A Comprehensive Plan to Strengthen Ontario’s Public Healthcare System
Ask yourself if you have better or worse access to healthcare since Doug Ford took office?
Emergency room wait times have increased as have periodic ER closures in rural communities.
Millions of Ontarians don’t have access to primary care and health professionals are leaving the sector in record numbers.
Instead of investing in our public system, Ford is expanding private healthcare delivery. More money for investors and less money for front line care. And knowing Ford, there are real concerns that his friends will receive preferential treatment.
Even where the government is on the right track, including expanding family health teams and school access to mental health supports, it is failing to deliver anywhere near the support necessary to meet the scope and scale of the challenge. The current system leaves more than 2 million Ontarians without access to a family doctor or health team, for example.
The healthcare budget is inadequate to meet our needs and, incredibly, the Financial Accountability Officer of Ontario found that the Ford government spent almost $1.7B less on healthcare than planned in 2022-23. It is clear that healthcare isn’t a priority.
There is no doubt that protecting and improving our care system is complex. It will take time and require a continuous improvement approach, with a firm commitment to patient-centred care alongside respect and support for the healthcare workforce that delivers that care.
As leader of the Ontario Liberals, Nate will improve care by investing in the foundations of our public healthcare system. We will prioritize investments to improve equity and innovation, reverse the trend toward privatization, and ensure everyone has access to quality primary, home, and community care, with reliable urgent and emergency services.
Here are our goals:
- Action to address the health human resources crisis: Ontario is facing a health human resources crisis across all sectors from family health teams to mental health to home care. We need to train and recruit more health professionals and also improve working conditions so that we can retain them.
- Family Health Teams for all Ontarians: Less than 30% of Ontarians have access to a family health team, even though it is the foundation of effective primary care and supported by numerous reports and organizations, including the College of Family Physicians Canada, the Canadian Nurses Association, and the OurCare initiative.
We will widely expand team-based care, to better deliver the right care by the right professional at the right time.
Accessible mental health services: We have known for a long time that mental health and physical health are fundamentally linked, yet we do not treat them equally. This has led to chronic underfunding of infrastructure and processes designed for treating mental health issues. It’s time to prioritize mental health, including by expanding access to structured therapy and community mental health services.
- Support aging with dignity: The COVID-19 pandemic laid bare the long standing challenges in our approach to caring for our seniors. We need to improve the quality of seniors’ care in long-term care homes, at the same time as we make new investments in home and community-based care.
- A strong public health system: Our public health units stepped up during the pandemic to keep Ontarians safe. But a public health approach isn’t only reactive; it’s also preventative. We will strengthen public health and preventative healthcare efforts, with a renewed focus on the social determinants of health.
As we work towards achieving these ambitious goals, we are mindful that different parts of the province have different needs, especially in rural and northern communities. In addition, we acknowledge that we must support Indigenous-led initiatives to improve health care for First Nations, Inuit and Metis communities.
Prioritize Solutions To The Health Human Resources Crisis
Retain and recruit healthcare professionals
- Fair wages: Freezing wages for healthcare workers is not the way to balance the books. Ultimately, expensive for-profit staffing agencies backfill vacancies that would not exist if we created more attractive work environments for these critical professionals. To attract and retain our skilled healthcare professionals, we need to give them the respect that they deserve and ensure that wages are competitive.
- Better work conditions: Healthcare professionals need to feel safe and supported in the workplace. They deserve access to sick days, limited overtime and reasonable workloads. Ontario should consider all options to support safer and more balanced work environments, including PSW and nurse-to-patient ratios. We will guarantee 10 sick days for all workers, including those in healthcare.
- Training supports: We need to attract new professionals to priority areas like primary and home care. To that end, we will develop more placement and training opportunities for nurses and personal support workers, alongside incentives for experienced nurses to remain in the system to teach and mentor.
- Foreign trained professionals: Too many professionals trained abroad face barriers to accessing both residency and employment opportunities. We will provide a clear path to credential recognition in Ontario, and work with partners to improve pre-arrival credential assessment and professional licensure so that professionals can work in their field while they become fully certified. We will also assertively recruit health care professionals from high-income countries like the United Kingdom where workplace satisfaction is low.
- Increased Mobility: The discussion on national licensure has already been started, and we will lead the conversation with other provinces and professional colleges to make sure that it is easy for health professionals moving to Ontario to practice when they arrive, and reinstate locum programs in rural and northern Ontario.
- Prioritizing bilingual care: We will work to create a more bilingual workforce and explore incentives in under-served regions to ensure that the Francophone community has widespread access to health services in their language of choice.
