Published plans and annual reports 2015-2016: Ministry of Health and Long-Term Care

Ministry of Health and Long-Term Care Overview

Mandate

The Ministry of Health and Long-Term Care’s mandate is to:

• Establish the strategic direction and provincial priorities for the health care system;
• Develop legislation, regulations, standards, policies and directives to support strategic directions;
• Monitor and report on the performance of the health care system and the health of Ontarians;
• Plan for and establish funding models and funding levels for the health care system;
• Manage key provincial programs, including the Ontario Health Insurance Program, primary care, drug programs, independent health facilities and laboratory services;
• Oversee public health, including providing funding to public health units for local programs, for example, family health, infectious diseases, and other programs; and
• Work with public health units and the Ontario Agency for Health Protection and Promotion (also known as Public Health Ontario) on emergency management such as influenza pandemic planning, among other activities.

Ministry Contribution to Priorities and Results

The budget of the Ministry of Health and Long-Term Care historically has grown at an average rate of 6% per year. However, if it continued at this pace, health care would account for 80% of Ontario’s total program spending by 2030.

In recent years the ministry has placed an emphasis on using evidence-based care and proven treatments to manage fiscal restraint and drive efficiency. It was able to reduce its growth from almost 6% in 2009-10 to 2.5% in 2014-15 without compromising quality of care. Drug system reforms have resulted in $500 million in annual savings that were reinvested in the health system.

Ontario’s financial pressures have not abated. We are delivering on the government’s Action Plan while managing within our envelope, and moving toward our target of an average of 2% growth expenditure per year. We will extend the focus of health system funding reform into the home and community care sector and all models of primary care.

Ministry Programs and Activities

Over the past five years, the ministry has become a leader in improving quality, accountability and cost-effectiveness across the health care system. We have improved sustainability and quality in acute care hospitals, Family Health Teams and elements of long-term care through performance management and activity-based funding.

Thanks to the extraordinary efforts of the ministry’s committed health system partners, our transformation work has been:

• Improving patient outcomes and delivering better value for investments;
• Enhancing the experience of Ontarians when they use the health care system; and
• Creating value and capacity in the health system to make it more efficient in the long term.

The province has already achieved some significant cost savings but continues to face big challenges in terms of fiscal pressure. Moving forward, we must implement structural changes to our health care system to put patients and families first, serve Ontarians more efficiently and effectively, and improve health outcomes, all without compromising quality of care.

Delivering quality services within approved funding envelopes will always be a challenge, but we can sustain the health care system by maintaining system growth at about 2%, and by reinvesting in key areas of focus.

We have achieved a great deal already with the Action Plan for Health Care in moving from a provider focused, fragmented system to one that puts patients and people first and increases access to quality health services while achieving better value for our investments.

Patients First: Action Plan for Health Care

The Action Plan for Health Care laid the foundation – now we have to deepen and broaden the achievements of the past three years.

The next phase of of the Patients First: Action Plan focuses on four key objectives:

1. Access: Improve access – providing faster access to the right care.
2. Connect: Connect services – delivering better coordinated and integrated care in the community, closer to home.
3. Inform: Support people and patients – providing the education, information and transparency they need to make good decisions about their health.
4. Protect: Protect our universal public health care system – making decisions based on value and quality, to sustain the system for generations to come.

Patients First has been designed to deliver on one clear promise: to put people and patients first by improving their health care experience and their health outcomes. The four key objectives will help to ensure our success.

Access - Providing Faster Access to the Right Care

If we want our system to serve each patient, we need fast, timely and responsive care, which also means defining access from the patient’s perspective. We need a dynamic primary care system with team-based integrated and coordinated care, leveraging the skills of more health care providers and with fewer unattached patients. That means more same day and next day visits to family doctors or other primary care providers. It means being able to see a specialist sooner. It means more coordinated care for patients with complex medical conditions.

By providing faster access to care, diagnosis and management for patients with significant mental health, chronic and multiple conditions, we can avoid unnecessary, costly emergencies, and people will spend less time waiting in the emergency department.

To address the needs of individuals in need of mental health and addictions services not only for acute care, but longer term care and supports, we are making targeted investments of $138 million over the next three years. The intent is to shift more mental health services into the community to provide timely, effective, responsive and ongoing care and supports that treat patients as people and breaks down the barriers facing those struggling with mental illness and addictions.

We can improve access to care by expanding the scope of practice of our health care professionals, as we have done by allowing nurse practitioners to prescribe assistive devices without having to see a doctor.

To provide Ontarians with equitable access to high quality medical laboratory services with better value for money, we are moving forward with initiatives to modernize Ontario’s community laboratory sector. In supporting this, the Community Access and Performance Fund will incent laboratories to reach access targets such as number of additional new hours of operation and specimen collection sites.

Connect - Delivering Better Coordinated and Integrated Care in the Community, Closer to Home

Better access to health care depends on better transitions in care. We need to strengthen these transitions to achieve integrated and coordinated patient care, especially in the home and community care sector.

A primary focus over the next three years will be to modernize home and community care so that we can enhance the quality of care and improve the patient experience.

Modernizing Home and Community Care

We know that Ontarians want to remain in their homes as long as possible and, when appropriate, avoid emergency rooms, hospitals and long-term care. That is why the last two Budgets invested an additional 5% in home and community care. Now it is time to leverage these investments and build further capacity in the sector to provide higher quality and more integrated care closer to home.

But to achieve this, clients will need more flexible and reliable community and home care supports. We also need to measure quality, reduce variation in services, and explore innovative models of care, like bundled care - a whole new process of care that directly integrates hospital and community services for patients.

Better Care in the Community

Delivering better care in the community entails providing frail seniors with 10,000 more rehabilitation therapy visits. Geriatric care training will be expanded for more than 2,000 clinicians. The number of patients who get nursing and personal support visits within a five-day window will continue to increase. The ministry has added 250 convalescent beds and is enhancing palliative care at home or in the community.

Through Patients First, we will also connect Ontarians with better home and community services by recruiting and retaining personal support workers who provide publicly funded care in the home and community through wage increases, more on-the-job training for new graduates, and efforts to help make this a more permanent job to reduce turn-over and enhance continuity of care.

To address disparities between older and newer long-term care homes, the ministry is providing support to operators, including an increased construction funding subsidy, to help reach our goal of redeveloping 30,000 older beds as a part of the Long-Term Care Home Renewal Strategy. The ministry is also committed to continuing to inspect all homes to ensure the safety, security and quality of care of residents.

Health Links

This same patient-centered approach for the management of high risk patients laid the foundation for Health Links. We know that 5% of our population accounts for as much as two-thirds of health care costs. Health Links have the opportunity to be a catalyst not just for cost savings, but for better quality of care and a cornerstone in our primary care system by connecting patients to community-based care.

To provide more comprehensive care to seniors and those with complex needs, the plan includes integrating physiotherapists and other types of health care providers into the family health practice.

Community Paramedicine

Paramedics too can be a vital link in providing care coordination, including referring patients to services such as meals on wheels and personal support workers. Through community paramedicine programs across the province, paramedics proactively visit patients with chronic and complex needs in their homes, and apply their skills and training to assess, refer, and educate patients.

Local Health Integration Networks (LHINs)

LHINs will continue to play a key role in integrating service delivery across the province. Their organizational model makes LHINs the experts on what needs to be done at the local level and how to implement the appropriate changes.

LHINs are already providing leadership in their work with community Health Links across the province. We are seeing great success and innovation as LHINs work with their respective Health Links to develop sustainable, integrated, local health care models.

By developing a more integrated network of providers and care planning and by providing people with services as close to home as possible, we can provide patients with seamless transitions between other parts of our health care system and improve their experience with the system.

Integrated Funding Models

The ministry has issued an Expression of Interest to develop Integrated Funding Models for home and community care for populations with short-term post-acute needs. The ministry will support providers to test innovative approaches to integrate funding over a patient’s episode of care.

Supporting innovative approaches to funding is one way we will improve care coordination, because by covering all the steps in a patient’s journey, we can make the patient’s experience more seamless. It is expected that these integrated funding models will result in better integration across services for patients, their families and caregivers, improved quality outcomes for patients (e.g., keeping people at home, reducing emergency department visits, and reducing hospital readmissions), improved efficiency through more integrated use of resources, and improved value for money.

The ministry has been supporting St. Joseph’s Health System in Hamilton, which has led a proof of concept initiative that has been providing seamless care for patients from hospital to home. The learnings from this model have led us to adopt a broader strategy to help identify and support others doing innovative work that truly follows the patient, regardless of where the patient is and who is providing the care.

Inform - Providing the Education, Information and Transparency People and Patients Need to Make Good Decisions about their Health

Building a quality, sustainable health care system means making available timely, relevant, accurate and useful information to allow people to become more knowledgeable about their own health.

Promoting Healthy Behaviours

To help Ontario achieve the lowest smoking rates in Canada, we will continue to help inform people about the health risks of smoking and improve access to cessation services to help them quit. We are proposing a ban on the sale of flavoured tobacco, a product that often appeals to youth, and which can lead to smoking at a younger age. We have also prohibited smoking on bar and restaurant patios, playgrounds and public sports fields, and the sale of tobacco on university and college campuses.

