Creating Better Health Care Experiences for Ontarians

February 22, 2023 annieparkerfoundation

Canada's Health Care, Complex, Large-Scale, Multi-Stakeholder Innovation Projects, Federal, Provincial and Territorial Policy Makers, Health & Wellness, Healthcare, Integrative Thinking, Interdisciplinary Teams, New Approaches and New Ways Of Thinking, Ontario Health Care Systems, Rallying And Unifying Diverse Stakeholders, Social Innovation, Supportive Care, Systems-Level Issues And Requirements

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By Patricia Thangaraj

In an effort to create better health care experiences for Ontarians, Pillar 2 of the “Your Health: A Plan for Connected and Convenient Care” is focussed on addressing the surgical backlogs and other long wait times that residents in the province face in order to access the critical health care services that they need such as mental health and addiction services.

The Ontario’s Government ability to move forward on the areas outlined this this Plan would depend heavily on garnering support from the federal government financially and otherwise and connecting provincial goals with federal goals in order to better meet the health care needs of Ontarians.

Linking Ontario Provincial Goals with Federal Goals

The federal government’s meeting with provincial and territorial leaders on February 7, resulted in Prime Minister, the Honourable, Justin Trudeau proposing a list of options for the transfer of funds from the federal government to the various provinces and territories to help them tackle the mounting health care crisis that they are facing.

Trudeau said that their announcement was focussed on addressing the health care challenges are currently plaguing public hospitals and other health care facilities to ensure that all Canadians can access the health care services that they need including mental health.

Minister of Health, the Honourable, Jean-Yves Duclos acknowledged that Canadians need better access to health care, whether it be family health services, more mental health and substance abuse programs, shorter wait times for surgeries and collecting, sharing and using health information to enhance health care delivery and support front line workers.

Meanwhile, Ontario Premier, Doug Ford wants Trudeau to include a formal review of the federal health care plan at their next bilateral meeting that would “provide certainty and ensure long-term sustainability,” according to a press release from the Premier’s Office on Thursday.

“As discussed at the working meeting of First Ministers in Ottawa, Ontario is looking to ensure sustainability and certainty in federal health care funding to support our ongoing work in improving health outcomes.”

“I believe that we will swiftly come to an agreement to ensure that our health-care system can meet the needs of Ontarians both now and into the future,” the release stated.

Regardless of the future outcome of these bilateral talks, Canadians want to be assured that they will see improvements to Canada’s universal, public health care system and that their concerns will be addressed. These include reducing wait times for critical surgeries, greater access to mental health and addictions support, ensuring that older adults can access the health care services that they need in facilities close to their neighbourhoods and wherever possible in their own homes and initiatives to improve Ontario’s pediatric hospitals capacity to deal with the influx of patients especially during peak seasons like flu season, which results in an increase in respiratory illnesses and therefore, more hospital visits and stays.

While all of these concerns have been promised in this plan and the just concluded meeting with the various policy makers, it remains to be seen if these Government stakeholders will follow through on their promises.

This blog takes a closer look at Ontario’s Plan, how it interweaves with the recently concluded federal-provincial-territorial meeting and what Ontarians can expect moving forward.

Equitable and Timely Access to Care

The Ontario Government will start by tackling the current backlog for cataract surgeries, which has one of the longest wait times. In this regard, they have granted four new licences to health centres in Windsor, Kitchener-Waterloo and Ottawa that are aimed at supporting a further 14,000 publicly funded cataract surgeries every year. In doing so, they will help to tackle up to a quarter of Ontario’s current cataract wait list, thereby significantly reducing surgical backlogs.

They will also invest over $18 million in existing centres covering over 49,000 hours of MRI and CT scans, 4,800 cataract surgeries, 900 other ophthalmic surgeries, 1,000 minimally invasive gynecological surgeries and 2,845 plastic surgeries so that Ontarians can get the surgeries that they need.

These would be provided via community surgical and diagnostic centres so that hospitals can use their human and financial resources on more complex and high-risk surgical procedures, all of which would be publicly funded.

