PRESIDENT AND CEO REPORT TO THE BOARD AND COMMUNITY February 2012

Transcription

1 PRESIDENT AND CEO REPORT TO THE BOARD AND COMMUNITY February PERFORMANCE EXCELLENCE Creating a Culture of Safety in the Intensive Care Unit (ICU) Project University Hospital ICU s hand hygiene rates have improved over the past year, but given the high vulnerability of that particular patient population, who are often in critical condition, ICU staff initiated a new continuous quality improvement project to take hand hygiene compliance to new levels. The team took influencer training last spring and decided to use this methodology to change behaviours around hand hygiene compliance and modeled their work on the successes of Spectrum Health in Western Michigan. Spectrum Health is a corporation of seven hospitals, 8000 employees and 1500 physicians. Spectrum Health achieved 100% compliance in six months and has sustained it for over two years. The LHSC ICU project plan kicked off on January 16, 2012 with staff members signing their commitment to follow the three vital behaviours that will guide the success of the program: 1. Wash in, Wash out: Wash your hands when you go into a patient s room and when you leave % accountability: 100% accountable for one s own actions and 100% accountable to remind others if they have missed an opportunity to wash their hands. 3. Say thank you: The only response to being reminded to wash your hands is thank you. The project s goal is to reach 100% at Moment 1 and Moment 4 in 100 days (April 24 th ). The project team has increased the number of audits completed and posts the data to both share results and keep the team engaged in the continuous quality improvement. After just 4 weeks, the ICU results are already trending up and are now well above the 80% LHSC target threshold. This kind of initiative reflects the transformation under way at LHSC to become a learning organization and I commend the staff of the ICU for creating a culture where it is expected and safe to speak up when you see missed opportunities for excellent care. Home First at LHSC, Ensuring that patients receive the right care in the right place-- As a part of its ongoing focus on improving patient access and flow, London Health Sciences Centre, in collaboration with the South West Community Care Access Centre (SW CCAC) and the South West Local Health Integration Network (SW LHIN), has begun implementation of Home First, a strategy intended to reduce the number of newly designated Alternative Level of Care Long Term Care (ALC-LTC) patients. Project teams have been created for both University and Victoria hospital sites that include various disciplines and front line CCAC staff to redesign processes and influence a number of behaviour changes within the organization. Since kicking off Home First last September, the number of newly designated ALC-LTC patients has seen a sustained

2 Chief Executive Officer Report to the Board Page 2 decrease. To date, LHSC has successfully sent 30 patients home on CCAC s new Intensive Hospital to Home service plan (one of many components of Home First). An increase has also been seen in the number of patients supported on Safe at Home, another high intensity service plan offered by CCAC in the community, as well as an overall increase in the number of referrals to CCAC. The hospital and CCAC implementation teams are also working on developing a new screening tool that will flag patients early in their admission to hospital of being at risk of having a challenging discharge. In addition to the new screening tool, the implementation teams are developing an e-notification system that will interface the LHSC Cerner system with CCAC s Client Health and Related Information System (CHRIS) and will allow both organizations to be aware of patients who are already CCAC clients. The final deliverable of the project is an e-referral system that will allow staff to input information into the electronic record and automatically generate a referral to CCAC. These e-health solutions will be implemented over the coming months. Lawson Health Research Institute receives Canada's first whole body PET/MRI-- The new hybrid imaging scanner, which combines magnetic resonance imaging (MRI) and positron emission tomography (PET), is an exciting acquisition of Lawson's Imaging Program at St. Joseph's Hospital. There are five other such hybrid imaging devices in the world, three in the United States and two in Germany. The 10-tonne state-of-the-art piece of equipment, which will be used by researchers to improve diagnosis and treatment of major health challenges such as cardiovascular disease, neurological diseases, mental illness, and cancer, was lifted by crane and lowered into its new home on Tuesday, February 7 th. Provided are links to some of the local media coverage Lawson received: Metro: CTV-2: Implementation of New Magnetic Resonance (MR) Simulator Service for Cancer Patients--The new MR Simulator went operational in November and has been going through an initial startup phase as staff develops their operational skills with this new technology. The MR Simulator is a cost-effective solution for preparing patients for MRI or fmri studies. Familiarization is essential for reducing the stress and discomfort commonly experienced by patients. The MR Simulator helps to increase the quality of your studies and reduces the risk of premature session termination related to patient discomfort. The new MR Simulator has already been used to plan the radiation therapy treatment of over 35 patients for a range of cancers including; CNS Brain, Cervix, Head & Neck, Prostate, Rectum and Vagina/Cervix with both an external radiation beam treatment using our LINACs as well as treatment with internal radioactive pellets using high dose brachytherapy. Regional Hip Fracture Improvement Project -- This project was initiated across the SWLHIN to enhance access to care. Dr. Steve MacDonald, orthopaedic surgeon LHSC, and Andrew Williams, CEO Huron Perth Healthcare Alliance are co-chairs of this committee.

3 Chief Executive Officer Report to the Board Page 3 The primary objective for this initiative is that all hospitals in the SWLHIN achieve the provincial target of operating on 90% of hip fracture patients within 48 hours of admission to their institution. This initiative was further guided by principles of quality, patient safety and timeliness of care. For the period of September to October 2012, the SWLHIN is reporting that 88% the hip fractures are receiving surgical intervention within 48 hours across the region. A number of recommendations have been implemented. Notably, University Hospital will be making available OR time during the day for Orthopaedics to create more capacity to accommodate emergent hip fracture surgeries. In addition, Woodstock General Hospital is implementing important elements of the Bone and Joint Health Network model of care. Providing seamless on-call coverage by orthopaedic surgeons at secondary care facilities was identified as a key priority during the analysis phase of the project. This was effectively addressed through cooperation of the orthopaedic surgeons across the SWLHIN. As a demonstration of such cooperation, the Regional Ortho On-Call Protocol has emerged and is being piloted across the region. The essence of the arrangement is as follows: Four secondary care hospitals (Stratford, Strathroy, St. Thomas and Woodstock) form the first tier of response: if an orthopaedic surgeon is not on call at one of these hospitals, new patients requiring hip surgery are transferred to one of the other three facilities, per the consolidated regional on-call schedule. Tertiary cases are transferred to London, per the currently established practice. Patients from other centres in the region are promptly repatriated back to home hospital when appropriate. One Number protocol is used to facilitate transfers. There are numerous advantages to this tiered approach. The pilot commenced on December 1, 2011 with three hospitals; extended to include Woodstock on January 1, ACADEMIC SCHOLARLY LEADERSHIP Bench to Bedside Newsletter by Lawson Research-- In an international study based at Lawson Health Research Institute and London Health Sciences Centre s London Regional Cancer Program (LRCP), scientists are testing a therapy with the potential to eradicate cancers previously thought to be incurable. Using stereotactic ablative radiotherapy, or SABR, scientists believe they may have found a solution that could eradicate spreading cancer cells. More on this exciting study and other updates on the External Scientific Review can be found in the winter edition of the Lawson newsletter: link here City Wide Joint London Health Research Day This inaugural event is taking place on March 20 th at the London Convention Centre. It has generated great interest from research students at both Lawson and the Schulich School of Medicine. With an unprecedented 354 abstract submissions, the day promises to be stimulating. It is an opportunity to showcase London as a major centre of academic health research innovation and collaboration, and is also being used as a vehicle for outreach to local VIPs and government officials.