E-cigarettes are increasing in popularity (especially amongst youth) and currently there is a gap in regulatory oversight of e-cigarettes. Ontario is taking a precautionary approach, until further evidence becomes available, to regulate e-cigarettes by restricting their sale, use, display and promotion. The proposal will ban the use of e cigarettes in any place where smoking tobacco is not permitted, and prohibit the sale of e-cigarettes to those under the age of 19.

The province will further promote healthy behaviours by:

• Encouraging physical activity and healthy eating, through the Healthy Kids Strategy.
• Encouraging healthier food choices through proposed legislation that would require food service premises with 20 or more locations in Ontario that serve ready to eat foods and beverages to post calories on menus and menu boards.
• Expanding proven programs in schools and workplaces to promote mental well-being and prevent addictions, to help people deal with challenges and recognize when they need help.
• Making it easier for children in low-income families to get dental care through a single integrated program.
• Strengthening the effectiveness of Ontario’s immunization system, including better informing parents about their school-aged child’s immunization status.

My CancerIQ

Ontarians now have a new way to take action to improve their overall health, with the help of My CancerIQ, created by Cancer Care Ontario in partnership with the ministry. My CancerIQ is an online personalized cancer risk assessment tool designed to empower Ontarians to be more proactive about their health and to learn about their individual cancer risk and how they can reduce it.

Protect - Making Decisions Based on Value and Quality, to Sustain the System for Generations to Come

With an aging population that will have a growing need for health care services, maintaining a sustainable system means controlling costs and targeting funding towards preventing illness and improving results for patients.

This includes creating a culture of openness alongside an unwavering commitment to patient privacy because transparency, when used appropriately and responsibly, is one of the greatest tools at our disposal for enhancing performance and patient safety.

Today, Ontario hospitals and some primary care organizations are required to develop quality improvement plans to continuously improve the care patients receive. For hospitals, executive pay is tied to quality improvement performance and results are reported publicly on their websites. Patients deserve to know how their hospital or provider is performing when it comes to their care.

Patient Ombudsman

Another step we are taking is to appoint a Patient Ombudsman, who will help people who have an unresolved complaint about their care at a hospital, long-term care home or Community Care Access Centre. This will help make sure that health care is continuing to focus on patients' needs first. Once appointed, the Patient Ombudsman may investigate health sector organizations either in response to a complaint, or on his or her own initiative. The Patient Ombudsman would also issue public reports on his or her activities and recommendations to the Minister of Health and Long-Term Care at least annually and to the Local Health Integration Networks (LHINs) as appropriate.

Patient Engagement

The Excellent Care for All Act, 2014 has already led the way toward patients being partners in their own health care.

Over the next few years, Ontario will publicly post reports on how the health system is performing and how patients are being treated, in areas that include mental health, wait times and public health. These reports will compare the performance of the health care system to other international and provincial jurisdictions.

This level of transparency will help show Ontarians where their health care system is working effectively and where it needs to improve. It will make health care more accountable and help promote more innovative approaches to patient care, which are based on evidence. For example, by working with our health regulatory colleges, we are making more information publicly available to patients.

We will continue to expand how patients are engaged throughout the health care system so they can play a greater role in their own care. This includes developing care plans directly with patients through Health Links and working with Local Health Integration Networks on community engagement initiatives. By engaging patients, we can make our health care system more transparent and accountable now and into the future.

Transparency and patient engagement are major underpinnings that will help the province achieve its transformation goals. Improving accountability and transparency will help ensure the quality and sustainability of the health care system.

Conclusion

In order to improve health care, it is not necessary to choose between bending the cost curve and putting patients first. Both are possible but it means finding ways to better serve patients by strengthening community-based care, improving transparency and accountability, increasing access to preventative supports, and developing evidence based models that will tell us whether what we are doing is working as intended.

In collaboration with our valued health system partners, Patients First: Action Plan for Health Care provides the ministry with the opportunity to revolutionize health care in this province in ways that will better serve Ontarians in the months and years ahead.

Ministry Financial Information

Ministry Planned Expenditures 2015-2016 ($)

Ministry Organizational Chart

• Minister – Dr. Eric Hoskins
  • Parliamentary Assistant – Indira Naidoo-Harris
  • Parliamentary Assistant – John Fraser
  • Associate Minister – Dipika Damerla
  • Deputy Minister – Dr. Bob Bell
    • Director, Legal Services – Janice Crawford^{footnote 1[1]}
    • Director, Policy and Delivery – Patrick Dicerni
    • Associate Deputy Minister, Policy and Transformation – Sharon Lee Smith
      • Director, Health Capital Investment – Peter Kaftarian
      • Executive Director, Public Health – Roselle Martino
        • (A) Director, Public Health Standards, Practice and Accountability – Paulina Salamo
        • (A) Director, Emergency Management – Clinton Shingler
        • Director, Public Health Planning and Liaison – Elizabeth Walker
        • Director, Public Health Policy and Programs – Nina Arron
      • ADM (Interim), Health Promotion – Martha Greenberg
        • (A) Director, Strategic Initiatives – Jackie Wood
        • Director, Health Promotion Implementation – Laura Pisko
      • ADM, Health System Strategy and Policy – Nancy Kennedy
        • Director, System Policy and Strategy – Joanne Plaxton
        • Director, Community and Population Health – Anna Greenberg
        • Director, Planning, Research and Analysis – Michael Hillmer
        • Director, Strategy and System Productivity – Louis Dimitracopoulos
        • (A) Director, Transformation Secretariat – Rebecca Ramsarran
    • Associate Deputy Minister, Delivery and Implementation – Susan Fitzpatrick
      • ADM, Health System Accountability and Performance – Nancy Naylor
        • Director, X-ray Safety and Long-Term Care Homes – Nancy Lytle
        • Director, Local Health Integration Network Liaison – Kathryn McCulloch
        • (A) Director, Implementation – Rob Francis
      • ADM, Negotiations and Accountability Management – Lynn Guerriero
        • Director, Negotiations – David Clarke
        • (A) Director, Provincial Programs – Pearl Ing
        • Director, Primary Health Care – Phil Graham
        • Director, Health Services – Pauline Ryan
        • Director, Program Development and Delivery – Pearl Ing
      • Executive Director, Health System Funding and Quality – Melissa Farrell
        • (A) Director, Health Quality – Jillian Paul
        • (A) Director, Health System Funding Policy – Brian Pollard
        • Director, Quality-Based Procedures – Michael Stewart
    • ADM (Interim), Health System Information Management and Investment – Lorelle Taylor
      • Director, Information Management Strategy and Policy – Alison Blair
      • Director, Health Data – Jeanette Munshaw
      • Director, Health Analytics – Ashif Damji
      • Director, e–Health Liaison – Greg Hein
      • (A) Director, Special Projects – Aileen Chan
    • ADM and CAO, Corporate Services – Mike Weir
      • Director, HR Strategic Business Unit – Kristen Delorme ^{footnote 2[2]}
      • (A) Director, Fiscal Oversight and Performance – Gabriella Martin
      • Director, Supply Chain and Facilities – Shelley Gibson
      • Director, Financial Management – Pier Falotico
      • Director, Accounting Policy and Financial Reporting – Charles Brown
      • Director, Corporate Management – Michele Sanborn
      • Director, Health Audit Service Team – Charles Meehan ^{footnote 3[3]}
      • Director, Ministry Project Management and Process Improvement Office – Simon Trevarthen
    • ADM, Direct Services – Patricia Li
      • Director, Claims Services – Josephine Fuller
      • Director, Emergency Health Services – Tarmo Uukkivi
      • Director, Psychiatric Patient Advocate Office – Nancy Dickson
      • Director, Assistive Devices Program – Susan Picarello
    • CIO, Health Services I&IT Cluster – Lorelle Taylor ^{footnote 3[3]}
      • Head, Health Solutions Delivery – Kevan Malden
      • Director, Ontario Public Health Integrated Solutions (OPHIS) – Karen McKibbin
      • (A) Executive Lead – Shelley Edworthy
        • Head, Consulting – Joan Berry
        • Head, Integrated Health Solutions – Cathy Bulych
        • (A) Head, I&IT Strategy and Architecture – Hope Knox
        • (A) Head, Technology Management and Solutions Integration – Elizabeth Hyland
        • Director (Interim), Business and Financial Services – Joan Berry
    • ADM and Executive Officer, Ontario Public Drug Programs – Suzanne McGurn
      • Director, Drug Program Services – Brent Fraser
      • Director, Exceptional Access Program – Rob Campbell
    • ADM, Communications and Marketing – Jean-Claude Camus ^{footnote 4[4]}
      • Director, Strategic Planning and Integrated Marketing – Naomi Rose
      • (A) Director, Public and Corporate Affairs – Marysia Szymczak
    • ADM, Health Human Resources Strategy – Denise Cole ^{footnote 5[5]}
      • Director, Nursing Policy and Innovation / Provincial Chief Nursing Officer – Kaiyan Fu
      • (A) Director, Health Workforce Policy – Tim Blakley
      • Director, Health System Labour Relations and Regulatory Policy – John Amodeo
    • (A) Chief Medical Officer of Health – Dr. David Mowat
      • Associate Chief Medical Officer of Health, Communicable and Infectious Disease – Vacant
      • Associate Chief Medical Officer of Health, Infrastructure and Systems (Transition) – Dr. Robin Williams
      • Associate Chief Medical Officer of Health, Environmental Health – Vacant
      • Associate Chief Medical Officer of Health, Health Promotion, Chronic Disease and Injury Prevention – Vacant

Agencies, Boards and Commissions

Operating and Capital Summary by Vote (2015-16)

Operating and Capital Summary by Vote (2014-15)

Annual Report 2014-15 Overview

The government renewed its commitment to transform Ontario’s health care system to be truly patient-centred, driven by quality and evidence and delivering value that builds sustainability to protect the system for generations to come. This was reflected in the February 2015 release of the Patients First: Action Plan for Health Care, which represents the next phase of Ontario’s plan for improving the health system. Patients First will build on the progress that has been made since 2012, when Ontario’s Action Plan for Health Care was launched.