More minimally invasive surgical procedures such as hip and knee surgeries, MRI and CT scans and regular colonoscopies and endoscopies will also be provided, all in an effort to ensure that surgical wait lists can return to pre-pandemic levels by next month.

The Ontario Government will also introduce legislation this month that, if passed, will ensure that existing community diagnostic centres can conduct more MRI and CT scans so that people in the province can get the publicly funded diagnostic services that they need closer to home and at a faster pace. This will be followed by more surgeries for hip and knee replacements next year.

The Ontario Government will also ensure that staffing at public hospitals is protected as they venture on a partnership with these community surgical and diagnostic centres to provide surgeries. New facilities will be required to provide detailed staffing plans as part of their application process and a key component will include having a certain number of physicians at these centres who have active privileges at their local hospital.

Additionally, Ontario Health will ensure that these centres are included in regional health system planning. Funding agreements will require these new community surgical and diagnostic centres to collaborate with local public hospitals to ensure health system integration and linkages such as connection and reporting are included in Ontario’s wait times information system and participation in regional central intakes, where possible. These centres will also work with local public hospitals to accept referred patients so that Ontarians can get the surgery they need asap.

Bridging Gaps Between Hospitals and Communities to Provide Connected Care

Recognizing that certain types of health care services can be provided outside of the walls of the hospital, the Ontario Government plans to implement a system where patients can avoid going to the emergency room or being admitted to a hospital when it is deemed safe to them and to provide in-person and virtual care, community programs and other health and support initiatives.

Over 40 communities across Ontario have successfully implemented 9-1-1- models of care, where paramedics can provide certain types of care to Ontarians within their own homes or communities.

Deploying paramedics to the homes and communities of Ontarians has resulted in these patients receiving the care they need 17 times faster with 94 percent of people avoiding going to the Emergency Department (ED) following their treatment.

The Ontario Government will now partner with various organizations to expand these models of care to patients with various ailments such as people with diabetes based on the success of this program. They will also implement a new treat-and-release model, which would incorporate providing advice to patients on proper follow-up care.

Diverting patients away from the ED and reducing hospital visits results in shorter wait times and ensures that hospital beds are available for those who need it the most.

Additionally, the Ontario Government will also work with hospitals to reduce offload delays by investing $23.1 million to support dedicated offload nurses and other health care workers so that paramedics can drop off patients faster and be available to get to their next call within a shorter time frame.

By keeping patients with fewer complications out of the hospital, they can enhance the patient care experience for Ontarians and by providing accessibility to care within their homes and communities, they can effectively reduce patient volumes in hospitals.

Image reproduced from the Canadian Institute for Health Information.

Breaking Down Barriers to Accessing Health Care Services at Ontario’s Hospitals

3,500 more hospital beds have been added at hospitals and other health care facilities across Ontario. This move to enhance the province’s health care institutions would receive a further boost to the tune of $40 billion in health infrastructure across the province over the next decade, aimed at increasing the number of people hospitals can care for, build new health care facilities and modernize existing hospitals and community health centres.

50 hospital development projects that will create more than 3,000 new hospital beds in communities across the province by 2032 were approved by the Ontario Government by the end of last year. They are also investing $182 million this year to facilitate much needed repairs, maintenance and other enhancements at Ontario hospitals.

By financially supporting these redevelopment projects across the province, the Ontario Government hopes to see a reduction in the wait times in hospitals as well as fewer hallway health care practices.

Supporting Pediatric Care at Ontario’s Children’s Hospitals

In order to support more hospitals across the province that offer health care to youth and children especially during peak periods such as the late fall and the winter season, both of which results in an increase in patients with respiratory illnesses, the Ontario Government will be investing $8.5 million at Children’s Hospital of Eastern Ontario (CHEO) in Ottawa to increase the number of critical care beds to 12. These beds will also be for children who have or get severe infections such as meningitis, single organ dysfunction infections and those who may need non-invasive ventilation to facilitate their breathing.

The funding will also ensure that CHEO can add a further six beds for children who have more critical illnesses such as sepsis, trauma, young people with heart-lung bypass and other conditions.

The Ontario Government will also invest $3.3 million to increase the number of critical care beds at the London Health Sciences Centre Children’s Hospital, $547,500 at the McMaster Children’s Hospital and $545,700 for the Hospital for Sick Children.

