January 11, 2016

The Honourable Kathleen Wynne
Premier of Ontario
Room 281, Main Legislative Building
Queen’s Park
Toronto, Ontario
M7A 1A1

Dear Premier:

It is an honour to serve Ontarians as their Minister of Health and Long-Term Care and I thank you for this opportunity. I am pleased to report that we have made significant progress in delivering on our shared commitment to build a health care system that truly puts patients first. We are creating an accountable, efficient and transparent health care system that promotes healthier lifestyles for Ontarians and contributes to making our province the best place to grow up and grow older.

In January 2015, we launched the Patients First: Action Plan for Health Care to improve the health care experience by ensuring it is patient-centred. Our plan will provide better access to quality health services, ensure that every Ontarian who wants a primary care provider has one, and protect our health care system for generations to come.

Putting Patients at the Centre

  • We have put forward a proposal to achieve greater integration of health care services, strengthen patient-centred care and meet our commitment to ensure that every Ontarian who wants a primary care provider has access to one.
  • Our plan, Patients First: A Roadmap to Strengthen Home and Community Care, was released in May 2015, and lays out the 10 steps we are taking to ensure people can receive care where they want to be — in their homes and communities — instead of in a hospital or in long-term care.
  • We are expanding access to in vitro fertilization (IVF) to an estimated 4,000 additional Ontarians.
  • Immunization 2020 is a first-of-its-kind roadmap for Ontario that will help our government and its partners modernize our immunization system over the next five years.
  • We continue to implement our Personal Support Worker Workforce Stabilization Strategy to bring stability to this workforce by paying these dedicated professionals more appropriately, and investing in training and other initiatives.
  • We are improving the capacity of the health care system through our investment of $11 billion over 10 years to expand, renew and modernize hospitals.
  • We have engaged key health partners to receive advice on the implementation of our government’s commitment to allow registered nurses to prescribe medications so patients receive faster access to the care they need.
  • We are expanding access to referrals for sex reassignment surgery for transgender people.
  • The associate minister announced the implementation of the Attending Nurse Practitioner in Long-Term Care Homes initiative last fall. This initiative will strengthen the care that residents of long-term care homes receive and ensure ongoing co-ordinated care. This is part of a three-year plan to provide funding for up to 75 new attending nurse practitioners in long-term care homes.
  • My Parliamentary Assistant, John Fraser, has consulted with stakeholders to help inform the creation of a comprehensive plan for better palliative care.
  • My Parliamentary Assistant, Indira Naidoo-Harris, is hosting targeted stakeholder roundtables across the province to inform requirements for a dementia strategy.

Moving Forward on Accountability and Transparency

  • We continue to work in partnership with health care administrators, institutions and providers to drive accountability, transparency and quality throughout the system, while limiting expenditure growth. We introduced the Health Information Protection Act to better protect the personal health information of patients, bring greater accountability in the event of a privacy breach, increase transparency when critical incidents occur and maintain quality in Ontario’s health care system.
  • We have selected Ontario’s first patient ombudsman following public consultation on the skills and experiences Ontarians wanted to see in a candidate and an independent selection process. The Office of the Patient Ombudsman will open on July 1, 2016.
  • We are adopting all of the recommendations of the Ontario Health Innovation Council to support more made-in-Ontario health technologies that will improve patient care and spur economic growth, including hiring a Chief Health Innovation Strategist. In October 2014, we asked each council and transitional council to make transparency a priority in their strategic plans, and to publicly disclose full, detailed and useful information with respect to inspections they conduct (for those colleges that perform inspections). All colleges have now confirmed that their strategic plans include transparency as a priority.

Collaborating on Shared Responsibilities across Government

  • As part of our commitment to delivering on the next stage of the Comprehensive Mental Health and Addictions Strategy, we have created the Mental Health and Addictions Leadership Advisory Council, which has delivered its first report to our ministry.
  • We have launched a dedicated Aboriginal engagement process with First Nations, Métis and urban Aboriginal partners to inform phase two of Ontario’s Mental Health and Addictions Strategy.
  • Working with partner provinces and territories, we continue to support work on brand name and generic drugs through the pan-Canadian Pharmaceutical Alliance (pCPA). A new pCPA office was opened in Ontario in September 2015 to support this work.
  • I have continued to be an active proponent of a pan-Canadian pharmacare strategy and have continued to engage with my federal, provincial and territorial counterparts.
  • Our ministry is working closely with its French Language Health Services Advisory Council and Francophone stakeholders to improve access to French-language health services.