In fiscal 2014-15, the ministry made strides in providing better access to quality health care services for all Ontarians. Care is increasingly being delivered in the community, closer to patients' homes or in their homes. Home care continued to be an area of increasing importance due to the growing population of seniors who wish to remain in their own homes for as long as possible. Over 76,000 more Ontarians had access to home care services than in 2012.

Providing better access to appropriate supports in the community reduces the reliance on acute care services and frees up capacity, allowing hospitals and emergency departments to focus on the most serious cases. The ministry also continues the process to shift routine procedures, such as cataract surgery, from hospitals to ambulatory clinics in the community. Not only does access to appropriate care in the community improve patient satisfaction, it also makes the most effective and efficient use of valuable health resources.

To ensure patient safety, the ministry has asked Health Quality Ontario to conduct a review of quality oversight in non-hospital clinics and provide recommendations on how quality can be strengthened in these clinics.

The ministry continued to strengthen the coordination and integration of health care services for Ontarians with complex health needs in order to improve patient outcomes and deliver increased value for health care dollars invested through transformative patient-centered initiatives such as Health Links.

A comprehensive slate of initiatives and activities carried out over the last fiscal year has collectively advanced the transformation of the health system, ensuring quality and sustainability today and for the future.

Enhancing the Coordination and Delivery of Care in the Community

Ambulatory Clinics

The ministry continued the process to move routine, low-risk procedures out of acute care settings into not-for-profit clinics located in the community. These clinics can serve more patients faster while maintaining high quality care and outcomes. Providing people with faster access to these services results in greater patient satisfaction. At the same time it frees up capacity for hospitals to perform more complex procedures sooner.

The ministry started in 2014 by launching an application process to shift cataract procedures to ambulatory clinics. In addition, birth centres in Ottawa and Toronto opened in 2014. Led by midwives, these centres give pregnant women with low-risk pregnancies more choice regarding where they deliver their babies.

All ambulatory clinics must meet mandatory requirements, including:

• Being non-profit and providing OHIP-insured services;
• Operating under existing legislation, accountability and quality assurance frameworks;
• Having the support of the local hospital and the Local Health Integration Network (LHIN).

Funding for procedures would be shifted from hospitals to ambulatory clinics, based on a best practice price.

Community Paramedicine

Community Paramedicine is an innovative approach to help seniors and other patients to live independently in the community for as long as possible, while at the same time reducing unnecessary emergency department visits, hospital admissions, and long-term care placements.

Community Paramedicine initiatives allow paramedics to apply their health care training skills beyond the role of emergency response. Paramedics visit seniors and other high-risk patients in their homes and reach out to known or potential frequent users of 911 services. In addition, paramedics can play a role in educating seniors and other patients in their homes about chronic disease management and can refer patients to local community service providers and other supports.

In 2014, the province invested $6 million to support 30 Community Paramedicine initiatives across Ontario. These initiatives are currently at various stages of implementation and involve working with various health partners, such as Health Links, Family Health Teams and Community Care Access Centres (CCACs).

Personal Support Worker Initiatives

Personal Support Workers (PSWs) are of vital importance to the health care system and will become even more so with the rapidly growing demographic of seniors. In particular, PSWs will play a key role in home and community care to help seniors stay independent longer and will support the growing number of people coping with complex health issues. It is estimated that more than 34,000 of Ontario’s 100,000 PSWs provide care and assistance to seniors and others with complex care needs in their own homes and communities.

The government announced a number of initiatives during the fiscal year aimed at supporting PSWs, including:

• An immediate wage increase and new base wage in 2014-15 for PSWs working in the publicly funded home and community care sector;
• The PSW Training Fund – providing up to $10 million annually to support training and education for PSWs in home and community care; and
• Development of a Common PSW Educational Standard – led by the Ministry of Training, Colleges and Universities and released in September 2014 – to improve consistency of learning outcomes for PSWs across the health care system.

Community Care Access Centres

Home and community care are key priorities for the ministry. The province is focused on providing care in the community to help people remain at home longer as they age or develop chronic complex medical conditions. Home is where people want to be for as long as possible.

Investments in community and home care help to keep people out of more costly hospitals and long-term care homes longer. It frees up hospital beds for those in need and shortens the long-term care bed wait-list.

The government allocated $2.5 billion to home care in fiscal year 2014-15. This included an additional $75 million during the fiscal year to LHINs to help Community Care Access Centres (CCACs) reduce wait times for nursing services and support services for clients with complex needs.

The Expert Group on Home and Community Care was established to develop recommendations on strengthening the home and community sector. In addition, the government sought advice from patients, caregivers, physicians, nurses and personal support workers. The Expert Group’s final report was publicly released on March 12, 2015.

The ministry also continued to work with LHINs to improve practice, increase access and reduce wait times in the home care and community sector. CCACs are working with their health service providers to ensure clients are properly assessed and that they receive the appropriate health care services based on their individual needs.

Physiotherapy, Community Exercise and Falls Prevention Programs

The government invested $156 million to implement changes to support greater access to community and primary care physiotherapy. In addition, the province improved the availability and access to community exercise and falls prevention classes for seniors. It has enhanced access to these services to 200,000 additional patients – mainly seniors – to promote health and wellness. This funding is also helping residents in long-term care homes receive physiotherapy that best suits their needs and supports their rehabilitation and quality of life.

In-home Physiotherapy Services

It is anticipated that about 60,000 more seniors and community clients will have received in-home physiotherapy services in 2014-15. CCACs are the single point of access for in-home physiotherapy services to ensure standardized assessment and equitable access across the province.

Clinic-based Services

Since August 2013, the province has expanded access to clinic-based physiotherapy services across Ontario. To date, at least 258 sites have been approved. Previously underserved areas, such as Thunder Bay, North Bay and Timmins now have community-based physiotherapy clinics. This expanded model resulted in 78,000 patients receiving physiotherapy services in 2014-15. The new model has increased accountability among providers to deliver high quality physiotherapy services, informed by evidence.

Primary Care Physiotherapy

The ministry is committed to integrating physiotherapists into primary health care organizations. In November 2014, a joint ministry and LHIN team approved physiotherapy positions in 25 primary health care organizations to be integrated into their existing interdisciplinary programs.

Community Exercise and Falls Prevention Initiative

Each LHIN was allocated funding for community exercise and falls prevention programs for seniors, based on the total number of people aged 65 and older in their geographic area. To date, LHINs have collectively launched free and publicly accessible exercise and falls prevention classes in more than 2,000 locations throughout Ontario. The initiative has expanded access to more seniors in need.

Protecting the Health of Ontarians

Making Healthier Choices Act, 2014

The ministry is committed to providing Ontarians with information that supports them in making healthier lifestyle choices. To further protect the health of Ontarians – youth in particular - the province introduced The Making Healthier Choices Act, 2014 on November 24, 2014.

The proposed legislation addresses three areas:

Menu Labelling Legislation

This would require food service premises with 20 locations or more in Ontario that are selling or serving ready-to-eat food and beverages to post calories on menus and menu boards. In addition, the premises would have to post information about daily calorie intake requirements. This legislation is linked to the Healthy Kids Strategy and its commitment to reducing childhood obesity. Raising public awareness about the calorie content of foods eaten outside the home will help people to make healthier choices when dining out. The legislation would make Ontario the first province in Canada to require food service premises to post calories on menus.

Smoke-Free Ontario Act Amendments

The proposed amendments to the Smoke-Free Ontario Act (SFOA) would make it more difficult for youth to buy tobacco products, make tobacco products less tempting for teenagers and further protect people from the exposure to second-hand smoke in public areas. The proposed steps include:

• Increasing the maximum fines for selling and displaying tobacco products to youth – making Ontario’s penalties the highest in Canada;
• Prohibiting the sale of flavoured tobacco products (Menthol flavoured tobacco products would be exempt for a period of up to two years); and
• Expanding the seizure authority of tobacco inspectors.

The government also made regulatory amendments to ban smoking on outdoor grounds of hospitals and specified provincial government properties – except designated smoking areas.