4 Chief Executive Officer Report to the Board Page EXEMPLARY COMMUNITY PARTNERSHIPS Common Benefit providers for Southwest LHIN Hospitals now in Place In April 2009, the Shared Services Sub-Committee of the Health Human Resources Advisory Group (HHRAG) recommended to the Hospital CEO s within LHIN 2 that a Benefit Steering Committee be struck to pursue opportunities for collaboration as it relates to Benefit Consulting services and Benefit provider(s). The following major project gates have been completed and, as of February 2012, all hospitals in the SWLHIN have transitioned to the new common providers. June 2009: sixteen (16) Hospitals signed on to participate on the Benefits Steering Committee (BSC) July 2010: Aon Hewitt was selected as a shared benefit consultant, January 2011: A request for proposal (RFP) was finalized together with evaluation criteria based on the requirements identified by the broader steering committee. July 13, 2011: Steering Committee members confirmed their support of the quotation and recommended that the participating hospitals of SW LHIN commence contract finalization and implementation with Manulife Financial (for Health/Dental/Life/LTD coverage) and ACE INA for Accidental Death and Dismemberment coverage. December 2011: A staggered implementation across various hospitals commenced to ensure a smooth transition to the new carriers. February 2012: Implementation across all hospitals achieved. Aon Hewitt has predicted significant savings over the five year period for both LHSC and other SouthWest LHIN hospitals. South Street Hospital -- The decommissioning design detail, tender drawings and specifications for Part A are underway. The City provided direction on heritage conservation of buildings at the Planning & Environment Committee on January 16, 2012, and Municipal Council on January 30, We have now received a letter confirming Council s direction. We proceed to develop specifications and tender documents for the work. 4.0 CEO RECOGNITIONS Canadian Certified Physician Executive Credential Award Congratulations extended to Dr. Andrea Lum on obtaining this certification. Physicians awarded the CCPE have demonstrated that they have the leadership capabilities, knowledge and skills needed for successful performance and, more important, to direct, influence and orchestrate change in Canada's complex health care system. Dr. Lum has also been recently appointed by the Board of Directors as Interim Vice- Chair of the Medical Advisory Committee.

5 Chief Executive Officer Report to the Board Page HEALTHCARE REGIONAL NEWS Public Services for Ontarians: A Path to Sustainability and Excellence Commonly referred to as the Drummond Report, this comprehensive look at Ontario s public services was premised upon a 5-fold mandate: 1. Advise on how to balance the budget earlier than the fiscal year. 2. Once the budget is balanced, ensure a sustainable fiscal environment. 3. Ensure that the government is getting value for money in all its activities. 4. Do not recommend privatization of health care or education. 5. Do not recommend tax increases. The report concludes that, although there is a stated commitment to balance the budget by , the 2011 budget measures signaled to date would not be sufficient to do so. The report argues that the province cannot continue to count on accelerated economic growth or rapid productivity gains to finance our future needs. The report also notes that Ontarians will not accept increases in taxes or the reduction/privatization of other government services to square the province s fiscal accounts. Ontario s $14 billion deficit in was equivalent to 2.3 per cent of gross domestic product (GDP), the largest deficit relative to GDP of any province. Net debt came to $214.5 billion, 35 per cent of GDP. The 2011 Ontario Budget set as the target year to balance the books at least three years behind any other province. The government asked this Commission to help meet and, if possible, accelerate the deficit-elimination plan. This will no doubt put tremendous pressure on the health care sector in Ontario which continues to be the largest spending program (40% of total spending = $44.77 billion). Going forward, the Provincial government will be further challenged by planned changes to the Canada Health Transfer (CHT). The federal government recently announced the continuance of the CHT at six percent through , after which it will grow in line with a three-year moving average of GDP, representing estimated annual growth of about 4%. The Drummond report concludes that Ontario faces a series of deficits that would undermine the province s economic and social future and therefore significant reforms to the delivery of public services are needed that not only contribute to deficit elimination, but are also desirable in their own right. The commission has recommended 105 ways in which health care reform can be accomplished but the report lacks clarity on the how part of the plan. Many stakeholders will be actively engaged in the ensuing reform dialogue and it remains to be seen to what extent the provincial government will adopt the Commission s recommendations. While there will no doubt be challenging times ahead, the need for change may well present opportunities to meaningfully reform the health care system to provide better outcomes for

6 Chief Executive Officer Report to the Board Page 6 patients. LHSC welcomes the opportunity to work together with the government and all stakeholders to find the necessary solutions to meet the challenges facing today's health care system. The full Commission s report can be found here. Drummond Report Next Steps: There will be many reports and articles tabled in reference to the Drummond report from all stakeholders within the public sector. Examples of these have been included into my report this month. Please find attached the following reports: The action plan for Ontario Healthcare-Deb Matthews (Appendix I), The Ontario Hospital s Association Analysis of the Drummond recommendations for healthcare (Appendix II) Lawson Health Research Institute Communication summary (Appendix III) Karen Michell, Executive Director, Council of Academic Hospitals of Ontario (Appendix IV) Drummond Report Calls for Systemic Changes to Health Care (Faskin Martineau) (Appendix V) Ontario Research Fund Reduction in Investment -- Please find attached (Appendix VI) a letter submitted on behalf of London Health Sciences Centre by Mr. Peter Johnson which formally expresses our concern respecting the recent announcement of ORF defunding. 6.0 LHSC IN THE NEWS Please find attached the Media Report in Appendix VII Respectfully Submitted, Bonnie Adamson

7 Ontario s Action Plan For Health Care Better patient care through better value from our health care dollars ontario.ca/health

8

9 Ontario s Action Plan For Health Care Better patient care through better value from our health care dollars Taking Stock Ontario s Health Care System Today Our goal is to make Ontario the healthiest place in North America to grow up and grow old. And this is our plan to get us there. Our parents and grandparents had the vision and compassion to create our uniquely Canadian universal health care system. And now, it's our turn to protect and strengthen health care, so it s there for our children and grandchildren, just as it is there for us. Since 2003, we ve built a stronger foundation by providing better access to care, higher quality care and better value for money. Better Access The first step we took towards rebuilding Ontarians health care system was to improve access to family health care and reduce wait times across the province. Together, we ve: Ensured over 2.1 million more Ontarians have a family doctor 1 Created and expanded new primary care models, including Family Health Teams, Community Health Centres, and Nurse Practitioner-Led Clinics Opened 200 Family Health Teams providing care to over 2.7 million Ontarians Cut wait times for key procedures in half Ontario now has the shortest wait times in Canada Introduced public reporting of wait times by hospital Expanded the roles of nurses, physician assistants and other practitioners Added over 3,400 more doctors since 2003 Reversed the brain drain on physician supply Better Quality The next step in rebuilding Ontario s health care system was to focus on the quality of care people receive. We re ensuring care is patient-centred, driven by outcomes and based on evidence. Together, we ve: Passed new legislation the Excellent Care for All Act (ECFAA) to help focus our efforts on quality patient care Introduced annual public quality improvement plans for every hospital Linked hospital executive compensation to achievement of quality improvement targets Required all hospitals to publicly report on nine key patient safety indicators Required patient and employee satisfaction surveys and a patient complaints process in all hospitals Created Health Quality Ontario (HQO) - an agency responsible for promoting evidencebased standards of care, recommending best practices, and monitoring, publicly reporting on and supporting quality of care. 1 According to figures from the Ontario Medical Association 3

