Spotlight on Health Care: Ontario Election at a Glance June 2018 Note: This document reflects feedback and public information available as of May 22, 2018. Any platform changes or announcements made after this date are not included in this document. a
Keeping Ontario Healthy In representing more than 13,500 family physician members, the Ontario College of Family Physicians (OCFP) strives to ensure that the provincial government delivers on its responsibility to maintain a strong health care system. The OCFP does this guided by its mission: Supporting Ontario family physicians through education, leadership, research, and advocacy in the delivery of high-quality health care. This document summarizes the health care platforms or announcements of the three largest political parties participating in the upcoming June 7, 2018, provincial election the Ontario Liberal Party (Liberals), the New Democratic Party of Ontario (NDP), and the Progressive Conservative Party of Ontario (PCs) and how each party plans to meet the needs of patients and those who provide their care. Recognizing that there is much discussion among many other organizations and health care professionals about critical health system issues such as wait times, hospital overcrowding, long-term care bed shortages, and the ongoing matter of physician funding in binding arbitration this document focuses on five priority areas for family physicians as identified by our national organization, the College of Family Physicians of Canada (CFPC), and through the OCFP and the CFPC s member research. These areas, or health indicators, have been featured consistently in other recent provincial election reports, such as those prepared for British Columbia and Manitoba: A family doctor for every Ontarian Mental health and addiction care and access to services Equitable access to team-based care, based on the vision of the Patient s Medical Home (PMH) Rural and remote support The health of Indigenous people and other marginalized populations 1
Election Platforms We sent a questionnaire to the Liberals, NDP, and PCs asking how each party plans to address our health indicators. The PCs formally declined to complete the questionnaire. This document reflects the responses we received directly from the Liberals and the NDP and any related public announcements the OCFP and CFPC reviewed from the Liberals, NDP, and PCs. Please refer to the Additional Readings and Resources section to read the full responses the Liberals and the NDP provided. Indicators 1 A Family Doctor for Every Ontarian Recognition of primary care as the foundation of an effective health system, and recognition of the essential and central roles family doctors play in providing care and leading needed transformation efforts. Liberal Party The party notes it is working with medical schools to increase the number of family medicine residency positions; partnering with more than 155 Ontario communities to recruit new graduates; and, through the Action Plan for Health Care, implementing programs such as Health Care Connect to improve access to family doctors across the province. New Democratic Party The NDP emphasizes the importance of working collaboratively with family doctors to improve the public s access to primary care providers, enhance patient care, and make it easier for Ontarians to find family doctors. No specific policy was provided by the party or available publicly online. Progressive Conservative Party The PCs have stated that they will work with front-line doctors and nurses to put forward better care for Ontarians. No specific policy was provided by the party or available publicly online. OCFP COMMENTARY Family doctors are on the front lines of patient care and are central to an effective health system. There are currently many Ontarians without access to family physicians, and many new family doctors have difficulty accessing practice settings that include interprofessional health care providers similar to the models in which they trained. The OCFP has advocated for the meaningful engagement and active participation of family physicians in health system changes, and this includes the need to consider health human resources planning. Having more family doctors is only part of the solution, and it is not so much a question of how many are practising but how they are practising. Our members want to see recognition of and support for the vital roles they play in primary care and across the health care system as a whole, and solutions that consider what their practices look like and the populations they serve. Despite the challenging environment for family doctors, many have taken on system leadership roles across Local Health Integration Networks and sub-regions to support health system planning and delivery. This document reflects the responses we received directly from the Liberals and the NDP and any related public announcements the OCFP and CFPC reviewed from the Liberals, NDP, and PCs. 2