Furthermore, they have instructed all hospitals to use beds normally reserved for adults to accommodate more pediatric patients, when required to do so.

Improving Connected Care Experiences for Older Adults

In an effort to ensure that seniors can continue to remain connected to their loved ones and communities, the Ontario Government will be investing $6.4 billion to build over 30,000 new long-term care beds in the province by 2028 and renovate more than 28,000 older beds to bring them up to contemporary design standards.

These initiatives, which will increase the number of available beds, will lead to a reduction in wait lists for long-term care and ensure seniors can connect to more social activities and other things that they would not otherwise receive in a hospital.

The Ontario Government will also continue this year with their four year $4.9 billion project aimed at increasing the direct care that residents in long-term care homes receive on a daily basis. The project, which began two years ago, will see to it that residents get about four hours of direct care by nurses and personal support workers daily by March 31, 2025. Ontario is the first province in Canada to administer this cutting edge model of care, which would help these facilities recruit and retain additional registered nurses, registered practical nurses, personal support workers and allied health professionals.

They will also invest more than $40 million this year to help long-term care homes provide more specialized services and other supports so that these older adults can get the care that they require outside of Emergency Departments (EDs) and without having to be admitted to hospitals.

This funding will also go to transferring patients who do not need acute care any more from hospitals to long-term care facilities.

364 projects including building 31,705 new beds as well as modernizing 28,648 older beds are in the development phases, starting from the end of last year.

Additionally, 25 long-term care projects are under construction including 4,755 long-term care beds, 1,802 of which are new beds and modernizing 2,953 older beds.

Enhancing the Continuum of Care to Manage Seniors in Long-Term Care Homes

The Ontario Government will also partner on pilot projects with the Royal Victoria Regional Health Centre in Barrie and the Toronto based, Humber River Regional Hospital to provide more diagnostic services for long-term care residents throughout the various stages of their care, including assessment, diagnostic testing and timely interpretation of results to ensure seniors have access to more connected, convenient care, which would enhance older adults access to health care within long-term care homes so that they can avoid visiting emergency rooms or being admitted to hospitals.

They will also partner with hospitals and community labs on an Ontario plan that will encompass all stages of care that older adults in long-term care usually require and create solutions to narrow service gaps, increase convenience and timeliness and augment their overall experience.

Ensuring Dignity, Choice, Comfort and Support in the Final Days

The Ontario Government will also work to increase palliative care services in local communities by adding 23 new hospice beds to the 500 existing beds so that Ontarians can spend their last days in comfort and dignity close to their family and communities.

Investing in Mental Health and Addictions Support Program Operations

The Ontario Government will invest $10.5 million to address health care gaps. This will include augmenting access to needed services, thereby reducing current wait periods and lists. This investment will also ensure that the child and youth mental health Secure Treatment Program can be expanded to cater to more patients.

They will also add up to 24 new beds to serve vulnerable children and youth. This program provides intensive care for children and youth who are experiencing acute and complex mental health challenges that could increase their risks of harming themselves or those around them.

A further investment of $3.5 million for two new step-up, step-down live-in treatment programs will result in them providing more connected care services to children and youth living in western and northern Ontario.

They will add up to 16 new beds to meet the needs of youth who need more support than a community-based live-in treatment program can offer, but do need the highly intensive care that a hospital or secure treatment facility provides. Ensuring that more children and youth can access the mental health and addictions support programs that they require will result in these groups getting the less-intensive services within their communities so that they can return to their homes quicker.

These initiatives will enhance the Ontario Government’s one-time investment of $90 million that they have made over a three-year period, starting from February of last year, via the Addictions Recovery Fund to cater to people in these demographics who need substance abuse services. This funding will open new addictions beds and other substance abuse services across Ontario, ensuring that the province can meet the anticipated surge in demand for these services.

Accessing All Sides of the Debate

On February 7, Prime Minister Justin Trudeau announced during the federal-provincial-territorial meeting in Ottawa that they will allocate $196.1 billion over 10 years, including $46.2 billion in new funding to provinces and territories.