10 Better Value We improved the value Ontarians gain from our investments in health care. We owe it to Ontarians to get the most health care for each hardearned tax dollar. Together, we ve: Cut the cost of generic drugs in half, saving Ontarians $500 million annually Introduced evidence-based changes to the fee schedule, reallocating $125 million this year towards more effective patient care Reduced the number of unnecessary vitamin D tests Increased screening rates for cervical, breast and colorectal cancer through comprehensive screening programs Decreased smoking rates from 24.5 per cent in 2000 to 19.3 per cent in 2010, reducing the number smoking-related illnesses Introduced accountability agreements with hospitals to tie funding to achieving reduced wait times and better patient care Ensured that, through accountability to Local Health Integration Networks (LHINs), hospitals are balancing their budgets Ensured that all Ontarians with diabetes who wish to have a primary care provider now have one Reduced the need for Ontario residents to go out-of-country for bariatric surgery by 99 per cent But there is so much more we need to accomplish We have made great progress since 2003, and our health care system is undeniably better as a result. Despite this progress, there is more to do. We re not as healthy as we could be In 2010/11, over 271,000 emergency room visits were made to Ontario hospitals that could have been treated in alternative primary care settings. Twenty five per cent of health care costs are due to preventable illnesses. Nearly half of all cancer deaths are related to tobacco use, diet and lack of physical activity. Obesity has a direct effect on the rate of type 2 diabetes and diabetes costs Ontario $4.9 billion a year. Currently, over 50 per cent of adults in Ontario, and about 20 per cent of youth, are overweight. We re taking avoidable trips to the emergency room (ER) instead of receiving care closer to home... In 2010/11, over 271,000 emergency room visits were made to Ontario hospitals that could have been treated in alternative primary care settings. These trips to the ER are avoidable and these patients could have received optimal care at a lower cost outside of the hospital. 4

11 We re returning to the hospital for follow-up care when we could be receiving it at home When patients leave hospital and don t receive the right care at home, they may end up being re-admitted to hospital. For example, in 2009 there were 140,000 instances of patients re-admitted to hospital in Ontario within 30 days of their original discharge. We re having difficulty navigating the system and we re falling through the cracks There are still too many instances where patients don t know how to access the care they need, don t know what services are available or are waiting in hospital until home care or long-term care are available. Better integration through our local health networks will put the right care in the right place for the benefit of patients and the system. We can do better. We need a patient-centred system that has better integrated health providers such as family health care, community care, hospitals and long-term care that moves patients more seamlessly from one care setting to another. Demographic and Fiscal Challenges The health care system is facing unprecedented challenges. Most prominent among them are the demographic and fiscal challenges. Indeed, if we didn t change anything, kept the age-specific costs what they are today and applied them to the 2030 population, our health costs would increase by $24 billion 50 per cent more than today from changing demographics alone. Our population age structure is changing. We re living longer and baby boomers are reaching the age where they ll need more health care. Just as our education system responded decades ago to the baby boom, today s health care system must now prepare for the demographic shift that will double the number of seniors living in Ontario over the next 20 years. Of course the older we are, the more we depend on our health care system. The cost of care for a senior is three times higher than for the average person. Indeed, if we didn t change anything, kept the age-specific costs what they are today and applied them to the 2030 population, our health costs would increase by $24 billion 50 per cent more than today from changing demographics alone. Even if the province wasn t facing serious economic pressures, the health care system would still need to transform to address the coming demographic shift. Today, health care consumes 42 cents of every dollar spent on provincial programs. Without a change of course, health spending would eat up 70 per cent of the provincial budget within 12 years, crowding out our ability to pay for many other important priorities. Ontario s Action Plan For Health Care 5

12 A system ready for change: From administrators through to frontline nurses, from doctors to patients, there is an eagerness to re-tool the system for the challenges of tomorrow. With all hands on deck, our shared commitment will achieve the goal of a sustainable health care system that is there for generations to come. These demographic changes are happening concurrently with the province s need to reduce the historical growth of health spending as we continue to cope with the global economic downturn, and eliminate the provincial deficit. Limited resources will require us to choose carefully between health priorities so that we can best serve patients as we transform our system to improve quality of care. Health care dollars must be shared between hospitals, doctors, long-term care, palliative care, drugs, home care and other services. Money spent in one area simply means that there is less funding available to pay for the needs in another area. We re going to have to make tough trade-offs and shift spending to where we get the best value for the dollar. For example, a one per cent increase in compensation to physicians is equivalent to the funds needed to pay for home care for 30,000 seniors. A one per cent increase in funding for hospitals is equivalent to the funds needed to pay for over five million hours of home care. While the demographic shift compels us to reform health care, today s fiscal reality requires that we act now to make Ontario s health care system sustainable. But sweeping cuts to health care aren t the answer this has been tried before, and would not serve Ontarians well. What is needed is an action plan to create a system that delivers care in a better way a smarter way. One that improves quality for patients as it delivers increased value for taxpayers. To do this requires that we take decisive steps. Together, we will take those steps to transform the system. The Opportunity While the challenge before us is significant, we have many reasons to be optimistic that we can meet our goal of improving patient care by gaining better value from our health care system. Some of those opportunities are: A system ready for change: From administrators through to frontline nurses, from doctors to patients, there is an eagerness to re-tool the system for the challenges of tomorrow. With all hands on deck, our shared commitment will achieve the goal of a sustainable health care system that is there for generations to come. Technology: Technological advances have resulted in productivity gains and effectiveness of care. New advances have resulted in reduced wait times, better diagnostic tools that are saving lives, virtual health initiatives that are eliminating the barrier of distance, and electronic health records that are enabling a more patient-centred system. 6 Evidence: Scientific research and a focus on patient outcomes have produced more evidence on the effectiveness of treatments, diagnostics, and medications. This evidence helps answer the question of how finite health care dollars should be allocated to best serve patients.

13 Our plan is obsessively patient-centred. Our Action Plan Our plan is obsessively patient-centred. As a result, our priorities are based on what you, the patient, should be able to expect from your health care system. Ontarians should have: We will aggressively take on the challenge to reduce childhood obesity by 20 per cent over five years. 1. Support to become healthier 2. Faster access and a stronger link to family health care 3. The right care, at the right time, in the right place We have a plan to transform Ontario s health care system to meet these goals for patients and ensure our system is sustainable for our children and grandchildren. We will achieve our objectives in the same way we have achieved our progress to date by working together with all our partners across Ontario s health care system. Change will not always be easy, and will not happen overnight. However, by working together, this plan will become reality. #1) Keeping Ontario Healthy Helping people stay healthy must be our primary goal and it requires partnership. As a government, we re increasingly putting our efforts into promoting healthy habits and behaviours, supporting lifestyle changes and better management of chronic conditions. But to succeed, we need everyone to play an active role in their health care by participating in healthy living and wellness, while also taking advantage of recommended screening and vaccination programs. Here are some key next steps we will take, in partnership with Ontarians, to promote better health. Childhood Obesity Strategy Obesity in childhood contributes to the rise in life-long chronic diseases, such as diabetes, cancer and heart disease. Some experts suggest that this generation of children could live shorter lives than their parents, so we must take action today. We will aggressively take on the challenge to reduce childhood obesity by 20 per cent over five years. Success on this front will require partnership, so we will bring together a panel of advocates, health care leaders, non-profit organizations, and industry to develop the strategy to meet our target. This panel will report back to us by Fall Ontario s Action Plan For Health Care 7