Flexible funding models
Our current fee-for service approach to paying physicians doesn’t enable practitioners to innovate in their practice or incentivize them to modernize care delivery. We know that a modern and flexible healthcare system is not only what patients want, but what the next generation of healthcare professionals is demanding.
Data on our workforce
We have limited data to support healthcare workforce planning in Ontario. Clinics and hospitals are often operating in silos and it becomes challenging to know where resources might be available to backfill vacancies where there are critical shortages, identify and understand trends in vacancy rates, and develop effective strategies for long term staffing. We need more data on health human resources in all care settings with much of it being made publicly available to support better decision making and accountability
Develop and adequately fund a northern and rural healthcare strategy
It is a particular challenge to recruit and retain healthcare professionals in rural and northern communities. As a result, among other impacts, we see too many emergency room closures. We will develop and fund a specific strategy to support northern and rural communities, as part of which we will look to increase admissions at the Northern Ontario School of Medicine and examine loan forgiveness for those who commit to practice in underserved regions for 5 years.
Family Health Teams For Everyone
Increase team-based care to increase capacity
Team based care models ensure that health professionals maximize their value to patients by working with other professionals who can help increase the amount of time they spend with patients and the number of patients they can see. With a team that can take on work that doesn’t have to be done by a doctor or nurse practitioner, patients can get the right care from the right professional at the right time.
Studies of team based care in Ontario have shown that doctors working in team settings increase their services by 26% per year and they also see and enroll more patients relative to those practicing in non-team environments.
With a team-based model, we will help healthcare providers spend more time doing the work they love and less time doing paperwork.
Scope of practice
To support effective health teams and serve patients more efficiently, we will further examine where we can expand scope of practice for talented professionals.
Invest in our public healthcare system
We know that system wide change and innovation is needed, but chronic under funding of our public healthcare system has left us paying more for the same basket of services. If we want to see change, we need to increase public investment to bring it up to par with the national average and with other OECD countries. Even countries like the Netherlands – often cited as a model for Canada to follow given it has a greater mix of public and private delivery of care – invests a greater proportion of public funding into the healthcare system than we do (84.1% of total health spending vs. Canada’s 71.1%).
Give Ontarians control over and access to their own health data
Despite an increase in virtual care through the pandemic, most patients still don’t have control over their own health records. We will establish interoperable digital records so that patients have access to and share control over their own health records, and health professionals can see a patient’s full health history to provide more effective and efficient care.
Centralized referral system and standardized forms
Our current referral system is complex, time consuming and fragmented. Referrals are still very often faxed and depend largely on primary care professionals maintaining their own networks. We will work with medical professional associations to standardize and modernize referrals to specialist care and centralize referrals to support wait time reductions and promote equitable access to care.
Expand access to virtual care, especially to address distance and accessibility
The pandemic propelled a long awaited expansion of access to virtual care. However, the speed at which it happened also contributed to fragmentation in the system with patients moving from one virtual care “clinic” to the next. We will work with partners to expand successful virtual care models that integrate in-person and virtual care.
Accessible Services For Mental Health And Substance Use
One in five Canadians will experience mental illness in their lifetime across a number of conditions from depression to schizophrenia. Yet mental health issues are rarely treated with the same urgency as physical health challenges.
For many, the pandemic increased feelings of anxiety, loneliness and depression and research shows that Canadian’s mental health is not improving.
At the same time, waitlists for mental health professionals continue to grow.
Without timely access to the right supports, we see increased medical leaves from work, isolation and disintegration of relationships with families and community, repeated visits to emergency rooms, and in the worst of cases overdose or suicide.
Mental health is health and the provincial government has a key role to play.
Health human resources strategy for mental health and substance use
We will work with the regulatory colleges and professional associations to develop a health human resources strategy specifically for mental health and substance use professionals.
Maximize scope of practice and support more consistent coverage
There are many different designations for mental health professionals in Ontario, but not all professionals are covered by insurance. We will work to regulate and define scope of practice to broaden the pool of professionals covered under both provincial and private insurance plans.
Expand access to structured psychotherapy
We will improve access to evidence-based therapies for depression and anxiety without a referral, including coverage for up to 12 hours per year of talk therapy through a stepped-care model. Ontario is on the right path with the Ontario Structured Psychotherapy Program, but the requirement that patients have a primary care provider to access support can create an unnecessary barrier to care.
Fund social services and community-based mental health promotion programs
Fund social services and community-based mental health promotion programs including culturally appropriate mental health services and programs for diverse communities, such as those facing language barriers.
