A Healthy Ontario: Building a Sustainable Healthcare System
The Premier’s Council on Improving Healthcare and Ending Hallway Medicine was set-up in October 2018 and is chaired by Dr. Rueben Devlin who formerly served as President and CEO of Humber River Hospital in Toronto. The Council was given a mandate to provide the government with strategic policy advice and actions leading to a) improved health outcomes for Ontarians, b) increased patient satisfaction, c) better value for taxpayers’ dollars, and d) lower wait times.
The Premier’s Council’s first interim report, published January 2019, identified major challenges contributing to hallway healthcare in the province. Report findings revealed the health care system is too complex and difficult for patients and caregivers to navigate; it is facing capacity pressures and is unprepared for a projected increase in complex care needs; and there needs to be better coordination across the system. From this initial report emerged opportunities for improvement, recognizing that the system should aim to deliver integrated health services across the continuum of care and make better use of digital tools and technology.
The expansion of digital tools and access to digital health services was announced by the Hon. Christine Elliot earlier this year. Ontario Budget 2019 announced it would implement a Digital-First for Health Strategy that will increase the use of virtual care and give the people of Ontario digital tools to access their own personal health information. However, the budget offered no further details on funding to support the proposed digital health enhancements.
In April, the Government of Ontario passed The People’s Health Care Act to proceed with its sweeping changes to the healthcare system and fulfill its commitment to end hallway healthcare. The legislation will integrate multiple provincial agencies into a single agency – Ontario Health – and establish Ontario Health Teams who will be responsible for the organization and delivery of health services in local communities. This was followed by an announcement of $27 billion over the next 10 years for hospital infrastructure projects across the province, including the creation of more than 3,000 new hospital beds. Further information about additional funding allocated to end hallway healthcare can be found in HealthCareCAN’s Ontario Budget 2019 Analysis.
The Premier’s Council on Improving Healthcare and Ending Hallway Medicine’s 2nd report was published on June 25, 2019. This policy brief serves to advise our members on the Premier Council’s recommendations and present implications for members and for HealthCareCAN’s advocacy going forward.
Bold changes to the health care system in the province of Ontario are in progress and new initiatives – such as Ontario Health Teams – are designed to create a system which is integrated, innovative, efficient, and able to respond to the needs of patients.
The Premier’s Council’s 2nd report lists 10 recommendations, which collectively intend to improve health outcomes and end the problem of hallway health care in Ontario.
The Council’s recommendations and their cross-cutting actions are aligned with the new vision for health care in Ontario: integration, innovation, efficiency and alignment, and capacity. The recommendations concern patient-centred care, access to digital health, data management, the socio-economic determinants of health, innovative primary care and home care delivery models, and health sector leadership development. The range of action items are designed to remove current barriers and introduce key enablers to create the sustainable, universal health care system patients deserve.
The Premier’s Council’s second report has several implications for HealthCareCAN members, including: (1) digital health and data platforms, (2) health system transformation, and (3) innovation.
Digital health and data platforms:
Improving access to digital health services has been a thread throughout the shift to an integrated health care system in Ontario. The Premier’s Council elaborated on this matter in Recommendations 2 and 4 of its report, recommending that the government “improve patients’ and providers’ ability to navigate the health care system, simplify the process of accessing and providing care in the community, and improve digital access to personal health information”, and “improve options for health care delivery, including increasing the availability and use of a variety of virtual care options.” Further to this, Recommendation 6 of the report recommends that “data should be strategically designed, open and transparent, and actively used throughout the health care system to drive greater accountability and to improve health outcomes.”
As illustrated in a report from Canada’s Health and Biosciences Economic Strategy Table, digital and data transformation will play an increasingly important role in diagnosing and treating diseases, and allow us to achieve greater success in targeting specific treatments to individual patients. HealthCareCAN’s 2019 budget “ask” advocated for an investment in the area of digital health and health data. At the National Health Leadership Conference (NHLC) Great Canadian Healthcare Debate, held on June 10th in Toronto, Julie Drury, Chair of the Patient and Family Advisory Council at the Ontario Ministry of Health and Long-Term Care, focused on the need for a federal digital health strategy and increasing patient involvement and leadership in health system transformation. Ensuring patients have access and ownership to their own personal health information is linked to improved patient outcomes.
Health system transformation:
The Council’s report advises that an efficient and sustainable health care system which delivers high-quality care must be well-aligned with services and supports outside of the health sector in other ministers and governments. Accordingly, Recommendation 7 recommends that governments “ensure Ontarians receive coordinated support by strengthening partnerships between health and social services, which are known to impact determinants of health.”
There has been a greater call for governments across all levels to step up and address the health inequities of its citizens. Having a job, a safe place to sleep, and access to affordable, nutritious food, among the other socio-economic factors, have an enormous influence on individual and population-level health outcomes. Removing and reducing barriers to social supports and services involves better integration among all levels of government and across ministries. Dr. Danielle Martin, Executive Vice-President and Chief Medical Executive at Women’s College Hospital, advocated for such a measure at the Great Canadian Healthcare Debate, when she focused on creating a guaranteed basic income for Canadians.
The Premier’s Council suggests the time is ripe to nurture innovative ideas and design new solutions to solve long-standing problems. Innovation is a fundamental cornerstone in the new vision for Ontario’s health care system. The recommendations address the growing demand and opportunity to innovate in care delivery; and provide access to innovative options in health services across the continuum of care, for all Ontarians, in all communities. For example, recommendation 5, recommends the government:
“modernize the home care sector and provide better alternatives in the community for patients who require a flexible mix of health care and other supports.”
Innovation in models of delivery of care would relieve pressure on hospitals and Emergency Departments by helping people stay in their communities longer and deliver care that fits into patients’ and families’ lifestyle. Now is the time to create the right conditions for innovative programs and initiatives to scale and spread across the province (and country).