Beyond the progress we have made, much work is underway to address the other priorities laid out in my mandate letter. I look forward to working with all of our partners as we continue to make progress on behalf of the people of Ontario.

Yours sincerely,

Dr. Eric Hoskins signature

Dr. Eric Hoskins
Minister

Results achieved

Mandate Letter Commitment Progress To Date
Lead the shift toward a sustainable, accountable system that provides co-ordinated quality care to people, when and where they need it. You will partner with administrators, health care providers and patients to achieve our shared commitment for a system that is there for generations.
  • The Patients First Action Plan was launched in February 2015 and focuses on transformation of the health system to improve access, better connect services to deliver coordinated and integrated care, inform through information and transparency, and protect our public health system.
Keep in mind three key goals: people receiving the right care at the right time and the right place; an accountable, efficient and transparent system; and promoting healthier lifestyles for Ontarians through shared responsibility across government.
  • The ministry launched Immunization 2020 in December 2015 as a first-of-its-kind roadmap to modernize Ontario’s immunization system. As part of the strategy, Ontario is proceeding with development of proposed legislative changes to the Immunization of School Pupils Act that, if passed, would include stronger requirements for school vaccine exemptions.
  • The ministry is engaging the health sector on requirements to enable pharmacists to administer travel vaccines in Ontario.
  • Each health regulatory college has now pledged to make transparency a priority in their strategic plans and operations.
  • A Task Force was established to advise the ministry on how to reinforce the province’s commitment to a zero tolerance policy regarding the sexual abuse of patients.
  • In support of a smoke-free Ontario, the ministry has implemented legislation banning the sale of flavoured tobacco products, including menthol. The ministry has also increased fines for those who sell tobacco to minors and further limited exposure to second-hand smoke in public areas by banning smoking on patios, playgrounds and sportsfields, and hospital grounds. The ministry has successfully implemented the Healthy Kids Community Challenge in 45 communities, to promote active healthy lifestyles for children.
Foster collaboration across the system and make the necessary trade-offs to shift spending to where Ontario will get the best value for our health care dollars — which must be shared between our health system partners.
  • The ministry is developing a Health System Capacity Plan to ensure a sustainable health system equipped to meet the needs of future generations through long-term community-driven planning. The consultations with Local Health Integration Networks and health sector partners began in December 2015.
Ensuring that patients receive timely access to the most appropriate care in the most appropriate place — and that the needs of Ontario’s patients are at the centre of the system. This means care that is appropriately co-ordinated around the person receiving it, especially for those who are transitioning through and across systems and sectors.
  • The Patients First Action Plan was launched in February 2015 and focuses on transformation of the health system to improve access, better connect services to deliver coordinated and integrated care, inform through information and transparency, and protect our public health system.
Championing the delivery of quality co-ordinated care to patients by making the best use of the skills and capacity of all our health care providers, hospitals, community clinics and organizations, long-term care homes and others. You will take the lead in ensuring that changes are informed by evidence — and that Ontario’s precious health care dollars improve quality of care and health outcomes for patients and families.
  • The ministry is developing a Health System Capacity Plan to ensure a sustainable health system equipped to meet the needs of future generations through long-term community-driven planning.
  • The consultations with Local Health Integration Networks and health sector partners began in December 2015.
Continuing to expand home and community care to ensure that people receive care as close to home as possible.
  • In May 2015, the ministry released Patients First: A Roadmap to Strengthen Home and Community Care, which lays out ten steps we are taking to bring change to the home care system.
  • We are focused first on improving the experience of patients and caregivers. Beginning in 2015-16, the government committed to investing $750 million in home and community care over the next three years.
  • The government announced six bundled care initiatives and increased nursing service maximums, and began consulting about the Levels of Care Framework, the Statement of Values and improving end-of-life and palliative care.
Strengthening Ontario’s end-of-life care.
  • In May 2015, we released Patients First: A Roadmap to Strengthen Home and Community Care. This includes plans for greater patient choice for end-of-life care, expanded access and equity, new supports for caregivers, and enhanced public education on the issue of advanced care planning. This will support patients and their loved ones when it comes to making decisions regarding end-of-life care.
  • Parliamentary Assistant John Fraser has been meeting with patients, families and stakeholders across the province to engage around the development of a comprehensive Palliative and End-of-Life Care Strategy for Ontario.