The ministry has conducted consultations with stakeholders and has developed a draft strategic plan for tobacco control that will build on the government’s goal for Ontario to achieve the lowest smoking rate in Canada.

Electronic Cigarettes Act, 2014

The government is proposing a precautionary approach to regulate the sale, display, promotion and use of e-cigarettes to protect people, especially youth, from the possible negative effects of e-cigarettes. This will allow the government to increase or decrease regulation of specific e-products when or if new evidence emerges. The steps include:

• Prohibiting the sale and supply of e-cigarettes to anyone under 19 years of age;
• Banning the display and promotion of e-cigarettes where the products are offered for sale; and
• Prohibiting the use of e-cigarettes in certain locations where the smoking of tobacco is banned under the SFOA, including enclosed workplaces, schools and common areas in condominiums.

Healthy Kids Strategy

The Healthy Kids Strategy is a cross-government, multi-faceted initiative to promote children’s health. Through the Strategy – launched in 2013 – the government continued to work to reduce childhood obesity. The Strategy was developed from recommendations of the Healthy Kids Panel.

The Strategy remained focused on three key pillars:

Healthy Start

The government helped babies get the best start in life by providing Ontario families with 24-hours/7-days a week telephone access to help breastfeeding mothers. The Ministry also provided Ontario’s hospitals and community health care organizations with training, tools, guidance and resources to help them achieve the World Health Organization’s Baby-Friendly Initiative designation and adopt clinical best practices in infant feeding.

In addition, the province funded the development and implementation of new targeted, community-based supports for mothers in population groups that have lower rates of breastfeeding, such as women having their first baby, Aboriginal women and women who plan to return to work within six months. Work was also underway to develop evidence-informed, pre-natal educational information to promote healthy pregnancies and positive parenting.

Healthy Food

The ministry continued to consult with the food industry and the health sector on taking additional steps to curb the marketing of unhealthy foods and beverages targeted at children. In addition, the government continued its investment in Ontario’s Student Nutrition Program to support the creation of more than 200 new breakfast programs, to bring nutritious food to more children and youth in higher needs areas including Aboriginal communities. The government also continued to support the Northern Fruit and Vegetable Program that provides free servings of fresh fruits and vegetables to school-aged children in northern and remote communities.

Healthy Active Communities

Forty-five communities across Ontario were chosen to participate in the Healthy Kids Community Challenge to deliver local programs and activities to help children and youth be more active and healthy. Communities will receive resources from the ministry including funding, training, guidance and social marketing tools to help promote healthy eating, physical activity and healthy lifestyle choices for children and youth.

EatRight Ontario

EatRight Ontario (ERO) gives Ontarians ready access to expert advice on healthy eating. ERO offers individuals e-mail and toll-free telephone access to registered dietitians, who provide advice on all aspects of nutrition and healthy eating. The free service is available in 110 languages. The ERO website offers tools, such as meal planners and resources to support healthy eating.

The ministry is committed to providing information and connecting people with appropriate tools to help them make the best choices to stay healthy.

The Skin Cancer Prevention Act

The Skin Cancer Prevention Act came into effect on May 1, 2014 banning the use of tanning beds by youth under the age of 18. Tanning bed operators are now required to register with their local public health units, which will ensure compliance. Marketing and advertising aimed at youth under the age of 18 is restricted, as well as false and misleading ads.

The new rules also include the following:

• Anyone under 25 must provide identification;
• Requires a sign be posted near the entry warning of the dangers associated with tanning bed use; and
• Does not allow the use of a tanning bed without an attendant.

These changes will help to protect youth, who are especially vulnerable to the harmful effects of ultraviolet radiation, which can lead to a deadly form of skin cancer later in life.

Dental Care for Low-Income Children

As of April 1, 2014, 70,000 more children from low-income families were able to access free dental care services, including regular cleanings and treatment through the expanded Healthy Smiles Ontario program. It means that over 460,000 children are now eligible for dental treatment through the program. Six publicly-funded dental programs will be integrated into one program to offer seamless enrolment and improve access to dental care for children in need. Good oral health is essential to the overall health and well-being of children.

Health Care Options and Health Care Connect

In February 2009, the ministry launched a website called Health Care Options, which is an online medical services directory to provide Ontarians with alternative options to emergency care. The website was improved in 2015 to provide a comprehensive list of primary health care resources in communities across Ontario, including urgent care centres, Family Health Teams, Nurse Practitioner-Led Clinics, Community Health Centres and family health care practices. The goal is to inform and help Ontarians find the most appropriate health care services in their community and avoid unnecessary emergency department visits.

Health Care Connect helps people who do not have a family doctor or nurse practitioner to find one. People can call or log onto the internet to register with the program. As of January 31^st, 2015, 352,700 people in Ontario have been referred using this service.

Ontario Temporary Health Program for Refugee Claimants

Ontario continued to provide health coverage to refugee claimants living in the province after the federal government made significant changes to the Interim Federal Health Program in 2012. The provincial government introduced the Ontario Temporary Health Program for Refugee Claimants (OTHP) because Ontario is home to over 46% of Canada’s refugee claimant population.

In 2014-15, Ontario provided reimbursement of up to $1.2 million to health service providers who delivered care to refugee claimants no longer covered by the federal program. The OTHP covers urgent and essential care, including primary, specialist and hospital care. The program ensures refugee claimants have access to needed health services and minimizes deterioration of medical conditions that could result in additional costs to the provincial health care system.

Children, Youth and Adult Immunizations

The province updated its immunization requirements under the Immunization of School Pupils Act for children and youth for the 2014-15 school year. Primary and secondary students must have their immunizations up-to-date in accordance with the new mandatory immunization and dose requirements reflecting changes as outlined in Ontario’s publicly funded immunization schedule. Students need to have proof of immunization against three more diseases: meningococcal disease, pertussis (whooping cough) and, for children born in 2010 or later, varicella (chickenpox). This is in addition to existing requirements for proof of immunization against many other diseases. The number of doses required for tetanus, diphtheria, polio and mumps has also been updated.

Currently, the Ontario government publicly funds 22 different (routine and non-routine) vaccines through its provincial immunization program that protect against 16 diseases. Vaccines are the best protection from preventable diseases that can lead to serious health concerns, especially for children, seniors and people with weakened immune systems.

Universal Influenza Immunization Program

Since 2000, each year Ontario’s Universal Influenza Immunization Program (UIIP) prevents about 300 deaths and 1,000 hospitalizations, as well as eliminates 30,000 visits to hospital emergency departments.

The ministry continued to focus on increasing immunization rates, including improving access and making it more convenient for Ontarians to get their flu shots. In 2012-13 pharmacists across the province were given the expanded scope to administer publicly funded influenza vaccines to individuals five years of age or older. As of February 28, 2015, there were about 2,400 participating pharmacies that had administered approximately 900,000 doses of the flu vaccine.

The ministry also continued to work with the health care sector in collaboration with the Ontario Hospital Association, long-term care associations and Public Health Ontario to improve flu immunization rates among health care workers.

The ministry will conduct a multi-sectorial review of Ontario’s UIIP to identify opportunities for further improvement and modernization. The process will include a joint ministry-Public Health Ontario scientific technical evaluation.

Cancer Screening and Prevention

The government continued to take steps to better inform Ontarians about their cancer risk. Cancer Care Ontario (CCO) launched the MyCancerIQ assessment tool in February 2015 to heighten public awareness. The tool measures cancer risk and then links those at higher risk to prevention supports, screening or genetic testing. The online tool also supports prevention and screening messages for breast, cervical and colorectal cancer and encourages individuals to take action to modify risk factors where possible. It also makes it easier for people to access local and provincial resources to support positive behaviour changes.

Ontario has one of the most comprehensive cancer screening programs in Canada. Led by CCO, the Cancer Screening Program includes:

• The Ontario Breast Screening Program
• The Ontario Cervical Screening Program
• ColonCancerCheck

The goals of the screening programs are to increase the participation of patients, improve the screening performance of primary care providers and maintain a high quality integrated screening system. The province continued to strengthen the comprehensive screening programs in these areas and alert and remind people when it was time to schedule their next screening.

In addition, each year about 77,000 girls in Grade 8 are offered free vaccines to protect against the human papillomavirus, which can cause cervical cancer. The vaccine program saves families up to $450 per child. The government also continued to fund Prostrate-Specific Antigen testing for men meeting the Ontario Health Insurance Program eligibility criteria.

The ministry also worked closely with CCO to implement recommendations from the Office of the Auditor General of Ontario’s (OAGO) 2012 report on cancer screening. In its follow up report released in December 2014, the OAGO noted that CCO had already fully implemented some of the recommendations and made significant progress on others. In partnership with CCO, the ministry will work to ensure that all the recommendations are implemented to strengthen the province’s cancer screening system.

The Ontario Diabetes Strategy

1.46 million Ontarians who have been diagnosed with type 1 or type 2 diabetes and to prevent those at risk from developing the disease. Since 2008, when the Ontario Diabetes Strategy was launched, the government has invested more than $800 million to support a comprehensive array of over 200 diabetes programs.