14 A recent study reports that 75 per cent of seniors with complex needs who are discharged from hospital receive care from six or more physicians and 30 per cent get their drugs from three or more pharmacies. A Smoke-Free Ontario We are determined to have the lowest smoking rates in Canada, and we will continue expanding our efforts to reach this goal. To help more Ontarians quit smoking, we have recently listed smoking cessation drugs on the Ontario Drug Benefit formulary, and expanded access to nicotine replacement therapies for those undergoing addiction treatment. We will increase fines on those who sell tobacco to children and we will continue to build on our contraband strategy by doubling enforcement efforts. Online Cancer Risk Profile and Expanded Screening Ontario ranks among the best in the world with our cancer survival rates. However, we must be relentless in maintaining our efforts to save lives and early detection is fundamental to this effort. Success in this area requires a shared determination between government and Ontarians. We all must be cancer fighters. All Ontarians will have access to an online Personalized Cancer Risk Profile that will use medical and family history to measure the risk of cancer and then link people at higher risk to screening programs, prevention supports or genetic testing. We will also expand our comprehensive screening programs for cervical, breast and colorectal cancer to notify and remind participants when they are due for their next screening. #2) Faster Access and a Stronger Link to Family Health Care When patients have faster access to family health care that serves as the hub of our health care system, they stay healthier, get connected to the right care and are less likely to require treatment in hospital. This is especially true for our seniors, who need a coordinated plan in place to receive the care they need, with help navigating the various parts of our system. A recent study reports that 75 per cent of seniors with complex needs who are discharged from hospital receive care from six or more physicians and 30 per cent get their drugs from three or more pharmacies. There are a number of steps we will take, in collaboration with all our family health care providers, to best serve patients. 8 Family Health Care at the Centre of the System Family care providers are a natural anchor for patients in our health care system. They are well positioned to help patients navigate the system, particularly patients with multiple complex conditions. When one of their patients is discharged from hospital, they need to be made aware and able to access information quickly for appropriate follow-up. They need to be spending less time on the phone searching for a specialist to see their patient and more time with their patients. We will work with our doctors and all our health providers to strengthen the role of family health care in our system, because it s better for patients, supports a

15 better quality of practice for our doctors and reduces the likelihood that patients will be admitted, or readmitted, to hospital. If we are successful, fewer patients will be readmitted to hospital within 30 days of discharge. Through the LHINs, we will hold the entire health system accountable for substantial progress towards fewer hospital readmissions. Faster Access Our goal is to have a family health care provider for every Ontarian who wants one and to provide more patients with faster and more convenient access to this care. Together, with our doctors and nurse practitioners, we have made great progress in this area. But we have more to do. Under our plan, even more patients will have access to same-day and next-day appointments and after-hours care. This means better care for our patients and less strain on other areas of our health care system, such as hospital emergency rooms. House Calls For frail seniors, getting to their family care provider can be a challenge. Too often, those patients who need family health care the most cannot access that care and only enter the system once their condition becomes acute and they find themselves in an emergency room. That is why we will be expanding access to house calls from health care professionals, like doctors, nurses and occupational therapists. We will also be improving access to online and phone consultations. Local Integration of Family Health Care That is why we will integrate family health care into the LHINs. Together, we will identify a model that brings planning and accountability for the full patient journey under the LHINs. If family health care providers are to have an even stronger role in our health care system, they must be well integrated at a local level with all the other providers involved in the patient journey. That is why we will integrate family health care into the LHINs. Together, we will identify a model that brings planning and accountability for the full patient journey under the LHINs. However, the Ministry of Health and Long-Term Care will continue to have a funding role with Ontario s doctors. Patient-centred integration is the right thing to do for patients, and for our health care system. Ontario s Action Plan For Health Care A Focus on Quality in Family Health Care Our drive to ensure quality in health care is relentless and we have made great strides in improving quality and accountability in our hospitals with the implementation of the Excellent Care for All Strategy. In consultation with doctors, nurses, and other health care providers, we will expand our focus on quality improvement to family health care, and ensure that all family health care providers are equipped to integrate the latest evidencebased care into their practice. 9

16 #3) Right Care, Right Time, Right Place At the heart of our action plan is a commitment to ensure that patients receive timely access to the most appropriate care in the most appropriate place. It s about getting the greatest value for patients from the system, allowing evidence to inform how our scarce health care dollars are best invested and ensuring seniors receive the care they need as close to home as possible. The Right Care High Quality Care we will continue to find ways to fully maximize the potential of our range of health care professionals. Higher quality care is better for patients and is also less expensive. It means getting it right the first time. It means allowing the best evidence and clinical guidelines to determine when an MRI or CT scan is required, so that these resources are accessible to patients who need them most. It means that funding and prescribing drugs is based on the best evidence, avoiding overmedication. Evidence will drive our decisions and it will drive our funding. If there is evidence to support a new procedure or test, we will fund it. If the evidence is not there, funding will not be available. Of course, as it is today, if a patient wishes to purchase an uninsured service they may make that choice. Health Quality Ontario (HQO) then helps to translate the evidence into concrete tools and guidelines that providers across the health system, including family health providers, can put into practice for the benefit of patients. As the mandate of HQO continues to expand, we will ensure that it has the tools and expertise required to fulfill this crucial function. The right care also means care that is provided by the appropriate health care professional. We have taken steps to expand the scope of practice of a number of health care professionals, such as nurse practitioners and pharmacists, so that they are contributing their full potential to the benefit of patients. As we move forward, we will continue to find ways to fully maximize the potential of our range of health care professionals. 10

17 At the Right Time Timely, Proactive Care Timely access to care is critical. It means patients having faster access to the care they need. We can achieve this by continuing to harness technological advances that allow patients to receive care more quickly, especially in rural and northern communities. For example, strengthening Ontario s Telemedicine Network means more patients are able to benefit from faster care in their community, while accessing the most highly skilled specialists that our province has to offer. We will continue to drive our wait time strategy, so that more patients receive medically appropriate waits for their procedures. Timely care also means getting patients the care they need before more acute and costly care is required. The Heathy Homes Renovation Tax Credit, for instance, helps seniors stay at home longer by giving them the supports they need to prevent falls and injuries. By providing support at the right time, we can reduce the number of broken hips, improving the quality of life of our seniors and freeing up resources in our hospitals. Timely preventative care is also critical to management of chronic diseases, like diabetes. By acting sooner to manage chronic conditions, we can reduce the number of unnecessary hospital visits and improve the quality of life for patients. Nowhere is early intervention more important than in mental health. Seventy per cent of mental health problems first appear in childhood and adolescence. That s why we will implement our mental health strategy starting with children and youth, including getting mental health nurses into our schools, supporting people with eating disorders, and smoothing the transitions of people between mental health care providers. And in the Right Place Care as Close to Home as Possible The most significant part of our plan focuses on ensuring patients are receiving care in the most appropriate setting, wherever possible at home instead of in hospital or long-term care. It means structuring the system to meet the needs of today s population, with more focus on seniors and chronic disease management. Ontario s Action Plan For Health Care One of the greatest challenges we have in the health care system is patients (known as Alternative Level of Care or ALC) who are in hospital beds who could be better cared for at home or in the community if the right supports were in place. Better serving these patients benefits the entire system, because it frees up hospital beds for those who need them, reduces pressure on emergency rooms and saves money. Our plan will aggressively move to make progress on this issue by building capacity in the community. 11

18 Seniors Strategy We will launch a Seniors Strategy with an intense focus on supporting seniors to stay healthy and stay at home longer, reducing strain on hospitals and long-term care homes. Our Seniors Strategy will include: We will launch a Seniors Strategy with an intense focus on supporting seniors to stay healthy and stay at home longer, reducing strain on hospitals and longterm care homes. Success of this strategy will be measured by fewer seniors admitted and readmitted to hospital who could otherwise be cared for at home or in the community, and providers will be held accountable for progress on this. An expansion of house calls More access to home care through an additional 3 million Personal Support Worker hours for seniors in need Care Co-ordinators that will work closely with health care providers to make sure the right care is in place for seniors recovering after hospital stays to reduce readmissions The Healthy Homes Renovation Tax Credit, which will support seniors in adapting their home to meet their needs as they age, so they can live independently at home, longer Empower LHINs with greater flexibility to shift resources where the need is greatest, such as home or community care. Local Integration Reform The creation of our Local Health Integration Networks (LHINs) has improved the integration of our health care system at the local level. Care is more cohesive, and providers are working together more. In short, the system is beginning to operate more like a system. This is the beginning of an evolution towards better integration, and system accountability for improved patient outcomes. However, if we are to meet the needs of a growing population with multiple, complex and chronic conditions, our health care system must be even better coordinated, with seamless levels of care. In addition to integrating family health care into LHINs, we will introduce further reforms to promote more seamless local integration, with fewer layers of administration, to ensure we have a system truly structured around the complex needs of an aging population. This integration will be particularly crucial in our effort to better serve the one per cent of the population that accounts for 34 per cent and the ten per cent of the population that accounts for nearly 80 per cent of our health care spending. With greater patient-centred integration across all facets of the patient journey, these patients will have a better coordinated plan of care, while gaining greater value from the system. 12