This money will be distributed in two ways, which are increases to the Canada Health Transfer (CHT), which is governed by the federal Canada Health Act, and $25-billion in special programs to be negotiated through bilateral agreements with provinces individually.

Although it was far below what the 13 premiers wanted, some of them expressed some hope on the deal that the federal government brought to the table.

Shortly following the announcement last week, Premier of Ontario, Doug Ford said that they see this deal “as a starting point. It’s a down payment on further discussions.”

However, public health care advocates are strongly against plans by some provinces to divert hospital services to private, for-profit clinics.

In a recent interview with the media, Canadian Health Coalition (CHC) Chairperson and Registered Nurse (RN), Pauline Worsfold, said that going down this path of referring patients to private, profit clinics will only escalate the issues that the Canadian health care system is confronted with.

“We want to stop public health care dollars from going to private, for-profit clinics operating outside of our Medicare system. Private health care will not decrease wait times in the public system – on the contrary, wait times would actually increase. This will also worsen the inequities in our system.”

This is because the Canada Health Act does not specifically prohibit provinces from spending public dollars on for-profit health providers.

NDP MP, Don Davies explained to the House of Commons recently that this will only lead to the establishment of a two-tier system.

“For-profit clinics across Canada are selling preferential access to surgery for those with the money to pay for it. They are exploiting a loophole in the Canada Health Act.”

The Premiers Accept Ottawa’s Proposal and the Premier of Ontario Weighs In

The current head of the Council of the Federation, Manitoba Premier Heather Stefanson announced recently that they had agreed to accept Ottawa’s proposal.

However, she also made it clear that this is only a short-term solution to fixing the issues that are negatively impacting the Canadian health care system.

Ottawa’s proposal includes a five per cent hike to the CHT every year for the next five years. This funding will then go back to a three per cent increase each year following that.

It also includes $25 billion over the next decade to advance shared health priorities specifically catered to meeting the health care issues for each province, which would be agreed upon by bilateral agreements between the federal government and provinces and territories individually. These will focus on family health services, shortages in health care workers, existing backlogs for surgeries, mental health and substance abuse services and a modernized health system.

Ottawa will also meet with the premiers of each province individually to come up with province specific agreements that would address the health care crisis that each province is facing. Federal Health Minister, Jean-Yves Duclos and Minister of Intergovernmental Affairs, Dominic LeBlanc have already met with representatives from the Ontario, Nova Scotia and Newfoundland and Labrador governments to start collaborating on these agreements.

They were in British Columbia Tuesday and this will be followed by meetings with representatives from the territories and then the prairies, all before the end of last week.

One of the concerns that the premiers have is that while the yearly Canada Health Transfer will continue to increase, the one-on-one agreements for targeted programs are only funded for a decade.

Ford suggested that to his colleagues ahead of the just concluded meeting that they ask Trudeau to extend those deals beyond the 10 years in a statement that his office released.

This statement explains the recommendations would facilitate sustainable funding that is “data-driven based on performance.”

Ford met with Duclos and LeBlanc last week and the statement from his office Monday said he was “confident” Ottawa would accept his proposal.

Stefanson would not go into detail on Ford proposed, but stated that they wanted to ensure that Ottawa keeps funding those programs for the long-term, whether it be through extended agreements or by adding that money to the annual Canada Health Transfer after the first 10 years is over.

Access to Health Care: A Fundamental Right for All Canadians

Regardless of which direction this ongoing debate continues to go in and the outcome of the federal meeting with the respective provinces, one thing remains clear and that is that universal health care is this country must never be compromised. Access to health care must continue to a right for all Canadians and not a privilege based on how deep their or their families pockets are.

Furthermore, provincial governments must address concerns raised by various cross sections of Canadian society that the money that the federal government has allocated to them will indeed go towards funding health care and not to paying off provincial debts.

Accountability from all sides is imperative in moving forward to ensure that the needs of all concerned parties are addressed such as alleviating the stress placed on front line workers due to staff shortages by hiring more health care workers and adhering to the promises that the federal and Ontario provincial governments have made that paying for health care would be done via an Ontarian’s OHIP card and their credit card.