Ontario is committed to continuing to address this chronic disease that affects 9.8% of the population and has about a $5.8 billion impact on costs to the health care system.

Key achievements during the fiscal year include:

• Centres for Complex Diabetes Care – located in six priority LHINs to provide coordinated access to specialized, patient-centred care for people with complex diabetes and associated health needs, over 8,100 new patients have been served as of March 31, 2015. The government invested $10.7 million in this area in 2014-15.
• The Hypertension Management Program – set up to respond to a key risk factor for diabetes and many chronic diseases, 7,700 patients have enrolled as of March 31, 2015. The province provided $1.2 million for this program during the fiscal year.
• Self-management skills training have been provided to over 16,500 individuals and over 13,500 health care providers as of December 31, 2014 – a $4 million investment during the fiscal year.

Prevention

In 2014-15, the ministry invested $2.25 million to fund projects and programs to support populations where the incidence of diabetes is increasing most quickly. These initiatives include:

• A Diabetes Mobile Service, which provides multidisciplinary diabetes care to individuals in rural and remote communities in the North West LHIN, including First Nations communities;
• Diabetes Risk Assessment Screening and Early Detection services providing culturally tailored risk assessment, screening, education and early detection; and
• The Primary Care Diabetes Prevention Program, which supports lifestyle and behavioural changes to help adults at high risk of developing diabetes.

In fiscal year 2014-15, the government also invested:

• $5.3 million to fund Diabetes Education Programs that help individuals manage their diabetes and avoid diabetes-related complications;
• $3.5 million on Aboriginal Diabetes Programming to support culturally appropriate diabetes services and care for Aboriginal and First Nations communities; and
• $13.7 million to the Diabetes Regional Coordination Centre, which streamlines and integrates regional diabetes services to improve access, equity and patient-centred delivery of care.

Chronic Kidney Disease Management

Through the Ontario Renal Network (ORN), a partnership between the ministry and Cancer Care Ontario, the ministry is improving Chronic Kidney Disease (CKD) management with a goal of preventing or delaying the need for dialysis. The ministry is also committed to improving the quality of care for patients with CKD.

In 2014-15, 95% of CKD funding was for service volumes; 3% was for quality initiatives related to CKD, and 2% was for infrastructure and program expansion, for example, lease funding, home dialysis and facility based expansion. The province took further steps to better integrate care by transferring the funding for peritoneal dialysis provided by CCACs and long-term care homes to the ORN.

The ORN is working to improve access to living donors, kidney transplants and the co-ordination and integration of care. The ORN will also work with the Trillium Gift of Life Network to increase kidney transplants to enable better patient outcomes and reduce the ongoing need for dialysis.

Mental Health and Addictions Strategy

About 30% of Ontarians will experience a mental health or substance abuse challenge during their lifetime and one out of 40 people will face a serious mental illness.

On February 25, 2015, the government announced that it was investing $28 million in 2014-15 in local mental health and addictions organizations to provide care closer to home for people experiencing mental health and addictions challenges. The new investment is aimed at supporting initiatives such as:

• Increased access to services, including supportive housing, short-term crisis support beds, peer support groups and treatment programs;
• Shorter wait times for care through the creation of a new registry of inpatient mental health beds. It will provide doctors, first responders and emergency departments with up-to-date information about available inpatient beds across the province;
• Improved transitions between care teams, so people do not have to tell their story multiple times; and
• Additional early intervention initiatives to reduce repeat visits to emergency rooms including expanding the number of early psychosis intervention teams.

The announcement was part of the ongoing implementation of Phase 2 of Ontario’s 10 year Comprehensive Mental Health and Addictions Strategy, announced in November 2014.

The first three years of the Strategy focuses on early intervention for children and youth, providing 50,000 more children and youth with access to comprehensive mental health and addictions services.

Phase 2 includes $138 million in funding committed over three years for community agencies to support improvements to mental health and addiction services through the LHINs. It expands the focus to include improved transitions between youth and adult services, with broader focus on addictions and adult mental health. The aim is to create better access, quality and value, as well as improving system integration, planning and accountability.

Overall, ministry funding for community mental health and addictions programs was $1.076 billion in fiscal 2014-15. Ministry funding for community mental health and addictions has grown by $501.9 million (or 87.4%) in the last 10 years, from $574.1 million in 2004/05 to $1.076 billion in 2014/15.

The province funds more than 300 agencies that provide community mental health services and supports. It invests in over 170 substance abuse and problem gambling treatment programs and provincial initiatives.

As part of the Poverty Reduction Strategy, the government is investing $16 million over the next three years to create approximately 1,000 new supportive housing spaces for people with mental illness and addictions who are homeless or at risk of becoming homeless. The ministry is also working and partnering with the Ministry of Municipal Affairs and Housing to leverage funding under the extension of the Investment in Affordable Housing for Ontario Program and to support better local coordination between LHINs and municipal/local governments.

The province also invested in expanding effective workplace mental health programs. Additional steps include:

• Investing $2.75 million to improve access to mental health care and reduce wait times at the specialty psychiatric hospitals in Toronto, Whitby, Ottawa, and Penetanguishene.
• Investing $20 million over the next six years in the Medical Psychiatry Alliance, which will assist up to 500,000 people with both physical and mental illness get the comprehensive care that they need.
• Improving supports for youth with eating disorders through a pilot program that will open a new 12-bed pediatric residential treatment unit caring for 32 patients a year.

In November 2014, the Mental Health and Addictions Leadership Advisory Council was announced. It will meet three times per year and provide advice to the minister on investments, promote collaboration across sectors, and report annually on the progress of its goals and priorities.

Public Health

In 2014, the ministry invested a total of $694 million ($672 million in base funding and $22 million one-time funding) for boards of health for the delivery of mandatory and related programs and initiatives such as 100% provincial funding for the Healthy Smiles Ontario Program, 180 Infectious Diseases Control staff, and 147 nursing positions.

The ministry continues to explore ways of ensuring equitable funding across all boards of health in an effort to ensure a fair, transparent and consistent method of funding. On April 9, 2014, the government announced that it would be increasing investments to the community health sector to help community organizations, such as Mental Health and Addictions agencies, Public Health Units, Family Health Teams, Nurse Practitioner-Led Clinics and Aboriginal Health Access Centres, to renew capital infrastructure.

The ministry is working to develop an integrated policy for funding community health infrastructure.

The ministry funds Public Health Ontario (PHO) – the province’s first stand-alone public health agency – to provide scientific and technical advice and support to the health system and the government to better protect and promote the health of Ontarians.

PHO has released its Strategic Plan 2014-2019 – Evidence, Knowledge and Action for a Healthier Ontario, which includes setting out direction to advance public health evidence and knowledge, accelerate integrated population health monitoring and strengthening Ontario’s public health sector by providing scientific and technical expertise.

Long-Term Care

The ministry is committed to providing high quality services for residents in Long-Term Care (LTC) homes. The government continued to strengthen and enhance the quality of care and services provided to LTC residents. LTC funding increased to $3.9 billion in fiscal year 2014-15, compared to $2.1 billion in 2003-04. In 2014-15, the ministry provided a 2% increase dedicated to addressing resident care needs.

The Long-Term Care Home Quality Inspection Program safeguards residents' rights, safety and security and improves quality of care through inspecting LTC homes to ensure they are compliant with provincial rules. As of January 30, 2015, the ministry had completed all of the 2014 annual inspections.

Compliance Public Reporting requires the ministry to publish all inspection reports and orders to demonstrate the government’s commitment to increased transparency to the people of Ontario. View the reports and orders for inspections conducted at LTC homes since July 1, 2010.

The ministry also invested in enhancements to safety of LTC residents through:

• Additional funding for staff training and development that focuses on supporting residents with complex care needs and on the prevention of abuse and neglect;
• Investments in fire and electrical safety measures, as well as specialized supplies and equipment;
• Funding for 2,500 PSWs and more than 900 nurses since 2008;
• $57.7 million annually to fund 1,200 registered practical nurse positions in LTC homes, to support at least one new nurse in every home since 2008; and
• The annual public reporting on quality of life and quality of care indicators for LTC homes by Health Quality Ontario.

The ministry has also created 250 more short-stay convalescent care beds in LTC homes to provide care for seniors who need time to recover their strength, endurance and function before returning to their own homes.

Key LTC Initiatives

Redevelopment of LTC Homes

In 2007, the government announced plans to redevelop 35,000 older LTC beds. The ministry continued to engage the LTC sector to support the government’s commitment to accelerate the redevelopment of LTC homes across the province.

On October 28, 2014, the government announced the Enhanced Long-Term Care Home Renewal Strategy that included the following measures:

• Establishing a dedicated project office to support the Enhanced Strategy;
• Increasing the Construction Funding Subsidy by up to $4.73 per bed per day;
• Supporting increases to preferred accommodation premiums;
• Extending the maximum long-term care licence term from 25 to 30 years for homes that redevelop;
• Scheduling LTC homes for redevelopment; and
• Establishing a committee to review variance requests from design standards.