19 Moving Procedures into the Community We will shift more procedures out of hospital and into non-profit community-based clinics if it will mean offering patients faster access to high-quality care at less cost. There are routine procedures currently conducted in hospital that could be performed in the community at the same high quality standard (if not better) and at less cost. We will shift more procedures out of hospital and into non-profit community-based clinics if it will mean offering patients faster access to high-quality care at less cost. We will not compromise on quality, oversight, or accountability. The Kensington Eye Institute has already put this model into action. The Institute is renowned for providing high-quality cataract procedures through OHIP. By focusing on a select few procedures, the Institute serves more patients and has excellent patient outcomes. Funding Reform Our entire patient care transformation will be successful only if our funding models reflect our priorities. As we transition towards a patientcentred system and away from a provider-centred system, the way in which we fund our providers must also change. Care providers should be rewarded for ensuring better patient outcomes. Funding must follow the patient. That is why we will accelerate the move to patient-based payment, as patients move through our health care system. Funding of small, rural hospitals will continue to be treated uniquely, given their lower patient volumes. Funding must follow the patient. Ontario s Action Plan For Health Care 13

20 Call to Action From patients to doctors, front-line nurses to hospital administrators, personal support workers to LHINs everyone has a role to play in this health care transformation. In tomorrow s health care system there is no room for self-interest, only the best interest of patients. The simple truth is that we can t keep increasing health care spending at the rate we have to date. This, coupled with the current state of our provincial deficit and Ontario s aging population, means that we need to make immediate reforms to our health care system. We must make changes today to protect our universal health care system. This action plan will get us there, but to achieve our goals we are going to need the support of the entire system. From patients to doctors, front-line nurses to hospital administrators, personal support workers to LHINs everyone has a role to play in this health care transformation. This is a call to action. We all must share the common goal of a health care system that will provide even better care for patients at less cost for our loved ones who are aging and for the generations that will follow us. In tomorrow s health care system there is no room for self-interest, only the best interest of patients. There is more work to be done, but we are building on the progress we ve made together and willingness from across the sector to embrace a patient-centred system. We are fortunate to have examples to look to from across the province where these changes are already taking shape and improving the quality of life for Ontarians. Change will not happen overnight, and it will not be easy. The reality is that we can t afford to wait and we must be relentless in our pursuit to meet this challenge. Patients are counting on us. But we know we will get there, together. 14

21 February 17, 2012 For the attention of: OHA Board of Directors, Hospital CEOs, Board Chairs, Chief Financial Officers, Chief Human Resources Officers and the OHA s Community Affairs and Communications Network (CACN) From: Mark Rochon, Interim President and CEO Analysis of the Drummond Commission Recommendations Over the past several days, the OHA has closely examined the overarching commentary and final recommendations of the Commission on the Reform of Ontario's Public Services (the Drummond Report). We have obviously concentrated on the section on Health, as well as the separate section on Labour. Overall, it is abundantly clear that much of the advice and suggestions of the OHA, as determined by its Board of Directors, has been incorporated by Mr. Drummond and his colleague commissioners into the final report. By clicking here, you may access the OHA's more detailed analysis. It identifies each specific recommendation; how it lines up with the Health Minister's recently announced Action Plan for Health Care; and, its consistency with OHA policy on the topic (if any). For each recommendation, we have also made observations and comments as appropriate. We will also draw your attention to any changes in our analysis as we gain further information. Please note that this is only our preliminary draft, and we intend to refine and update the document in the time ahead. We have substantive comments about several topics and would like to draw them to your attention, while also commenting on the core question of implementation and what happens next. Health System Structure: The Commission is clear enough in recommending that Ontario continue on the path of regional planning for health care services delivery. The Commission goes further than the status quo, however, and states that both public health and primary care should be added to the responsibilities of Local Health Integration Networks (LHINs).

22 The report also states that there should be a reduction in the number of separately governed hospital corporations, as well as many of the other independently governed health care providers. Ultimately, however, the report appears to endorse continued voluntary local governance within the health care system. Importantly, the report clearly states that primary care should be formally organized and better integrated at the regional level. It should be noted that the report does briefly comment on various potential structural models for the health care system, including the so-called "hub hospital" model. While ultimately endorsing a preference for LHINs with additional authority, the report does suggest that the "hub-hospital" model, with approximately 25 network organizations as its foundation, as a credible alternative. It should also be noted that the report frequently uses the term Regional Health Authority to describe LHINs with additional responsibilities. As you are aware, Regional Health Authority has a specific meaning in all other Canadian provinces where generally speaking, independent provider governance has been replaced with regional governance and the consolidation of providers into a single employer organization at the regional level. Given the Commission's apparent endorsement of continued, albeit consolidated local hospital governance within a more integrated health care system, our working assumption is that the term Regional Health Authority is simply being used in a different way in the Drummond report than the application of the term in other provinces. We are working to verify the reasonableness of our assumption. In the government's Action Plan for Health Care the Minister suggests that the government will move to bring public health and certain elements of primary care under the authority of LHINs. Specifically, the Action Plan says the government will integrate family health care into the LHINs. Together, we will identify a model that brings planning and accountability for the full patient journey under the LHINs. However, the Ministry of Health and Long-Term Care will continue to have a funding role with Ontario s doctors. The Action Plan is otherwise silent on the question of health system structure. LHSIA Review: As you are aware, the Local Health System Integration Act (LHSIA) requires a comprehensive review of LHINs and their governing legislation by an all-party committee of the Ontario Legislature. The Ministry of Health and Long-Term Care (MOHLTC) website states that this review must begin no later than July At present, it is not yet clear how the government will proceed with implementing structural reform given that in the minority Parliament, the three political parties have not yet agreed on how to constitute any of its legislative committees. It may be that this spring, the government introduces its own health system structure related legislation (to implement the Action Plan's goal) and negates the legislative requirement for a formal LHSIA review. Health System Structure & Next Steps for the OHA: The OHA is well positioned to deal with the question of health system structural reform. As you are aware, in late 2011 we released our Board-approved position statement on options for health system structural reform in anticipation of postelection discussion about thus matter. The OHA Board of Directors has also recently

