 partners on the team.

Central to that conflict resolution process would be a mechanism to ensure the voices of small agencies with tiny budgets and little political clout are not drowned out by the large, more powerful institutions such as Niagara Health, which operates the region’s hospitals.

The formal conflict resolution process approved by the province places an emphasis on consensus building among members and gives dissenting voices the ability to object. If unresolved, those objections can eventually go to a third-party mediator.

Marcel Castonguay, executive director of Centre de sante communautaire Hamilton Niagara, and Wendy Sturgeon, co-chair of the Indigenous Health Network — both two of the smaller members of the OHT — said the framework allows the voices of the communities they represent to be heard.

“I might not agree with everything, but we will be heard and we will be able to reach decisions we can live with,” Castonguay said.

While the conflict resolution framework has been approved, other key questions about how the OHT will operate are unknown.

Key among them is the central claim by Oosterhoff that the OHT will create a health records system that will allow patients to navigate the local health-care system 24 hours a day, seven days a week. That will require a patient record that can be accessed by all OHT agencies and patients at any time.

Ontario has tried to fashion central health records that will move easily with the patient from agency to agency with mixed success in the past. Oosterhoff said the OHT is the first time all local health agencies will operate in a unified agency, making the establishment of the records possible.

However, no one at Thursday’s press conference could explain how the system will be created, how it will work and how patient privacy will be protected, nor when such a system will be created.

Guerriero said some sharing of records exists in Niagara, and those processes can be built upon. She also said the OHT will “start small” and is focused on a few key areas and about 60,000 Niagara patients.

To begin, the OHT will be focused on complex palliative and stroke care, children and youths with mental health and addictions needs, and building relationship with Niagara’s francophone and Indigenous communities.

Another key and unanswered issue is how publicly transparent the OHT will be.

Ontario Health itself does not hold public meetings and all its deliberations are held behind closed doors. It is not clear if the OHTs, including Niagara’s, will hold public board meetings, will be accessible to the news media, or if residents can make delegations.

Leaders at Thursday’s press conference said they are committed to transparency, but could not say in what form that commitment will take, nor why it was not a fundamental issue that was part of the planning that eventually resulted in provincial government approval.