2 Indicators Mental health and addiction care and access to services Improved access to services and resources that enable primary care to better support people living with mental health and substance use issues. Liberal Party As announced in the 2018 Ontario Budget, the Liberals pledge to invest $2.1 billion over the next four years to address mental health and addiction issues. The funding aims to create additional services in the community, reduce wait times, and ensure that every primary care team is connected to mental health supports for their patients. As part of this plan every secondary school will have access to an additional mental health worker, additional youth wellness hubs will be created, and publicly funded structured psychotherapy will be expanded. By 2021 a new helpline will offer mental health services, addiction screening, crisis counselling, and referral services online, by text, or by phone. The party will also invest more than $222 million over three years to combat the opioid crisis in Ontario. Among these initiatives, the Liberals have established an Opioid Emergency Task Force and opened and expanded Rapid Access Addiction Medicine clinics. New Democratic Party The NDP plans to hire 2,200 new mental health care workers (including counsellors, social workers, case managers, system navigators, and assertive community treatment staff). The party also plans to hire another 400 mental health workers to ensure every high school has access to mental health supports. The party will invest in 30,000 new supportive housing units over the next 10 years, building at least 3,000 every year the number recommended by the Ontario Mental Health and Addictions Leadership Advisory Council and provide funding for ongoing rent supplements and support-staff costs. It will invest $228 million per year in capital funding, plus operational funding that will increase by $50 million per year. It will also invest $590 million over five years to expand services and increase staffing for care targeted to youth. Based on recommendations from Children s Mental Health Ontario, the party believes this will ensure every child who needs care will get it within 30 days. The party will uphold the province s 2017 commitment to devote $100 million to Ontario s dementia strategy over three years. These investments will continue to expand community dementia programs and respite care services. Progressive Conservative Party The PCs will invest $1.9 billion over the next decade in mental health and addiction supports and housing. OCFP COMMENTARY With our members citing pain management, addictions, and mental health as among the most pressing and challenging clinical areas, it is encouraging to see the focus all parties have placed on these necessary and overdue investments. In addition, we recognize the NDP s focus on dementia another challenging clinical area, according to our physician members. The OCFP recommends that any new programs, services, and/or facilities be well integrated with primary care rather than creating additional silos and fragmentation. Timely access to mental health and addiction services, particularly for children and youth, is desperately needed. As well, all parties should consider a stronger focus on early intervention, prevention, and mental wellness promotion, all supported by interprofessional teams in primary care. This document reflects the responses we received directly from the Liberals and the NDP and any related public announcements the OCFP and CFPC reviewed from the Liberals, NDP, and PCs. 3
Indicators 3 Equitable access to team-based care, based on the vision of the Patient s Medical Home (PMH) Support for the PMH model, where every family practice offers the medical care that Ontarians want: seamless, centred on individual patients needs, provided within their community, throughout every stage of life, and integrated with other health services. Liberal Party The Liberals will invest $102 million over three years to support the expansion of interprofessional primary care teams. Additionally, the party will invest approximately $330 million over three years to support the recruitment and retention of health care professionals for primary care teams across the province, including in Aboriginal Health Access Centres and Family Health Teams. The Liberals plan to create 30,000 long-term care beds in 10 years, including 5,000 new beds by 2022. New Democratic Party The NDP will invest $42 million per year to build and expand 35 new health centres, such as Community Health Centres and Family Health Teams. The party will also increase funding for existing centres by $30 million. The NDP aims to create Canada s first provincial universal pharmacare program. It will also develop a program called Ontario Benefits to provide workplace health benefits, starting with dental coverage, to all workers who do not currently have them. As well, the party plans to provide publicly funded dental coverage to seniors without retiree benefits and to everyone on social assistance. The NDP will also create 40,000 more long-term care beds, including 15,000 new beds over the next five years. Progressive Conservative Party The PCs look to cut wait times by opening new long-term care beds across the province. They will invest in 15,000 new long-term care beds over five years and 30,000 new beds over the next 10 years. The PCs will also implement a comprehensive dental care program for low-income seniors. OCFP COMMENTARY Currently, 75 per cent of Ontario s family physicians practise in models that are not associated with Family Health Teams or Community Health Centres. A more equitable distribution of interprofessional health care team resources must be an area of focus to better meet population needs. This is why the OCFP works collaboratively to advance initiatives that support the features of the PMH, such as patient-centred care, team-based care, coordination, continuity, and comprehensiveness, so that family physicians are better connected across primary care through coordinated networks of providers and supported by appropriate infrastructure. Importantly, to better support the health of Ontario s population, the PMH must be connected with other parts of the health system, such as hospitals, long-term care, home and community care, mental health and addiction services, and others. This document reflects the responses we received directly from the Liberals and the NDP and any related public announcements the OCFP and CFPC reviewed from the Liberals, NDP, and PCs. 4