23 established a special board committee chaired by Grand River Hospital President and CEO, Malcolm Maxwell, to guide our efforts in advising the Legislature during the LHSIA review. Other committee members are: Sandra Coleman, OHA Board Member and CEO, South West Community Care Access Centre Colin Goodfellow, OHA Board Member and President and CEO, Kemptville District Hospital Murray Martin, OHA Board Member and President and CEO, Hamilton Health Sciences Centre Pierre Noel, OHA Board Member; Chair, OHA Mid-Sized Hospital Provincial Leadership Council; and, President and CEO, Pembroke Regional Hospital Mark Rochon, Interim President and CEO, OHA Wade Petranik, Chair, OHA Small, Rural and Northern Provincial Leadership Council and President and CEO, Dryden Regional Health Centre Glenna Raymond, Chair, OHA Mental Health and Addictions Provincial Leadership Council and President and CEO, Ontario Shores Centre for Mental Health Services Maureen Solecki, OHA Board Member and President and CEO, Grey Bruce Health Services Marcia Visser, 1 st Vice-Chair, OHA Board and Trustee, Sunnybrook Health Sciences Centre Marian Walsh, Board Member, Co-Chair, Hospital Service Accountability Agreement (HSAA) Steering Committee and President and CEO, Bridgepoint Health Should the LHSIA review be cancelled and health system structure-related legislation be introduced in the House, this board committee will have responsibility for shaping our submissions and advice in that context. The OHA will continue to work closely with the government in order to better understand its intentions, as well as working with the Opposition parties to ensure that the debate about health system structure takes place in an evidence-based manner, focused on improving quality of care and the patient experience. The first meeting of our OHA board committee will occur in early March. The Legislature will resume sitting on February 21st. Employment and Labour Relations Matters: The Drummond Commission's recommendations regarding labour are useful, but do fall short of what the OHA had recommended in two key areas: interest arbitration reform and the need to modernize the legislation (The Public Sector Labour Relations Transition Act [PSLRTA]) that regulates employment and labour relations matters when health services change. It is the view of the OHA that given the

24 financial challenges facing Ontario and all broader public sector employers, comprehensive change is needed in both areas in order to make the delivery of health services more affordable, as well as better facilitate integration and quality improvement at the local level. The OHA will continue to advocate for change in both of these areas in the time ahead. The Drummond Commission report is silent on the question of the efficacy of the government's existing policy of a full legislated freeze of wages for non-unionized public sector employees and its policy of directing BPS employers and unions to seek voluntary agreements with net wage increases of zero. However, in our recent meeting with the Minister of Finance and in subsequent media reports, it seems clear that the government will be pushing ahead with comprehensive wage constraint for the next several years for both unionized and non-unionized employees. In a break from the past, the government now appears to acknowledge that the problem of equity unionized and non-unionized employees being treated differently needs to be fairly resolved. Final Comments: The Drummond Commission s final report contains 105 specific recommendations for health care. In addition to recommendations related to the way the system is structured/integrated, the report covers a very wide variety of topics such as; quality and the use of evidence; e-health and the adoption of information and communication technologies; scope of practice among health care professionals; physician issues ranging from the operation of family health teams to the MOHLTC physician services agreement negotiations, and so on. Please contact us with any questions regarding our preliminary analysis of these topics from the Drummond Commission's report. Should you have any questions about the core topics covered in this bulletin, please do not hesitate to contact Interim President and CEO, Mark Rochon, directly at mrochon@oha.com, or Anthony Dale, Vice President, Policy and Public Affairs at adale@oha.com.

25

26

27

28 ( >>> Karen Michell 2/16/2012 5:18 PM >>> To: CAHO Council c.c. CAHO Committees Action Requested: For your information On February 15, the much anticipated Drummond Report was released. The report provides a stark review of Ontario's current economy and includes 362 recommendations to address the provincial fiscal situation. Overall, there is a degree of consistency between relevant recommendations in the report and what CAHO presented to the Commission in September 2011 when we met to provide our perspective on the role academic health science centres can have in improving public services. At that time, CAHO answered a number of questions from the Commissioners regarding the leadership role that AHSC's provide in health system governance, improved integration between the system and different providers (i.e. physicians, community, long-term care), the need to build critical mass for high cost/low volume cases, the need to better align funding and accountability in the system, and the challenges regarding health research funding in Ontario. CAHO did suggest that the Commission should consider in any future governance structure, the unique role AHSCs can provide given the skills, leadership and expertise that currently reside in academic health science centres. The report does incorporate recommendations to revise research funding structures. In the section regarding post secondary Institutions, the report recommends: Recommendation 7-16: Evaluate the research funding system of post-secondary institutions and research hospitals as a whole, including how it is affecting university and hospital budgeting practices. Recommendation 7-17: Award provincial research funding more strategically and manage it more efficiently. Consolidating and offering a single-window approach for access and reporting through an online portal will greatly improve efficiency and reduce paperwork, both for government and for post-secondary institutions. Recommendation 7-17 in particular is consistent with CAHO's long-term advocacy in favour of a Health Research and Innovation Council. The report also states that the Commission sees great value in the Early Researcher Awards and Ontario Research Fund -- Research Infrastructure program (the provincial component of the federal Canada Foundation for Innovation investment). We are concerned about the language that is referenced with respect to teaching and research in universities. The report articulates that research efforts should not trump the teaching experience and goes on to say that: "As federal support for research tripled between 1997 and 2003, universities pursued federal and provincial research dollars, all in the name of becoming "world-class research centres." Few of Ontario's research centres will become the best in Canada, never mind the world. Many, however, have gone so far in this quest as to cross-subsidize research, effectively supporting it with money from undergraduate tuition revenues. Increasingly, universities are letting professors sacrifice teaching commitments to conduct more research. There must be a better balance; excellent research should not trump excellent teaching." It is not clear what the particular reforms should be, nor what mechanisms that should be put in place to ensure this balance of research and teaching. As expected, considerable focus in the report is given to health care which includes over 100 of the recommendations. The report acknowledges that many of the recommendations regarding health care are not new, nor radical, and in many instances recognizes that the system is currently moving towards the kind of reformed system that is needed. Of particular interest to the CAHO community is the reference regarding system governance. The report recommends: Recommendation 5-11 A regional health authority should be clearly identified as the key point for interaction services and institutions across the full continuum of care for a geographic area. The Commission acknowledges that while they recommend that LHINs should assume this regional health authority role, the

29 Page 2 Commission also recognizes that this role could be delivered by the large, mostly academic, hospitals. The report also suggests that the LHINs need to be given the authority to better plan and integrate the system and suggest that amalgamation of the more than 2,500 funded health organizations, including hospitals, is needed. The report also speaks to the importance of evidenced-based policy. Health care providers, particularly physicians, work in a complicated and ever-changing environment. They need research-based clinical guidelines to help them stay current with developments in medicine. The report specifically recommends: Recommendation 5-45: The Institute for Clinical Evaluative Sciences and Health Quality Ontario must work in tandem, integrating their respective expertise into practical recommendation for health care providers. Recommendation 5-46: As a body of practice is established, expand the mandate of Health Quality Ontario to become a regulatory body to enforce evidence-based directives to guide treatment decisions and OHIP coverage. Other notable recommendations include: put in place a 20 year plan for health care that is patient centric and integrated across the continuum of care cap health budget growth at 2.5% until 2017/18 appointment of a Commission to oversee the implementation of the reforms (similar to the Health Services Restructuring Commission) a need for a blended funding model for hospitals (base and activity based funding) encourage hospitals to specialize better utilizing scope of practice for health professionals (i.e. nurses) tie executive compensation to health outcomes require hospitals to make discharge summaries available electronically to other HCP (i.e. primary care, home care) educate doctors in medical school on system issues For most of the recommendations on health, they tend to be more aspirational in tone and provide few specifics in terms of how these reforms should be implemented, or initiated. Now that the report has been officially submitted to the Minister of Finance, CAHO will continue to seek opportunities to advocate to government during budget deliberations. We will also continue to work with the Ministry of Health and Long- Term Care and the Ministry of Economic Development and Innovation in shaping their policy agendas around the Commission's recommendations. In the meantime, if you have any questions or would like to speak with me further about this, please do not hesitate to contact me. Karen Karen Michell Executive Director Council of Academic Hospitals of Ontario 200 Front Street W, Suite 2501 Toronto, ON M5V 3L1 T C [cid:image001.jpg@01cbda5c.98c0f520]

