Appendix A: Summary of feedback and engagement

Province-wide e-mail submissions

Following the release of the Premier’s Council’s first report, Hallway Health Care: A System Under Strain, patients, caregivers, frontline health providers, organizations and associations provided input. Below is a list of organizations and associations that provided submissions to  between January 31, 2019, and May 31, 2019. Submissions from independent or non-affiliated patients, providers and leaders were received, reviewed and shared with the Premier’s Council; however, their names have not been included in the list below.

AdvantAge Ontario
Alliance for Healthier Communities
Amour At Home Care
Association of Family Health Teams of Ontario
Association of Local Public Health Agencies (alPHa)
Association of Municipalities of Ontario
Association of Ontario Midwives
Black Health Alliance
Canadian Association of Physician Assistants
Canadian Centre for Accreditation
Canadian Geriatrics Society
Canadian Mental Health Association, Toronto Branch
Cancer Care Ontario
Centre de santé communautaire de l'Estrie
Centre de santé communautaire du Témiskaming
Centre de santé communautaire Hamilton Niagara
Centretown Community Health Centre
CNIB Foundation
Council of Ontario Universities
Durham Region Health Department
East GTA Family Health Team
eHealth Ontario
Family Caregivers Voices
Gateway Community Health Centre
Health Innovation Rx
Healthcare Advocate
HeartHouse Hospice Inc.
Hôpital Montfort in Ottawa
Hospice Palliative Care Ontario
Hospital for Sick Children
Independence Centre and Network, Sudbury
Local Health Integration Network, Central East
Local Health Integration Network, Central East, Patient and Family Advisory Committee
Local Health Integration Network, North East
Local Health Integration Network, North West
Local Health Integration Network, Toronto Central, Citizen’s Panel
LOFT Community Services
Municipality of Assiginack Family Health Team, Manitowaning, Ontario
National Home Doctor
National Initiative for the Care of the Elderly (NICE)
Neighbourhood Pharmacy Association
NRC Health
Ontario Association of Cardiologists
Ontario Association of Public Health Nurse Leaders
Ontario College of Family Physicians
Ontario Fall Prevention Working Group
Ontario Neurotrauma Foundation
Ontario Osteoporosis Strategy Osteoporosis Canada
Ontario Palliative Care Network Secretariat
Ontario Retirement Communities Association
Physically Handicapped Adults’ Rehabilitation Association
Planned Parenthood Toronto
Provincial Geriatrics Leadership Office
Royal College of Physicians and Surgeons of Canada
Sault Area Hospital, Algoma Geriatric Clinic
Sault Ste Marie Health Links Table
Sault Ste Marie Social Services
Schizophrenia Society of Ontario
Sherwood Park Manor Long Term Care
Society of Canadians Studying Medicine Abroad
St. Joseph’s General Hospital Elliot Lake
St. Lawrence Medical Clinic Family Health Organization
St. Michael’s Hospital, Psychiatry
The Association of Registered Psychotherapists & Mental Health Professionals
The Ottawa Hospital, Division of Geriatric Medicine
The Speech Clinic
United Way Centraide Ottawa
University of Toronto, Department of Medicine
University of Toronto, Faculties of Medicine and Factor-Inwentash Faculty of Social Work
Voices & Choices Family Support Group
Wellesley Institute
Windsor Essex Community Health Centre
Young Carers Initiative

Feedback from specific communities

Although there were some common themes across each regional engagement session, it was also very clear that each local community has its own challenges with the current health care system. 

For example, Northern communities have low population density and long distances to travel to receive care, and some communities face health provider recruitment and retention problems. The following is an overview of concerns we heard from specific communities in the province.

Children and Young Patients

We continue to hear from families and patient advocates that children and youth are not just small adults – they require unique health care services tailored to their specific needs. Often in the past, health care funding either overlooked children or didn’t address their most pressing concerns, such as mental health.

Certain programs and initiatives are working well for children and youth, such as creating a single point of entry to mental health and addictions services in some areas and centralized referral systems and sharing health records among care providers in others.

It is important to bring care to where the children already are, and facilitate stronger collaboration between the Ministry of Education, the Ministry of Children, Community, and Social Services, and the Ministries of Health and Long-Term Care where feasible. Finally, more can be done to facilitate smooth transitions between programs designed for youth, and programs designed for adults.

Francophone Patients

Francophone patients want to ensure that they can tell their stories to health care workers in French, and that they only need to tell them once through the better coordination of care. In addition, Francophone patients in rural areas expect the same quality of care as those living in cities.

We heard that French Language Health Services work well when they are actively offered. As with all patients, communication with care providers is so important throughout the entire continuum of care. French language navigation support, preventative care, social services and community care, including French-speaking home care workers, are just as important as French language services within a larger institution like a hospital.

Indigenous Patients

Collaborative partnerships with Indigenous communities and Indigenous-governed service providers are important, and the Premier’s Council has only just begun the process of engaging with them in a meaningful way.

From what’s been heard so far, certain roles and programs such as First Nations Navigators and Indigenous-governed primary care are working well when they are available to communities. Services for Indigenous people, families and communities that are designed, delivered and evaluated by Indigenous people are important. It is also important to recognize the impact of systemic racism and ensure health care providers have the appropriate cultural competence, tools and supports to provide culturally safe and appropriate health care.

Much can – and should – be done to improve health outcomes and achieve health equity for Indigenous populations. While engagement continues, it is acknowledged that there is also work underway to transform First Nations health care in Ontario through government-to-government trilateral discussions.

Patients in the North 

Social isolation and loneliness due to geography and out-migration are significant concerns for patients, families, caregivers and providers in Northern Ontario. Although there is generally support for increasing the availability and range of home care services, there are concerns in the North for what this might mean to the frail elderly patient living alone.

In Northern Ontario, local partnerships drive the quality and availability of health care. However, the region could benefit from more peer support, and by leveraging paramedicine services to deliver care in more remote communities. In the North, access to care can still be a challenge. For example, communities rely heavily on the use of Ontario Telemedicine Network services. There are some concerns with the structure of the Northern Travel Grant program, and we also heard that patients are travelling to Manitoba to receive certain health care services. Hotel-health care is a concern in the North-West, since there is limited accommodation available for patients and families who must travel to receive care. Increasing the number of visiting specialists to the North to reduce travel to Winnipeg, Thunder Bay or to other centres of care would help ensure patients can access the care they require locally.

Racialized Patients

Racialized communities, especially those who may be immigrants or newcomers who do not speak English or French, may face additional burdens in accessing the health care system related to bias, language or cultural barriers. This can be especially challenging when patients transition from hospital to community care and could benefit from additional translation support or case managers who are able to facilitate effective communication, and culturally appropriate care plans. 

Ontario’s health system also needs to evolve to meet the needs of older adults from diverse backgrounds including more culturally appropriate health services/programs, and caregiver support. This is particularly important for older Ontarians waiting for culturally appropriate long-term care placement. A 2016 study published by the Wellesley Institute found that ethno-specific long-term care homes across the Greater Toronto Area had much longer waitlists compared to mainstream homes, and there is also evidence of long waitlists for culturally appropriate placement in the North.