4 Indicators Rural and remote support Support for family physicians working in rural and remote settings to ensure equitable access to care for the whole province. Liberal Party The Liberals note there are still challenges to providing equitable access to health care to remote communities, but the government has taken steps to address this issue. This includes introducing Family Health Teams in 2005, with 42 located in northern locations, two more primary care teams in the northeast, and eight expanded teams across the north. In 2007 the Liberals established the HealthForceOntario Marketing and Recruitment Agency, which helps communities with the recruitment and retention of physicians and the promotion of career opportunities in places that need doctors. In addition, the 2018 budget dedicated funding to the renovation and construction of educational facilities in Sudbury to accommodate space requirements for the Northern Ontario School of Medicine of Lakehead University and Laurentian University. The Liberals will also maintain support for the Northern and Rural Recruitment and Retention Initiative, which offers financial incentives for physicians to establish practices in rural and Northern Ontario and supports telemedicine, mobile health services, and language services to address any language barriers between patients and health care providers. New Democratic Party Along with opening 2,000 new hospital beds, the NDP is committed to providing an additional $1.2 billion this year to protect and strengthen hospital services including in rural and remote locations. The party will also create a New Moms Guarantee. This is the NDP s commitment to protect maternal and newborn care services in all Ontario communities; prevent cuts to and closures of women s health facilities, including in rural and remote locations; and expand access to maternal health services to meet the growing needs of communities. Progressive Conservative Party The Conservatives will incentivize doctors to practise in northern communities by cutting their provincial taxes down to as low as zero per cent. OCFP COMMENTARY The OCFP recognizes the Liberals focus on supporting family doctors working in rural and remote locations, including creating new health teams and expanding some of the existing health teams in the north. Both the Liberals and PCs have initiatives designed to incentivize doctors to work in rural and remote locations. As part of creating a sustainability of rural family physician resources, the OCFP would like to see investments directed at developing innovative care models and better use of technology to support doctors in delivering care within their own communities, and recommends a review of practice models and resource allocation for rural and remote communities. The OCFP also acknowledges the important work that Health Quality Ontario has done in creating the Northern Ontario Health Equity Strategy, which highlights the significant disparities that exist in both health outcomes and health access across rural and remote Northern Ontario. This document reflects the responses we received directly from the Liberals and the NDP and any related public announcements the OCFP and CFPC reviewed from the Liberals, NDP, and PCs. 5
Indicators 5 The health of Indigenous people and other marginalized populations In addition to rural and remote initiatives, support for improved access to and management within primary care for vulnerable populations, such as low-income patients, Indigenous populations, new immigrants and refugees, etc. Liberal Party In 2016 the Liberals announced Ontario s First Nations Health Action Plan, an investment of $222 million over three years, which will be followed by sustained funding of $104.5 million annually. This funding aims to address critical health inequities and improve access to culturally appropriate health care services. It includes expanding or introducing new Indigenous-governed and community-driven interprofessional primary care teams; training up to 1,000 health care workers living and working in First Nations communities; providing funding for Indigenous health care organizations that offer palliative care; funding 34 Indigenous-led mental health and wellness programs; and establishing or expanding 10 Indigenous-led Healing and Treatment Centres. The party also recognizes the importance of improving service access to other underserved populations, such as racialized and refugee populations, LGBTQI2S people, and those who have experienced gender-based violence. New Democratic Party The NDP will double Ontario s investment in the First Nations Health Action Plan, providing at least $209 million per year, starting in 2019. The doubled investment will support initiatives such as health care programs designed and implemented by First Nations; services that allow communities to have access to a doctor for more than just a few days every month; measures to address the challenges of recruiting and retaining physicians and health care workers, especially in northern and remote communities; and more home and community care services and telemedicine options. Beyond First Nations communities, the party will also invest in new community-governed non-profit