30 BULLETIN Health Law February 17, 2012 Drummond Report Calls for Systemic Changes to Health Care By: Lynne Golding, Cathi Mietkiewicz and Jesse Harper Toronto On February 15 th, 2012 the Commission on the Reform of Ontario's Public Services (the "Commission") has released its much anticipated: Public Services for Ontarians: A Path to Sustainability and Excellence (the "Drummond Report").[1] The recommendations contained within the Drummond Report have the potential to fundamentally change how the public health care system is organized, how provincial funding is allocated, and how patients receive their care. Accordingly, the Drummond Report may constitute a turning-point for Ontario's health care system. However, much of the Drummond Report's impact will be determined by the provincial government's reaction to the report specifically, in whether they choose to accept or reject the recommendations contained therein. Background: the Drummond Report The Commission was established in the spring of 2011 by the provincial government prior to the latest provincial election. The stated purpose of the Drummond Report is to provide recommendations to the provincial government in order to eliminate the provincial deficit and balance the budget by While the Drummond Report seeks to fulfill this promise by recommending cost-saving measures across all provincial sectors, the large burden imposed by health care spending is targeted by the numerous recommendations directed at the health care sector. The recommendations generally focus on finding efficiencies and cutting needless spending from within the current system, which is not overly surprising given that the Commission was specifically mandated to avoid making recommendations that would lead to the privatization of health care.[2] In any event, the report recommends significant changes to the public health care sector, providing new opportunities and challenges for health care providers. Fiscal Issues Prior to the release of the Drummond Report, the provincial government had already planned to limit annual increases in health care spending to 3%. However, the report suggests limiting annual increases of aggregate government spending across all sectors to 0.8%,[3] and suggests a limit of annual increases in health care spending to 2.5% through [4] While these recommendations are likely to have an effect on all future health care spending decisions, they will be especially pertinent for the pending negotiations between the Ministry of Health and Long-Term Care (the "Ministry") and the Ontario Medical Association regarding physician payments through the Ontario Health Insurance Plan ("OHIP").[5] "Patient-Centred Care": Increased Home Care and Primary Care Integration A number of the Drummond Report's recommendations focus on "patient-centred care" by developing systems of coordinated and integrated care that support the patient throughout the various health care settings. The ultimate goal is to maximize the prevention of illnesses that lead to hospitalization, in order to decrease health care costs and increase overall patient well-being. The goal of reducing hospitalization would, according to the Drummond Report, be partially achieved by increasing the amount of health care provided in patients' homes.[6] Home care informs a number of recommendations, including those aimed at the costs associated with an increasingly senior population,[7] the use of telehomecare for patients with serious chronic health problems[8] and those in remote communities,[9] and the increased role that community-based care should play.[10] The Drummond Report states that these proposed changes would create increased opportunities for health care workers to deliver services that are flexible and customized to the patient's needs. There is likely to be an increased integration of family health care into the community health care model in further hopes of minimizing hospitalization. The Drummond Report specifically recommends that primary caregivers be given the mandate of tracking their patients as they move through the health care system (including while in hospital).[11] In addition, Community Care Access Centres and Family Health Teams and are both identified as systems that should be given larger roles in the overall provision of care.[12] These changes would accord with the Minister of Health and Long-Term Care's (the "Minister") previously announced "Action Plan For Health Care" (the "Action Plan"),[13] which contemplates the integration of Family Health Teams into the Local Health Integration Networks.[14] 1 VANCOUVER CALGARY TORONTO OTTAWA MONTRÉAL QUÉBEC CITY LONDON PARIS JOHANNESBURG

31 BULLETIN Health Law Expanding Scope of Practice In line with the push to reduce costs, recommendations are made to help ensure that services are performed by lower-cost health practitioners, where appropriate. Specifically, recommendations target a net shift in responsibilities from physicians to nurses and physician assistants (on procedures such as vaccinations)[15] and an increased role for the LHINs in ensuring that hospitals are utilizing staff to their maximum scope of practice.[16] Through its focus on maximizing the scope of practice of regulated health professionals within hospitals, the Drummond Report may open the debate on expanding the scope of practice for certain practitioners. It specifically recommends expanding the scope of practice of pharmacists,[17] and recommends that the provincial government generally play a more active role in working with the province's health regulatory colleges to make decisions regarding scope of practice.[18] These changes would provide a great opportunity for all health care professions to conduct a review to: (i) ensure that they are maximizing their scope of practice in the developing health care sector, and (ii) potentially identify areas where their scope of practice may properly be extended. Community-Based Clinics One of the likely consequences of the Drummond Report is an increased push for the use of specialized community-based clinics for procedures that do not require hospital facilities.[19] While this recommendation accords in some respects with the Action Plan, there is a significant difference. The Action Plan specified that such clinics must be not-for-profit; the Drummond Report envisions for-profit clinics that would operate in the public payor system.[20] While specifics have not been released as to the exact procedures that should be provided at such clinics, specialized, repeatable procedures would likely be targeted (such as diagnostic imaging, dialysis, mammograms, colonoscopies, cataract surgery and hip and knee replacements). Funding Paradigms The Drummond Report also specifically addresses a number of inefficiencies that have developed in the current system as a result of the current funding models. A number of changes recommended by the report focus funding on the provision of quality service in the appropriate setting (for both OHIP coverage and other funding issues) rather than the quantity of services performed. While there are no recommendations that specific procedures be delisted from OHIP coverage, the way in which procedures qualify for coverage may change if certain recommendations in the report were accepted. The most significant change would be the expansion of the mandate of Health Quality Ontario to enforce evidence-based directives to guide coverage, which the report suggests would ensure that costs are being incurred only when there is evidentiary support for the procedure's need.[21] A number of recommendations also promote the use of the Health-Based Allocation Model ("HBAM")[22] to ensure that resources are properly allocated within the system. The HBAM would effect differential funding for services across regions,[23] set appropriate compensation for procedures (in contrast to the current system of using average costs),[24] and promote the removal of incentives to perform medical interventions without due consideration to the quality and efficiency of care.[25] Conclusion While the Drummond Report recommends significant changes to the provision of health care in Ontario, it remains to be seen whether any of the recommendations will be adopted by the provincial government. Though a number of the changes correspond to announcements already made by the provincial government, some recommendations entail cost-cutting measures that are unlikely to be politically popular. In any event, Ontario's public health care sector is destined to face significant changes in the near future, and providers of services in all health care related industries will benefit from ensuring they are primed to take advantage of these changes. For more information on the subject of this bulletin, please contact the authors: Lynne Golding lgolding@fasken.com Cathi Mietkiewicz cmietkiewicz@fasken.com Jesse Harper jharper@fasken.com 2 VANCOUVER CALGARY TORONTO OTTAWA MONTRÉAL QUÉBEC CITY LONDON PARIS JOHANNESBURG