The Long-Term Care Task Force on Resident Care and Safety

The sector-led Long-Term Care Task Force on Resident Care and Safety was established to develop an action plan to respond to incidents and under-reporting of abuse and neglect in LTC homes. The Task Force released their third progress report on December 10, 2014. The ministry has made significant progress against the six recommendations identified for government leadership. These included:

• Continued hiring of LTC inspectors to ensure that all homes receive Resident Quality Inspections by early 2015;
• The introduction of the requirement that all homes must submit Quality Improvement Plans to Health Quality Ontario starting in April 2015;
• Amended legislation to streamline admission and discharge requirements for specialized units and improve recruitment and retention of LTC home staff;
• In 2011-12 and 2012-13, the ministry invested $59 million in Behaviour Supports Ontario (BSO) to meet the needs of individuals with challenging and complex behaviours due to Alzheimer’s and other related dementias. This funding supported the redesign of service delivery across the province and the hiring of specialized staff. The ministry continues to support this investment by providing $44 million annually in base funding to help the LHINs sustain the gains made by BSO.

Supports for Alzheimer’s Disease and Related Dementias

There are currently about 208,000 people living with dementia in Ontario. Alzheimer’s is the most common form of dementia – making up 60–80% of all cases. According to the Alzheimer’s Society of Ontario, the current direct and indirect annual cost of dementia in Ontario is over $5 billion.

The government recognizes the need to support people living with dementia, as well as their families. Ontario is committed to helping seniors stay as healthy as possible for as long as possible living in their homes and receiving services in their local communities – including people with Alzheimer’s disease. The province is committed to supporting Alzheimer’s patients across the continuum of care.

The ministry made a range of investments to improve the lives of Ontarians living with Alzheimer’s and related dementias, and their caregivers.

These include:

• Investing nearly $24 million in funding to various chapters of the Alzheimer Society of Ontario to deliver a range of services to improve treatment and management of Alzheimer’s disease.
• Providing greater flexibility for informal caregivers to access short stays for their family member at LTC homes by allowing people to apply to up to five different LTC homes for respite as a short-stay resident.
• Through the Ontario Public Drug Program, continuing to fund drug treatment for patients with mild to moderate Alzheimer’s disease and other dementias.
• Five Regional Geriatric Programs located in Ottawa, Hamilton, London, Kingston and Toronto, which provide comprehensive geriatric services, including the diagnosis and management of Alzheimer’s disease.

End-of-Life and Palliative Care

Enhancing the capacity of residential hospice care and increasing support to patients, their caregivers and community-based providers are among the steps being taken to strengthen the province’s end-of-life continuum of care to better support people and to provide them with dignified palliative care.

The government has committed to invest in 20 new hospices across Ontario. This will nearly double the number of beds for quality end-of-life care and will give more patients the option to spend their finals days in a supportive and home-like setting.

In fiscal year 2014-15, the ministry provided $0.7 million in base funding to five universities to co-ordinate palliative education to train physicians from various areas across the province.

Ontario is committed to ensuring that people are supported at the end of their lives and allowed to die with dignity.

Ontario Public Drug Programs

The Ontario Public Drug Programs (OPDP), including the Ontario Drug Benefit (ODB) Program, which primarily covers individuals over 65 years of age, people on social assistance, individuals living in long-term care homes and special care facilities, and those who are enrolled in the Trillium Drug Program.

The government invests over $4.8 billion to provide drug coverage to over 3.8 million eligible recipients in Ontario. A review of the system in 2005 yielded an estimated savings of over $2.5 billion, which has been reinvested into the drug system.

Investments include (as of February 2015):

• 68 updates to the ODB Formulary (The Formulary sets the provincial standard for price, quality and interchangeability of drug products.)
• 174 new brand drugs have been funded, including new drugs and new indications funded through the Exceptional Access Program (EAP)
• Increased access to 136 drugs/indications
• 73 cancer drugs/indications have been listed
• 784 new generic drugs (185 first-time generic drugs) have been listed on the Formulary as benefits

Additional, there are several OPDP initiatives that strengthen the drug system and better serve the needs of Ontarians. These include:

• The MedsCheck Program allows Ontarians taking multiple medications to schedule a 20 to 30 minute one-on-one annual meeting with their community pharmacist to discuss managing their medications.
• Establishment of the Narcotics Monitoring System to track all pharmacy dispensing of narcotic and controlled drugs, helping to reduce the misuse and abuse of these products in Ontario.
• The Citizens' Council, the OPDP's advisory body, the first of its kind in Canada and one of only a handful in the world, that captures citizens' views and makes recommendations to help the Ministry develop future drug funding policies and programs.
• The Ontario Steering Committee for Cancer Drugs enhances and supports the administration of Ontario’s cancer drug programs.
• The Pan-Canadian Pharmaceutical Alliance brings the provinces and territories together on the negotiation of agreements to add drugs to their publicly funded programs, which helps achieve greater consistency in drug access and better drug pricing.

Delivering Quality Care

Health Links

The ministry has established 69 Health Links across Ontario to date to provide the province’s most complex patients with targeted access to the care they need, when and where they need it. Health Links bring together patients, their families, primary care providers, specialists, hospitals, long-term care, home care and community supports to better coordinate care and ensure wrap-around services for patients with multiple complex issues. This is significant because 5% of the province’s patients, many of them seniors, are faced with multiple complex health issues and account for a disproportionate two-thirds of health care costs.

By supporting these patients to receive faster access to the most appropriate care, Health Links are helping to achieve more effective care that results in better outcomes and reduces the repetitive use of acute and emergency services. Health Links are at the forefront of achieving seamless care and supporting system sustainability.

Family Health Teams

In fiscal year 2014-15, the ministry invested more than $330 million to fund Family Health Teams (FHTs). Since 2005, FHTs have played an increasingly important role in providing comprehensive primary health care services to Ontarians across the province.

FHTs are currently serving 206 communities across Ontario through interdisciplinary teams working together to provide holistic care for their patients. These health care professionals include 2,727 physicians and more than 2,000 other health professionals such as nurse practitioners, social workers, dietitians and pharmacists.

More than 3.1 million Ontarians are now enrolled in FHTs, including 927,828 who previously did not have access to a primary care physician. FHTs continue to play a key role in improving access and quality and delivering appropriate and effective care.

Community Health Centres and Aboriginal Health Access Centres

Community Health Centres (CHCs) are non-profit organizations that provide primary health and health promotion programs for individuals, families and communities. CHCs work together with other stakeholders on health promotion initiatives within schools, in housing developments, and in the workplace. They link families with self-help groups that offer peer education, support in coping, or are working to address conditions that affect health status. CHCs help to develop healthier communities.

The centres' health promotion programs include domestic violence prevention, parenting education, addictions counselling, and stress management.

There are 76 CHCs providing health services to about 500,000 patients in Ontario, particularly underserved populations and patients with unique needs.

Aboriginal Health Access Centres (AHACs) blend traditional Aboriginal approaches to health and wellness, with primary health care and health promotion programs. There are 10 AHACs offering culturally appropriate services to 93,000 people. The sites are located both on and off-reserve. In 2014-15, the ministry invested $23.7 million in AHACs. Chronic disease prevention and management, smoking cessation and nutrition are among the programs delivered.

AHACs are part of a broader provincial approach that is committed to Aboriginal involvement in the planning, design, implementation and evaluation of programs and services provided to Aboriginal communities. Initiatives such as the five Aboriginal governed Family Health Teams, the Ontario Aboriginal Diabetes Strategy and the Aboriginal Cancer Strategy, are all focused on addressing the unique health risks and challenges facing Aboriginal communities.

Nurse Practitioner-Led Clinics

As of January 31, 2015, there were 25 Nurse Practitioner-Led Clinics (NPLCs) open and seeing patients in Ontario. More than 49,000 patients have registered with NPLCs and are receiving primary health care services – many of whom previously did not have access to a primary health care provider. NPLCs have improved access to comprehensive family health care for their patients and help to promote disease prevention and healthy living.

All NPLCs are led by a nurse practitioner and include a collaborating physician, as well as a team of interdisciplinary providers, such as registered nurses, social workers, registered dietitians, pharmacists, and health educators. Various NPLCs have developed programs to address targeted needs of specific populations within their communities. The existing NPLCs still have capacity to continue to increase their patient registration. The ministry invested more than $33 million in 2014-15 to support NPLCs.

Birth Centres and Midwives

The government invested in the creation of the province’s two midwife-led Birth Centres, located in Toronto and Ottawa. These birth centres provide pregnant women with low risk pregnancies a choice to deliver their babies in a safe, home-like setting. Seventh Generation Midwives Toronto, which is co-located at the Toronto Birth Centre, specializes in providing maternity care to Aboriginal women and their families. Providing pregnant women and their families with more choice for healthy deliveries supports the government’s priority to provide greater access to appropriate care.

Midwives

Midwives are primary care providers who support their clients in the pre-natal, labour, delivery, and post-partum period (up to six weeks following birth), including breastfeeding support and newborn care.

There were about 760 registered midwives in Ontario in 2014-15. Midwives delivered approximately 22,000 babies in 2014-15, compared to 8,000 in 2003. Midwifery care involves fewer medical and surgical interventions, which benefits mothers and their babies and provides better value for the health system.