health centres (as well as new satellite locations for existing centres) in the 35 regions that need them but do not yet have one. The NDP will also ensure that every resident has emergency room access and care regardless of their immigration or insurance status. Progressive Conservative Party No specific policy was provided by the party or available publicly online. OCFP COMMENTARY The OCFP recognizes and supports the work that dedicated family physicians are doing with Northern Ontario s Indigenous communities. The OCFP recognizes the importance of the commitment being made to support teams that can work with physicians to meet the needs of Indigenous people in remote communities, particularly for services that support mental health and addiction care. Support for physicians working with vulnerable populations, such as immigrant and refugee populations and LGBTQ+ youth, is valued. Work that is undertaken to support Indigenous, marginalized, and otherwise vulnerable populations has substantial overlap with work in the other key indicator areas: access to family physicians, access to team-based resources, access to mental health and addictions services, and support for rural and remote communities. As these initiatives move forward, it will be critical to ensure that efforts are made to avoid siloes and fragmentation of services or complicating care delivery for family physicians at the front lines of care delivery. This document reflects the responses we received directly from the Liberals and the NDP and any related public announcements the OCFP and CFPC reviewed from the Liberals, NDP, and PCs. 6
Useful Links How to vote Election day is June 7, 2018. There are many ways to vote in the general election: Vote in person before election day at your returning office between May 10th and June 6th. Vote in person before election day at an advance voting location from May 26th to May 30th. Vote in person on election day on June 7th at your assigned voting location. Vote by special ballot either in person, by mail, by home visit, or through the hospital program. Where do I vote? Use the Voter Information Service to find the dates, times, and locations for where you can vote. Find your electoral district Ontario has 124 electoral districts. You can use the Voter Information Service to find your electoral district. For information about your Member of Provincial Parliament please visit the Legislative Assembly of Ontario website. Who is my candidate? Find candidates in your electoral district through the Voter Information Service. You can also use the Candidate Search tool to search for candidates by name, party, or electoral district. 7
Additional Readings and Resources The Not A Second Longer campaign by the Ontario Medical Association intends to spotlight one of the major issues that burden the Ontario health care system unacceptable wait times. It is available from: www.notasecondlonger.ca. The CBC Vote Compass Ontario, a tool political scientists designed to help Ontarians stay up-todate on what the parties are saying and how that lines up with their own positions, is available from: www.cbc.ca/news/canada/toronto/vote-compass-ontario-2018-1.4654141. The OCFP s 2017 Membership Survey infographic, highlighting items such as their most challenging clinical issues and the issues facing family physicians today, is available from: https://ocfp.on.ca/docs/ default-source/default-document-library/ocfp-infographic_round-1.pdf?sfvrsn=5e8df989_2. The OCFP s 2015 Evidence Brief: Preparing for a Devolved, Population-Based Approach to Primary Care, which was developed based on published and grey documents and several key informant interviews, is available from: www.ocfp.on.ca/docs/default-source/news-current-events/pbfm_ evidence_brief_oct2015_final-updated.pdf?sfvrsn=4091fa89_2. New Democratic Party of Ontario response to OCFP questionnaire. May 3, 2018. Available from: https://ocfp.on.ca/docs/default-source/default-document-library/ocfp_healthcare_leaders_ questionnaire_ndp.pdf?sfvrsn=7b96fa89_2. Ontario Liberal Party response to OCFP questionnaire. May 3, 2018. Available from: https://ocfp.on.ca/docs/default-source/default-document-library/ocfp_survey_liberal_response. pdf?sfvrsn=b296fa89_2. Advancing Rural Family Medicine: The Canadian Collaborative Taskforce. The Rural Road Map for Action Directions. Mississauga, ON: Advancing Rural Family Medicine: The Canadian Collaborative Taskforce; 2017. Available from: http://www.cfpc.ca/uploadedfiles/directories/committees_list/ Rural%20Road%20Map%20Directions%20ENG.pdf. The College of Family Physicians of Canada s Best Advice guides are resources that provide practical advice on topics such as social determinants of health, patient-centred care, and communities of practice. Guides, summaries, and more are available from: http://patientsmedicalhome.ca/resources/best-advice-guides/. College of Family Physicians of Canada. Patient s Medical Home. 2018. Available from: http://patientsmedicalhome.ca/. College of Family Physicians of Canada. A Vision for Canada: The Patient s Medical Home. Mississauga, ON: College of Family Physicians of Canada; 2011. Available from: http:// patientsmedicalhome.ca/resources/resources-for-health-care-providers/2011-pmh-vision-paper/. Elections Ontario. Resources. 2018. Available from: https://www.elections.on.ca/en/resource-centre.html. Canada Health Act R.S.C., 1985, c. C-6. Ottawa, ON: Minister of Justice; 2017. Available from: http://laws-lois.justice.gc.ca/eng/acts/c-6/. 8
We welcome questions or comments about this document at: ocfp@ocfp.on.ca