  • The ministry is establishing a palliative care network, a broad partnership of palliative care stakeholders, to develop a co-ordinated, standardized approach for improving palliative care services across Ontario.
  • The ministry is investing in the development of online training to support hospice palliative care volunteers.
Improving the capacity of the health care system by making the following investments: capital grants for major hospital expansion and redevelopment projects; community infrastructure to help shift care from hospitals to community settings; and home and community care services.
  • The ministry is investing capital in the community to support priorities such as Patients First: A Roadmap to Strengthen Home and Community Care. Targeted investments will expand local community service capacity, support increased client acuity, reduce alternative level of care pressures and address Local Health Integration Network-specific service requirements and emerging needs in the community.
Bringing forward a plan to ensure that every Ontarian who wants one has a primary care provider.
  • Since 2003, the supply of primary care providers has improved significantly thanks to our investments and reforms. Despite population growth, 94 per cent of Ontarians now have a primary care provider, and the supply of family physicians in the province is sufficient to meet Ontario’s needs for many years to come.
  • Building on these successes to date, the ministry has engaged with stakeholders to receive advice and direction on how to improve access to primary care for Ontarians to ensure that provincial efforts meet the needs and priorities of patients. In December 2015 a discussion paper to the public was released, which outlines our vision for an integrated health care system (including primary care) that will include an overview of reforms designed to achieve our commitment of ensuring every Ontarian who wants a primary care provider has one.
Exploring options to improve wait times for referrals to specialist care.
  • The ministry is improving wait times through a number of initiatives, including the establishment of reporting and performance targets for the full wait time experienced by patients for certain surgical procedures; provincial orthopaedic Central Intake and Assessment Centre models to streamline the patient intake process; and renegotiating specialist physician contracts to support care closer to home.
Continuing to ensure that our system has the health human resources it requires to deliver quality and efficient care. This includes exploring appropriate expanded scope of practice for providers and more models for collaborative care.
  • Scopes of practice are being expanded to ensure faster access to care for all Ontarians. We are working with our partners in the wider system to determine how Registered Nurses may best prescribe medications directly to patients and to authorize pharmacists to administer a wider range of vaccines in the community.
  • In addition, 75 attending Nurse Practitioners (NPs) are being hired to coordinate care in long-term care homes across the province, and NPs can now refer patients directly to specialists.
  • This year we will continue to consult with our partners and with patients on how best to advance scopes of practice, so our providers have the tools they need to provide quality coordinated care.
Building on the 2014 Budget announcement to increase wages for Personal Support Workers (PSWs) in the home and community care sector, your goal is to develop a strategy to bring stability to this workforce and ensure we meet the need for PSWs in the long term.
  • Commencing August 1, 2015, the ministry further increased the minimum base wage for eligible Personal Support Workers to $15.50/hour. Additionally, an increase of $1.50/hour, up to a maximum of $19.00/hour, is provided to all individuals providing publicly funded personal support services in the home and community care sector. Both increases are retroactive to April 1, 2015.
Collaborating with hospitals to jointly bring forward a plan to reduce or cap hospital parking rates for frequent visitors.
  • Key stakeholders, including the Ontario Hospital Association, select hospitals, patient advocacy groups and select patient representatives, have been engaged and numerous potential options have been explored to ensure hospital parking rates are affordable. The ministry will continue to work with its partners to implement a fair and transparent parking rate policy.
Exploring ways to improve dementia supports, including new memory clinics.
  • On July 30, 2015, the ministry launched an expert advisory group, which includes the Alzheimer Society of Ontario, clinicians, Local Health Integration Networks, researchers and patients (and their caregivers), to provide advice on development of a dementia strategy. This work is being supported by Parliamentary Assistant Indira Naidoo-Harris, who has led collaborations with target stakeholder groups across the province to support the strategy.
Continuing the pursuit of affordable drug access for patients in partnership with your federal, provincial and territorial colleagues. This will include a co-ordinated process for approving new and expensive drugs to minimize the wait for people who need these lifesaving medications.
  • On June 8, 2015, the Minister of Health and Long-Term Care hosted a roundtable to seek input from experts on the elements needed in order to support the implementation of a national pharmacare program, based on new research and published literature on the benefits of pharmacare. These were followed up with stakeholder engagement sessions in November and December, with key drug and health industry representatives to review recommendations developed at the June 8 meeting from the perspective of their sector and offer input into the logistical and implementation considerations of pharmacare.