Physicians

The government continued to support programs to ensure an optimal supply of physicians working in the province to meet the needs of Ontarians. Between 2003 and 2013, the number of physicians in Ontario increased by 26.3% to 27,125 – while the population grew by 10.6%. This has improved the ratio of physicians for every 10,000 people from 17.5 to 20.0.

Medical Education

In fiscal year 2014-15, the ministry invested approximately $150 million to support medical education. Since 2004-05, the province has added 260 first year undergraduate medical spaces, increasing the number of spots from 692 to 952.

In 2014-15 Ontario had 4,732 postgraduate medical trainees at all levels – an increase of 99.4% since 2003-04. Over the same period, the ministry has also worked with medical schools to expand family medicine and increase the number of first-year family medicine residents by 127% corresponding to 294 new first year positions. The ministry continued to partner with the province’s medical schools to plan the location of training positions and the mix of specialties based on evidence.

International Medical Graduates Program

In fiscal year 2014-15, 220 International Medical Graduates (IMGs) were offered first year postgraduate training positions.

In exchange, IMGs are required to participate for five years in the Return of Service (ROS) Program, which allows smaller communities to recruit physicians. There are currently about 600 IMGs practicing in the province under ROS.

Physician Assistants

As of February 2015, there were more than 200 Physician Assistants (PAs) working in over 100 sites across Ontario. They were working in a variety of clinical settings, including emergency medicine and primary care. In addition, there were more than 100 students enrolled in the province’s two PA education programs and up to 54 PAs are expected to graduate annually.

Nurses

The government has supported initiatives that build a sustainable nursing workforce to provide patients with timely, safe and equitable access to the right care. Ontario’s Nursing Strategy enhances the education, recruitment and retention of nurses and supports them at each stage of their career.

According to data from the College of Nurses of Ontario, there were 135,280 nurses employed in nursing in Ontario in 2014 – up 2.7% from 2013 and an increase of 21.6% from 2003. The overall rate of full-time employment for nurses in Ontario remained strong at 63.9%.

Achievement highlights include:

• In February 2014, the government announced the Nurse Practitioner in Long-Term Care Homes (NP in LTCH) Initiative that will place up to 75 Nurse Practitioners in LTC homes to provide resident care. The investment of $14 million will support LTC homes to better meet the needs of residents. The ministry is implementing a phased approach to the roll-out of the NP in LTCH Initiative. Funding will be available beginning in 2015-16 with subsequent funding becoming available in 2016-17 and 2017-18. The province has invested in the creation of new nursing positions and roles across the health system to increase access for patients to the most appropriate care in the most appropriate place. The government invested $192.5 million in this area in 2014-15.
• The Nursing Graduate Guarantee (NGG) program provides up to six months of funding to encourage organizations to hire nurses into full-time employment. In April 2014, the NGG expanded eligibility to include new graduate nurses from other provinces and territories in Canada and Internationally Educated Nurses newly registered in Ontario. The government invested $84.6 million in this program in 2014-15 and has matched over 18,000 new graduate nurses with an employer since 2007.
• The Late Career Nurse Initiative provides funding to organizations to allow nurses aged 55 years of age and older to participate in less physically demanding roles for a portion of their time. From 2004-05 to 2014-15, more than 120,800 nurses have benefited from the program, which supports retention and allows organizations continued access to the expertise of these experienced health professionals. Since 2012-13, the home care sector has been able to benefit from this initiative that was previously opened to hospitals and LTC homes.

Strengthening the Health Care System

Local Health Integration Networks

Local Health Integration Networks (LHINs) have improved the integration of Ontario’s health care system at the local level. Care is more cohesive and providers are working more closely together as the province’s 14 LHINs have evolved in their mandate to plan, fund and integrate health services for their local communities. LHINs were created through the Local Health System Integration Act, 2006.

In fiscal year 2014-15, $25.9 billion was allocated to LHINs to fund more than 2,000 local health service providers, including:

• Hospitals
• Long-Term Care Homes
• Community Care Access Centres
• Community Support Service agencies
• Mental Health and Addictions agencies
• Community Health Centres

LHINs will continue to play an important role in achieving the provincial priorities to improve access and integrate care.

Health System Funding Reform

Health System Funding Reform (HSFR) was a key component of Ontario’s Action Plan for Health Care. It will continue to enable the goals of Patients First. HSFR encourages hospitals and community care access centres to provide services based on quality, evidence and value. High quality, efficient services ensure the province’s universal health care system is sustainable for generations to come.

Ontario continued to shift the focus of its health care system to one that revolves around the patient, rather than being primarily health care provider-focused. HSFR supports an evidence-based system organized around the health care needs of communities. This means:

• Funding hospitals, community and long-term care providers based on how many people they care for, the services they deliver, and the specific needs of the population they serve;
• Using the best available evidence and proven best clinical practices to provide care that works best for people and for the system; and
• Promoting efficient and high-quality service delivery.

HSFR has two key components:

1. Health Based Allocation Model (HBAM) provides funding based on past service levels and efficiency, as well as population health information. It supports more equitable funding for local health services.
2. Quality-Based Procedures (QBPs) groups health services based on evidence informed clinical practices that reduce variations across the province to improve patient outcomes. Health care providers are reimbursed for the number and type of procedures they undertake, using a standard rate. QBPs have been developed by Clinical Expert Advisory Groups in collaboration with key stakeholder partners and phased in over the last three fiscal years.

In 2014-15, the ministry and its partners focused on assessing and engaging in a dialogue with the health sector on HSFR implementation to inform the direction going forward.

Hospital Funding

In 2014-15, the government invested $16.4 billion in funding public and private hospitals and an additional $0.6 billion in specialty psychiatric hospitals (for a total of $17.0 billion) – a 50% increase over 2003-04. Since 2007, hospitals have been funded through the LHINs.

As of December 2014, 88 of Ontario’s 154 hospitals were receiving about half of their base funding through HSFR. This has helped to improve quality, efficiency and effectiveness in the health care system. To prevent funding fluctuations that may arise during the transition from the previous global funding model to HSFR, the ministry developed a mitigation strategy by providing one-time funding relief to hospitals that needed it.

Small hospitals and others in unique circumstances are excluded from HSFR due to their specific realities.

Public Sector and MPP Accountability and Transparency Act

The Public Sector and MPP Accountability and Transparency Act (ATA), which received Royal Assent on December 11, 2014 strengthens political accountability, increases transparency and improves oversight of classified agencies and the Broader Public Sector (BPS) entities.

The new Act provides the government with the power to control the total compensation of senior executives in the BPS. It will impact many of the ministry’s stakeholders, including 39 classified agencies, numerous BPS entities, such as 144 public hospital corporations, 14 CCACs and 3,000 Transfer Payment entities.

The new legislation also amended the Ambulance Act to provide greater oversight of air ambulance service providers by enabling the government greater powers, including the ability to:

• Appoint supervisors and special investigators;
• Protect whistleblowers who disclose information to an inspector, special investigator or the government;
• Appoint provincial representatives to boards of directors; and
• By regulation, set terms in a performance agreement with air ambulance service providers at any time.

Patient Ombudsman

The ATA also legislated the appointment of a Patient Ombudsman to respond to complaints from patients, residents, clients or their caregivers against public hospitals, long-term care homes and CCACs. Creating additional system oversight enhances patient-centred care and improves patient complaint management processes across the health care system. The first of its kind in Ontario, the Patient Ombudsman will work directly with complainants and health sector organizations to facilitate the resolution of complaints related to the person’s care or health care experience. The Patient Ombudsman may also undertake investigations following a complaint or on his/her own initiative and will report on his/her activities and recommendations. The Ombudsman will be appointed by the Lieutenant Governor in Council and will be housed within Health Quality Ontario.

Excellent Care for All Act

The Excellent Care for All Act, 2010 (ECFAA) is aimed at improving quality in the province’s health system and ensuring value for health dollars invested. It established Health Quality Ontario as the provincial agency to advise and provide expertise on quality and evidence-based health care. In fiscal year 2014-15, the ministry brought forward regulations under ECFAA to continue to improve current patient relations processes at hospitals. The regulations, which will come into force on July 1, 2015, set standards for public hospitals for handling patient complaints and require them to include patient engagement as part of their annual Quality Improvement Plan (QIP) process.

Under ECFAA hospitals have also been required to:

• Establish quality committees;
• Develop and publicly post annual QIP;
• Ensure that executive compensation is linked to achievement of quality targets in the QIP;
• Carry out patient and employee or service provider surveys;
• Establish a patient relations process; and
• Develop a patient declaration of values in consultation with the public.

Health Quality Ontario

Health Quality Ontario (HQO) is the province’s advisor on health care quality, helping to transform Ontario’s health care system so that it can deliver a better experience of care, better outcomes for Ontarians and better value for money.

HQO is well positioned to support the implementation of Patients First: Action Plan for Health Care through its legislated mandate. Specifically HQO:

• Has a well-established role in monitoring and reporting on health system performance in order to inform improvement activities;
• Is working with partners to galvanize the system toward a culture of continuous quality improvement;
• Strives to promote health care that is supported by the best available scientific evidence; and
• Will house the Province’s first Patient Ombudsman.