32 BULLETIN Health Law [1] Ontario, The Commission on the Reform of Ontario's Public Services, Public Services for Ontarians: A Path to Sustainability and Excellence (Toronto: Queens Printer for Ontario, 2012) (Chair: Don Drummond). Commonly termed the "Drummond Report" after the Chair of the Commission, Don Drummond, former Senior Vice President and Chief Economist at Toronto-Dominion Bank [2] Ibid at p 124. [3] Ibid at p [4] Ibid, recommendation 5-6 at p 176. After , annual increases in health spending would be limited to a maximum of 5%. [5] Ibid, recommendation 5-60 at p 189 specifically suggests setting a goal of "no increase in total compensation" in the negotiations. [6] See generally, ibid, recommendations 5-3 and 5-4 at p 175, and 5-52 at p 187. [7] Ibid, recommendation 5-26 at p 182. [8] Ibid, recommendation 5-40 at p 184. [9] Ibid, recommendation 5-71 at p 191. [10] Ibid, recommendation 5-74 at p 192. [11] Ibid, recommendation 5-32 at p 183. [12] Ibid, recommendations 5-33 at p 183 and 5-62 at p 189. [13] Ontario Ministry of Health and Long-Term Care, Ontario's Action Plan for Health Care: Better patient care through better value from our health care dollars (Toronto: Queens Printer for Ontario, 2012). [14] Ibid at p 9. [15] Supra note 1, recommendation 5-18 at p 181. [16] Ibid, recommendation 5-23 at p 182. [17] Ibid, recommendations 5-24 at p 182 and 5-94 at p 198. [18] Ibid, recommendation 5-19 at p 181. [19] Ibid, recommendation 5-97 at p 199. [20] Supra note 13 at p 13. The Drummond Report, ibid envisioned that the model could include private for-profit clinics. [21] Supra note 1, recommendation 5-46 at p 186. [22] The HBAM is a tool to allocate funding for services across communities in the province. Allocations estimate the demand and costs of these services based on clinical and demographic information such as age, health status, patient flow, and rural geography. [23] Supra note 1, recommendation 5-17 at p 180. [24] Ibid, recommendation 5-50 at p 187. [25] Ibid, recommendations 5-72 and 5-73 at pp Contacts VANCOUVER David W. Li ttle dlittle@fasken.com TORONTO Lynne Go lding lgolding@fasken.c om MONTRÉAL Sylvie Bou rdeau sbourdeau@faske n.com This publication is intended to provide information to clients on recent developments in provinc ial, national and international law. Articles in this newsletter are not legal opinions and readers should not act on the basis of these articles without first consulting a lawyer who will provide analysis and advice on a specific matter. Fasken Martineau DuMoulin LLP is a limited liability partnership and includes law corporations. Fasken Martineau LLP is a limited liability partnership which is registered in England and Wales. Registered number: OC Registered Office: 17 Hanover Square, London W1S 1HU. Authorised and regulated by the Solicitors Regulation Authority and subject to its Code of Conduct Fasken Martineau 3 VANCOUVER CALGARY TORONTO OTTAWA MONTRÉAL QUÉBEC CITY LONDON PARIS JOHANNESBURG

33 February 7, 2012 Honourable Deb Matthews Minister - MINISTER'S OFFICE Ministry of Health and Long-Term Care Hepburn Block 10th Floor 80 Grosvenor St Toronto, ON M7A2C4 RE: Ontario Research Fund Research Excellence Program Dear Minister Matthews, On behalf of London Health Sciences Centre I am writing to express our concern about the cancellation of Rounds 6 and 7 of the Ontario Research Fund Research Excellence (ORF- RE). While we recognize that the current fiscal environment is very challenging and many difficult decisions need to be made, the cancellation of the ORF-RE is especially concerning since it leveraged substantial investment from the private sector and achieved the goals of economic development and job creation that are paramount to the government s current economic plan. Although the decision to cut the next two rounds of the ORF-RE Program has freed up $120 million to allow MEDI to fund the Economic Development Funds, there will be significant unintended consequences for the research community and the Ontario economy. ORF-RE grants only covered one third of the overall research investment. The remaining two thirds were to be matched by institutional and private sector partners. Therefore, the total loss of research funding is over $360 million of which, historically, more than half was invested in advanced health discoveries. In the previous ORF funding rounds, the research hospitals alone in Ontario attracted more than $300 million in matching funds, from a wide range of multi-national corporations including IBM, Telus, and GlaxoSmithKline, to name but a few. This led to the creation of thousands of jobs including recruitment of many world-class researchers. In London, UWO and Lawson Health Research Institute together had 17 letters of intent in advanced stages of preparation with the matching industry support secured. Several planned studies were to involve LHSC. A London, city-wide proposal lead by Dr Anne Snowden would have developed an integrated knowledge translation approach to improving patient experience, quality of care, and health system capacity. The industry partner here was Hewlett-Packard who would have invested $2.3 million in further developing informatics technology that could have major implications for adopting best practice in health care. The investment is now likely to be South Street Hospital University Hospital Victoria Hospital and Children s Hospital

34 moved to the United States. Dr Rajni Patel had planned to submit a project on novel roboticsbased rehabilitation and assistive technologies to be developed within CSTAR. This would have attracted $3.5 million in industry support and doubled the size of his research group A proposed project from Dr Ravi Menon at UWO would have partnered with Siemens to develop the next generation of MRI imaging diagnostics, keeping London at the leading edge of imaging technologies. We are also concerned about the lack of consultation about the decision to cancel the ORF. The application deadline for Round 6 of the ORF-RE was the end of January. As such, researchers had largely completed their applications and had already secured over $100 million in private sector matched funding across the province. Most of these matching funds will be lost to the researchers and to the Ontario economy since they were promised on the condition of government support. Without sustainable research funding, Ontario risks losing its best and brightest research talent. As a result of past Ontario government investments, a robust health research engine has been created. Continuing to leverage these investments should be part of an innovative economic development strategy for Ontario. This will directly help create a knowledge-based economy which will contribute to our long-term economic prosperity. In addition it will result in a more sustainable health care system, and better outcomes for patients, which in turn will increase productivity as patients return to work sooner. Health research is a significant contributor to a strong, innovative economy. As a provincial sector, we employ more than 100,000 highly skilled individuals, including over 10,000 researchers. The return on investment of health research is significant, estimated be to as high as 39% based on total health and GDP gains. The Lawson Health Research Institute alone directly invests $36 million in salaries into London and region, providing employment for over 1000 skilled individuals. The province s future economic strength requires a focused investment in an innovative, knowledge- based economy. This requires long-term thinking, partnership and strategic investment. For the past 8 years, the Ontario government has championed research and innovation as it built an innovative, knowledge-based economy. We are concerned about the impact that the current fiscal environment will have on the leadership and continued support needed for a successful long-term research strategy. In times of fiscal constraint, innovation is critical to emerging as a strong, competitive economy. We feel that it is essential that the new Southwest Ontario Development Fund be open to applications from for-profit and not-for-profit research and development organizations, including research institutes. This sector creates skilled, well-paid and sustainable jobs. The opportunity for London researchers to utilize this fund to expand jobs would help to retain at least some of the private sector partner funding that was positioned as leverage for the cancelled ORF competitions. South Street Hospital University Hospital Victoria Hospital and Children s Hospital

35 Programs such as the ORF-RE are vehicles that should be the basis for Ontario s economic recovery plan; a magnet for private sector involvement and building blocks for our knowledge based economy. We urge the Government of Ontario to reinvest into Ontario s research and innovation goals as soon as is practically possible since there is a real possibility that momentum will be lost and the teams will disperse to elsewhere in Canada. Sincerely, Signature removed for publication Peter C. Johnson Chair, Board of Directors London Health Sciences Centre South Street Hospital University Hospital Victoria Hospital and Children s Hospital

36 Monthly Media Monitoring Jan. 12 Feb. 8, 2012 Summary There were 108 stories that referenced London Health Sciences Centre from January 12 to February 8, Print Media The London Free Press highlighted LHSC 37 times: 4 positive stories 4 neutral stories 9 negative stories 13 letters to the editor; all negative 1 Reader to Reader; positive 3 Point of View; all negative 1 Comment of the Day; neutral 1 Poll; negative 1 paid advertisement The Londoner highlighted LHSC 2 times; both positive. London Community News highlighted LHSC 9 times; 2 positive, 3 neutral and 4 negative. 1