  • Additionally, we have collaborated with our federal, provincial and territorial partners to support the launch of the pan-Canadian Pharmaceutical Alliance (pCPA) office, which officially commenced in September 2015. This collaboration is a major step forward towards expanding access to new and expensive pharmaceuticals for Ontarians.
We have succeeded in bringing down annual health spending growth from about six per cent in 2012 to about three per cent in 2013 – without compromising care. We did so in partnership with our health care administrators, institutions and providers. You will now work with them, as outlined below, to continue to drive accountability, transparency and quality throughout the system, while limiting expenditure growth.
  • The ministry has implemented the 10 Point Plan to help manage the growth in the physician services budget. The ministry is currently implementing further changes to begin reconciliation of the physician services budget to hold growth to 1.25 per cent.
Continuing to change Ontario’s funding system for hospitals, Community Care Access Centres and long-term care homes so that it reflects the care that people need and receive. I also ask that you explore opportunities to optimize quality and value in community laboratories and the broader laboratory sector.
  • Laboratory reform is moving forward. The Laboratory Services Expert Panel has been carrying out research and consultations, and will be recommending reforms to the funding of community laboratories to promote better value, quality, and access for Ontarians. The ministry expects the recommendations from the panel in the near future, which will guide future programs and opportunities.
  • The ministry is also providing long-term care homes with the flexibility to balance expenditures across the Nursing and Personal Care, Program and Support Services, and Raw Food envelopes. This allows long-term care homes to manage their funding pressures and more fully utilize their current allocations.
Partnering with stakeholders to establish the patient ombudsman, who will resolve patient complaints and drive improvements in quality across the health care sectors.
  • Throughout the summer of 2015, the ministry completed broad public consultation on the personality traits, skills and experience the new Patient Ombudsman should possess. A public report on the results of the consultation was posted at www.ontario.ca/patientvoices.
  • Informed by this public feedback, a formal search process has been completed and Christine Elliott has been announced as Ontario’s first Patient Ombudsman. She will officially come into the role on July 1, 2016. The ministry is working with Health Quality Ontario to support the implementation of the office of the Patient Ombudsman.
Continuing to work toward delivering excellent air ambulance service to patients that meets the highest standards of accountability and transparency.
  • Amendments to the Ambulance Act came into effect on July 1, 2015, which provides the government with a number of new oversight powers over the province’s air ambulance provider.
  • The ministry has also initiated a process for the review and renewal of the current oversight framework between the ministry and Ornge, and has implemented a new leadership structure at Ornge, with a renewed focus on providing the highest standard of care to patients. This will strengthen our commitment to ensuring Ontarians continue to receive accountable and transparent air ambulance services that meet the highest quality of care.
Pursuing changes to deliver more efficient and co-ordinated care to patients. This will include a review focusing on improving patient outcomes and value for money of Local Health Integration Networks (LHINs), Community Care Access Centres and Public Health Units.
  • In December 2015, a discussion paper to the public was released, which outlines our vision for an integrated health care system (including primary care) that includes an overview of reforms designed to achieve our commitment of ensuring every Ontarian who wants a primary care provider has one and to deliver more efficient and co-ordinated care to patients.
  • The ministry is committed to consulting extensively on the proposal and listening to staff (and their representatives, as applicable) and clinicians, patients, clients and caregivers, other health care partners, Indigenous peoples, and municipal and other community and government partners.
Exploring options to further strengthen the framework for ensuring that the community sector and LHIN-funded health service providers are accountable for delivering quality patient care, including expanding the Excellent Care for All Act.
  • The ministry is working with health system partners to explore opportunities to expand the principles of the Excellent Care for All Act to other sectors. This will include quality improvement initiatives in the community, support services, and community mental health and addictions sectors.
Continuing to respect the negotiation process with the Ontario Medical Association, which enhances our respective abilities to improve productivity, deliver quality services to patients and ensure fiscal sustainability.
  • The ministry continues to solicit feedback from the Ontario Medical Association (OMA) on programs and initiatives through the Physician Services Committee (and via email as necessary). The ministry communicates with the OMA regarding expressions of interest via monthly reporting.
  • The OMA recently accepted the ministry’s invitation to participate in the Task Force on the Future of Physician Services in Ontario, which former Chief Justice Warren Winkler endorsed. The OMA and the ministry are discussing terms of reference and membership prior to establishment of the task force.