Increase access to comprehensive, low-barrier community and school health mental health services for youth
70 percent of persons living with a mental illness see their symptoms begin before age 18. Yet, in Ontario, over 28,000 kids are on the waitlist for care, with long wait times. We will invest in a stepped-care approach to deliver access to high quality, youth-appropriate, evidence-informed mental health services through integrated service hubs, schools, universities etc. to help overcome common barriers to care like stigma, financial stress, and transportation. We will make it as easy as possible for youth to get the care they need.
Fully treat substance use challenges as a health issue and save lives
We’ve seen far too many lives lost in the opioid crisis, and it’s past time for leadership. We will treat substance use as a health issue by expanding evidence-based harm reduction and treatment options, supporting municipalities with housing solutions, and working with medical experts, law enforcement, and families who have lost loved ones to remove all barriers to seeking treatment.
Support Aging With Dignity
We find ourselves largely unprepared to respond to the health and housing needs of a rapidly aging population.
The pandemic put a spotlight on the challenges in long-term care, including infection prevention and control, staffing, and infrastructure, and overall quality of care. At the same time, we continue to invest less than other OECD countries in home and community-based care – a critical component to keep seniors healthy and reduce the need for costly nursing care.
The lack of integration between primary care, hospital care, and long-term care is also costly. There are thousands of patients lying in hospital beds waiting for “alternate levels of care” that we can and should better support.
Address health human resources for seniors’ care.
Like all other areas of healthcare, recruiting and retaining health professionals in home care and long-term care settings is central to providing quality care to patients. We will:
- Ensure fair pay for PSWs and home care nurses, codify what home care workers must be compensated for (e.g., travel), and develop a sectoral bargaining system to stabilize compensation and benefits across the sector in the long term.
- Work with nurses and PSW leadership to find ways to prevent violent situations in their workplaces (abusive patients/clients).
- Institute minimum PSW & nurse-to-patient ratios.
- Provide tuition support for those who undertake post-secondary education to become a PSW or nurse.
- Expand culturally appropriate care, including access to caregivers with relevant language skills.
Increase funding for home care and community-based services.
According to the Canadian Institute for Health Information, approximately 10% of older adults newly admitted to LTC homes had potential to remain at home with adequate home and community care support.
Home care enables direct medical support as well as referrals to social and community services to help address barriers to aging in place, whether it’s home maintenance or cooking meals.
We need to increase the proportion of spending on home care and community support services to ensure that seniors can live in their communities as long as it is reasonably possible.
Support caregivers by making care coordination work
In Ontario, home support services are particularly inaccessible for older adults who require lower levels of assistance (e.g., housekeeping, laundry and meal preparation), and too many family caregivers suffer burn out without adequate supplementary care support. We will improve care coordination, with a single window system that will help seniors and family caregivers navigate and obtain the right support for their needs.
Long-Term Care Standards
When home care is no longer an option, Ontarians should have the confidence that long-term care homes will provide consistent quality of care.
We will prioritize non-profit care, and implement Canada’s new Long Term Care Standards as well as the recommendations of the Ontario Long-Term Care COVID-19 Commission.
We will also deliver transparency about long-term care costs, to be clear about what will be covered and where additional funding may be required. Cost transparency will help homes be accountable and help people make the right choices for themselves and their loved ones.
Strong hospice care
Everyone deserves to live and die with dignity, and we will ensure high-quality community and hospice care
Strengthening Public Health
Our public health teams have been front and centre in the pandemic and deserve recognition and support. Outside of emergency response, a public health approach is focused on keeping people healthy and preventing injury, illness and premature death.
To support a sustainable healthcare system and a healthy population, we must strengthen our public health system by addressing key social determinants of health like housing and investing in programs that support healthy active living and community connection.
Income security and housing
Poverty and lack of access to adequate housing are major social determinants of health. We will increase social assistance, make it easier to access benefits, and massively expand non-market affordable rental housing. Our social safety net plan will be released in the coming weeks and you can read our full housing plan here.
Supporting social inclusion
Social isolation and loneliness is linked to higher rates of depression and anxiety and associated with a greater risk of dementia and death. We will support expanded programming for social inclusion of seniors.
Promoting healthy and active living
Ontario needs to do more to prevent and delay chronic diseases and injuries by promoting healthier lifestyles. We will support the expansion of healthy eating and active living programs to enhance physical and mental health. We will also ensure there is healthy and quality food in provincially regulated institutions, including schools, hospitals, and long-term care.