During fiscal 2014-15, through the passage of Bill 8, the Public Sector and MPP Accountability and Transparency Act, 2014, HQO's mandate has been expanded to include:

• Patient relations;
• Monitoring and reporting on the performance of health sector organizations with respect to patient relations;
• The promotion of enhanced patient relations in health sector organizations through the development of patient relations performance indicators and benchmarks for health sector organizations;
• Providing quality improvement supports and resources for health sector organizations with respect to patient relations; and
• Providing support to the Patient Ombudsman in carrying out his or her functions.

HQO is in its fourth year of operation as a consolidated agency with a mandate that was initially set out by the ECFAA to monitor and report on health system performance, support continuous quality improvement and to promote health care that is supported by the best available scientific evidence. This mandate includes making funding recommendations to the ministry on health care services and medical devices.

Patient Safety

Safeguarding Health Care Integrity Act, 2014

In December 2014, the government’s Safeguarding Health Care Integrity Act, 2014 was passed, which among other things, is aimed at strengthening the oversight of hospital pharmacies and the safety of drugs that are provided in Ontario’s hospitals to further enhance patient care. The province was following through on its commitment to implement recommendations contained in Dr. Jake Thiessen’s review of the province’s drug supply system. In 2013, Dr. Thiessen conducted a thorough investigation into the discovery of under-dosed chemotherapy drugs at four Ontario hospitals and one in New Brunswick.

Legislative changes, which require amendments to the Drug and Pharmacies Regulation Act, give the Ontario College of Pharmacists the authority to inspect and license hospital pharmacies. Pharmacies in the community are overseen by the Ontario College of Pharmacists, whereas hospital pharmacies have been the responsibility of individual hospital organizations. Expanding the college’s authority to regulate hospital pharmacies will ensure that consistent standards are met across the province.

Specifically, the government passed legislation that:

• Provides the Ontario College of Pharmacists with the authority to license and inspect pharmacies within public and private hospitals, in the same way it currently licenses and inspects community pharmacies;
• Allows the college to enforce licensing requirements regarding hospital pharmacies;
• Mandates the college to make regulations to establish the requirements and standards for licensing, operation and inspection of hospital pharmacies; and
• Provides the government with the ability to extend the college’s oversight to other institutional pharmacy locations in the future, as appropriate.

The legislative changes also improve the health system’s ability to quickly identify and respond to any future incidents that could affect patient care and safety.

Patient Safety Reporting and Indicators

The government continued to implement ongoing initiatives to improve patient safety in health care institutions across Ontario including:

• Mandatory public reporting of patient safety indicators in hospitals;
• Strengthening existing patient safety legislation and regulation;
• Investing in patient safety training for health care providers; and
• In addition, HQO – the government’s key advisor on quality – is responsible for implementing a patient safety strategy, focused on measurement and reporting.

Ontario’s health system is achieving improvements in patient safety on critical measurements, including:

• Decreasing rates of central line-associated primary bloodstream infection from 1.56 per 1,000 central line days in 2008-09 (Q4) to 0.58 in 2014-15 (Q2);
• Decreasing ventilator-associated pneumonia from 3.51 per 1,000 ventilator days in 2008-09 (Q4) to 0.76 in 2014-15 (Q2); and
• Decreasing rates of Clostridium difficile Infection from 0.39 per 1,000 patient days (August 2008) to 0.24 (November 2014).

Since hospitals began collecting data on the use of the surgical checklist five years ago, its use has increased from 91.8% to 99.5%. The Surgical Safety Checklist provides a list of the most common tasks that operating room teams carry out to optimize patient safety.

Quality of Care Information Protection Act

The Quality of Care Information Protection Act, 2004 (QCIPA) is designed to encourage health care professionals to share information and have open discussions about improving the quality of health care delivered. This includes learning from critical incidents in their organizations that involve the delivery of patient care without fear that information will be used against them.

QCIPA applies to hospitals, independent health facilities, long-term care homes, licensed medical laboratories and specimen collection centres.

In July 2014, a review of QCIPA was convened to advise on potential improvements to QCIPA and related legislation. This review was led by a panel of experts supported by Health Quality Ontario and co-chaired by a Patient Experience Advisor and Physician Leader.

The QCIPA expert panel submitted its recommendations to the Minister in December 2014.

Emergency Room/Alternative Level of Care Strategy

The ministry continued to support a multi-pronged approach to reducing the amount of time Ontarians spend waiting for emergency services, allowing them to be treated faster and to free up capacity for other patients.

Initiatives under the Emergency Room/Alternative Level of Care Strategy include:

• A Pay-for-Results program that provides funding incentives to 74 high volume emergency departments (EDs) across the province to reduce wait times. In fiscal year 2014-15, $99.3 million was invested in this area.
• An Alternative Level of Care (ALC) Resource Matching and Referral Initiative to streamline and standardize patient referrals. The investment during the fiscal year
• was $0.4 million. (A patient is designated as ALC when the individual is occupying a bed in a hospital, but does not require acute services and is waiting for availability in a more appropriate setting.)
• Nurse-Led Long-Term Care Outreach Teams are working across 14 LHINs to reduce transfers of Long-Term Care residents to EDs. The annual investment was $6.1 million.

By December 2014, the overall ED Length of Stay had decreased by 1.2 hours to 8.2 hours compared to 9.4 hours in April 2008. Overall, Ontario hospitals have been able to decrease time spent in EDs by 13.3% since April 2008. 87% of all ED patients are currently being treated within the provincial targets.

Wait Time Strategy

Ontario’s Wait Time Strategy was created in 2004 to reduce wait times and improve access to key diagnostic imaging and surgical services. The ministry publicly reports on wait times through the website (www.ontariowaittimes.com) to remain accountable and encourage better hospital performance. Ontario currently reports on wait times for over 190 different surgical and diagnostic procedures.

In fiscal year 2014-15, the ministry invested $83.6 million to address wait times by funding additional surgical procedures and diagnostic tests. Ontario has invested over $1.9 billion for more than three million additional procedures to help reduce wait times since 2003-04. Ontario continued to receive straight A's from the Canada-wide Wait Time Alliance for meeting performance targets in reducing wait times in five priority health service areas - hip replacements, knee replacements, cataract surgery, radiation oncology and cardiac services.

eHealth

The ministry continues to invest in eHealth initiatives to enable health system modernization, which supports improved integration, quality, safety and delivery of care to all Ontarians.

Progress on key initiatives includes:

• As of January 2015, 12,367 providers (including approximately 79% of primary care providers and 77% of community-based specialists) representing more than 10 million Ontarians have or are in the process of implementing Electronic Medical Records.
• As of February 2015, the Ontario Laboratories Information System collects approximately 76% of all hospital, community and public health laboratory data in the province, creating a centralized record of patients' lab test results that are available to nearly 85,000 clinicians.
• As of February 2015, the electronic Child Health Network system contains electronic records for 70% of the Ontario pediatric patient population.
• eHealth Ontario continues to work with the selected vendor to develop the provincial Health Information Access Layer, which will support broad clinical information sharing across the province.
• The Telehomecare Expansion Project is underway to provide telehomecare services across seven LHINs (Toronto Central, Central West, North East, North West, Erie St. Clair, Central, and North Simcoe Muskoka). To date, over 5,100 patients have been enrolled in the project. Telehomecare has been shown to reduce emergency room visits, hospital admissions, as well as walk-in clinic visits.

The ministry received approval in April 2014, to provide the Care Coordination Tool (CCT) to up to 20 Health Links over a 12 to 15 month proof of concept project. CCT will meet core Health Link requirements for care coordination by enabling them to create, maintain and share coordinated care plans and send secure messages throughout the circle of care. Since January 2015, a vendor has been in place to deliver CCT and the ministry has begun engaging Health Links in the implementation process.

Other eHealth Achievements

• Diagnostic Imaging / Picture Archiving and Communication System is now implemented in all Ontario hospitals. All of the province’s hospitals have connected to regional repositories and are able to share images with other hospitals in their respective regions.
• The Drug Profile Viewer was operational in 245 hospital sites and 20 Community Health Centres. It gives authorized health care providers access to electronic prescription drug information and medication histories for 3.8 million Ontario Drug Benefit recipients, 24 hours a day, 7 days a week.
• In 2013-14, the Ontario Telemedicine Network enabled over 314,000 clinical consultations through telemedicine, reaching an estimated 141,000 unique patients across Ontario, over 1,700 sites. Telemedicine saves travel and inconvenience for patients in northern and remote locations and reduces the environmental impact of the health system, including an estimated cost avoidance of over $60 million annually in northern travel costs.
• The government and eHealth Ontario have made significant progress toward addressing recommendations of the 2009 Provincial Auditor General’s special report of Ontario’s Electronic Health Record Initiative. As of December 2014, 96% of the remediation actions had been taken. As an example, eHealth has reduced its reliance on consultants from 394 in April 2009, to 43 in October 2014.

Ministry Interim Actual Expenditures 2014-15 ^{footnote **[**]}($)