Accelerating the adoption of new health technologies and innovations that demonstrate value and contribute to a more productive and sustainable health care system. You will do so by partnering with the ministers of Research and Innovation, and of Government and Consumer Services — and by continuing to work with the Ontario Health Innovation Council.
  • The Government of Ontario has selected William Charnetski as the province’s Chief Health Innovation Strategist. Mr. Charnetski will lead the implementation of the Ontario Health Innovation Council’s recommendations to make Ontario not only a leading centre of innovative health technology, but also for bringing that technology to market in Ontario and around the world.
Striving for a system that delivers the best quality care to meet the needs of patients and that continues our success in lowering the growth in health care spending. With support from the Associate Minister of Health and Long-Term Care (Long-Term Care and Wellness), you will continue our drive for a sustainable, accountable and quality health care system.
  • The ministry continues to support a patient-centred health care system of the highest quality of care, while ensuring sustainability for generations to come. The ministry is committed to ensuring that Ontarians who need long-term care receive high-quality care as residents of long-term care homes.
  • In 2015-16, government investments in long-term care included a two per cent increase to Resident Care Needs.
  • The ministry continues to ensure all homes have a resident quality inspection every year, and follows up on all orders issued to ensure improvements to care are made.
Working with the Minister Responsible for Seniors Affairs on initiatives that will especially impact seniors.
  • The ministry is working closely with the Ontario Seniors Secretariat on a number of important initiatives, including implementation of the Patients First Roadmap to Strengthen Home and Community Care, developing the dementia strategy and improvements to the Ontario Drug Benefit.
Working with the Minister of Aboriginal Affairs on ongoing work related to Aboriginal health and wellness.
  • A Dedicated Aboriginal Engagement Process has launched with First Nations, Métis and urban Aboriginal partners to inform Phase two of Ontario’s Mental Health & Addictions Strategy.
  • The ministry is working with Aboriginal partners and investing in the development of Indigenous cultural competency training for mainstream providers, public health units and Local Health Integration Networks.
Delivering on the next phase of the Mental Health and Addictions Strategy to support the delivery of co-ordinated, timely and quality services. You will lead this work — partnering with those across government and across systems — to support healthier, resilient and inclusive communities.
  • In November 2014, the Minister of Health and Long-Term Care announced the creation of the Mental Health and Addictions Leadership Advisory Council. The council’s role is to strengthen system planning and accountability across the mental health and addictions sector.
  • The council has identified five working groups that represent their priorities for the coming year, and has released its first annual report.
Working as part of Realizing Our Potential, Ontario’s Poverty Reduction Strategy to expand access to health benefits for children in low-income families. You will do so in collaboration with the ministers Responsible for the Poverty Reduction Strategy, of Community and Social Services, of Children and Youth Services, and others. This will build on work underway to expand access to existing dental programs to all low-income children. I also ask that you explore long-term options for a sustainable program that provides health benefits to lower-income Ontarians.
  • The ministry has made extensive progress on the Poverty Reduction Strategy.
  • Ontario has expanded the Healthy Smiles Ontario program so that 70,000 more kids from low-income families without dental coverage can access dental care.
  • Phase two of the Mental Health and Addictions Strategy committed $16 million over three years to create 1,000 new housing spaces for people with mental health and/or addiction issues.
Helping develop a policy on community hubs that reflects the perspective of health and wellness. You will work on this in partnership with the ministers of Education and of Municipal Affairs and Housing, the Associate Minister of Health and Long-Term Care (Long-Term Care and Wellness), and others — and in consultation with stakeholders.
  • The ministry is supporting the government’s work to establish community hubs, which will provide a central access point for a range of needed health and social services, along with cultural, recreational and green spaces to enhance community life.
Working with the Associate Minister of Health and Long-Term Care (Long-Term Care and Wellness) to build a culture of health and community wellness, including supports and programs, to help people stay healthy. This will include encouraging Ontarians to play an active role in health care by participating in healthy living and wellness, and by taking advantage of programs that support these goals. You will work in collaboration with other ministers, including the ministers of Children and Youth Services, and of Education, and the Minister Responsible for Seniors Affairs.
  • Associate Minister Dipika Damerla has initiated a ministers working group to develop the next set of initiatives for the Healthy Kids Strategy, while continuing to implement existing initiatives such as the Healthy Kids Community Challenge in 45 communities across Ontario.
  • Through this group, physical activity and healthy eating will continue to be promoted to build a culture of wellness for children and their families.
Updated: June 01, 2021
Published: January 10, 2016