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Better Health, Better Healthcare

(Cette politique sera bientôt traduite)
My father recently lost his family doctor. At 90 years old, and after 59 years of living in Kingston, he has now joined the two million Ontarians without a primary care physician. 

Meanwhile, I’m told that the Ministry of Health doesn’t know how much time each family doctor works in primary care, in a walk-in clinic, hospital or emergency room (ER). Researchers have also noted the difficulty in getting the numbers needed to understand what’s going on in healthcare. 

Flying blind with our public healthcare system isn’t good enough. 

Healthcare is the largest item in the provincial budget. There are four fundamentals to consider to provide better outcomes and control costs in the long term:

  • Short and long term planning with strong data collection.
  • Investments in prevention as a strategy to improve overall health and well being, and manage the overall costs of chronic diseases.
  • Innovation within the public healthcare system.
  • Build a strong economy, with higher productivity and overall prosperity, to support a caring and fair society. See my economic vision, which is based around this idea. Many aspects of my vision of a strong economy overlap with the social determinants of health.

Here's my vision for Better Health, Better Healthcare:

  1. Better data, better understanding, better planning
  2. Address overcrowded ERs, overcrowded hospitals
  3. Invest in alternatives to Long Term Care
  4. Invest in primary care innovation
  5. Support mental health
  6. Empower local decision making, invest in prevention

It starts with better data.

 

Key takeaways

  • Collect better measures of health outcomes and population health status.
  • Collect complete, timely and standardized data on the supply of and demand for the health sector’s workforce and services.
  • Make all electronic medical records compatible and digitally linked.
  • Use the data to plan years ahead.

 

Every day, I get phone calls and emails about people who tell me that they don’t have a family doctor. 

It’s a problem years in the making and won’t improve overnight. A study released earlier this year found that, in 2019, 1.7 million Ontarians had a primary care doctor over the age of 65. We are already seeing the effects of some retiring now, but what happens when all of those doctors retire? The government has increased spots for medical students, but that won’t help anytime soon.

At the core of this problem: it takes a long time to train doctors and nurse practitioners and we should have been planning years ahead. What we need in order to plan ahead is better measures of health outcomes and population health status, and complete, timely and standardized data on the supply of and demand for the health sector’s workforce and services. This should be used to make smart, long term investments in our healthcare system.

As we do that it’s very important to recognize  that there are inequities in health care that need to be remedied. Women, Indigenous communities, francophones, racialized communities, newcomers, rural and northern residents, 2SLGBTQIA+, and low-income people have particular challenges accessing healthcare, or having their needs addressed by the healthcare system, which should be documented to inform our planning.

The standardization and collection of health information for individuals will benefit their own care and, with the proper privacy frameworks, will feed into data to improve the system. This can happen in conjunction with making all electronic medical record (EMR) systems compatible and digitally linked. Access to patient health information for care providers will improve safety, quality and efficiency of care.

We need to collect high quality data on the state of our healthcare system so that we can look confidently years into the future and plan for the long term. I will make that a priority because my experience in science and finance tells me that data informed approaches work. 

 

Key takeaways:

  • Pay attention to staff retention
  • Invest outside of acute care to relieve the pressure on hospitals
  • Invest in permanent community paramedicine as a tool for patient diversion from hospital ERs

Many people have a story about long wait times in ERs, long wait times for surgery, or hallway medicine. Closures of ERs is a serious problem in rural Ontario. In fact, every weekend at least one ER in Ontario closes because of overcrowding or staff shortages. 

Ontario’s Financial Accountability Office recently predicted a shortage of 33,000 nurses and personal support workers (PSWs) by 2027-28. That will impact the entire system, affecting hospitals’ ability to admit patients from ERs and to shorten wait lists. An immediate contributor to this problem has been staff retention. The current government has tried to limit pay increases through Bill 124. That and the vicious cycle of staff shortages, stress and burnout has caused more staff to leave. The current government is going down a path that will, in the long run, cost us more in health outcomes and tax dollars.

Patients without primary care physicians are one reason why ERs are overwhelmed. A bigger problem is that one in six hospital beds are occupied by people who no longer require hospital care, but can’t go home safely. So ER patients, who require admission, wait hours and often days for a hospital bed upstairs, causing crowding of the ER and inadequate capacity to treat new patients.  Then ambulances and paramedics are often stuck idle, waiting, yet unable to safely unload their patients.

I stand for:

  • Policies that are consistent with health care staff retention, with upfront investment to break the vicious cycle of staffing shortages
  • Greater investment in home and community-based care, and long-term facilities to free up space in hospitals.
  • Greater investment in rehabilitation focused transitional care facilities whose more effective support and care for recovering hospital patients will free up more expensive hospital beds and reduce rehospitalizations.
  • For preplanned elective care, dedicated out-of-hospital, not-for-profit, surgical and diagnostic centres, affiliated with and monitored by hospitals.
  • Increased investment in community paramedicine to divert patients from ER’s when possible.
  • Virtual emergency primary care to triage and reduce unnecessary ER visits when possible.

 

Key takeaways:

  • Make home and community care more accessible to reduce the cost of elder care and relieve the strain on caregivers and long term care institutions
  • Encourage physical activity and socialization in our elderly population.
  • Take advantage of naturally occurring retirement communities

Now around 90 years old, my parents remain independent and enjoy staying in their own home. Part of that is luck, but part of ageing well is staying active physically and socially. Encouraging that in the general population is an important part of a strategy to keep our elderly population happier, healthier and less reliant on long term care.

10 to 20 percent of people in long-term care could have lived elsewhere with adequate support. There are countries where the percentage of the elderly in institutional long term care is much lower. Institutional facilities are more expensive than home care and the elderly are happier at home. We need to make it easier for them to stay at home, when they can, by creating additional supports for them and their caregivers. There are a number of innovative ways to do this that have already been successfully implemented in Ontario and elsewhere.

  • Even modest direct financial supports help to sustain care in the community, delaying or avoiding a resort to costly long-term care beds. For example, we can provide direct financial support to low-income caregivers who can then manage the funds to hire workers of their choice. There is a refundable tax credit for that in Manitoba, Quebec and Nova Scotia. Either would replace a significant percentage of Ontario’s long-term care beds, for a net savings.
  • Health care co-operatives - We can learn from Saskatchewan and Quebec, and create a financial relief program for home care services that provides funding support to cooperatives or non-profit organizations. These home care co-ops deliver a range of services to people at home ranging from intensive medical aid to assistance with activities of daily living for older adults and people with disabilities.
  • Building health and social supports into naturally occurring retirement communities, like apartment buildings, housing high numbers of older adults. The Program of All Inclusive Care of the Elderly (PACE) in Burlington is a good example of this. Project Oasis in Kingston is another. “Spokes” could extend services out to the community surrounding these buildings where others may also require assistance.

 

Key takeaways:

  • Primary health care is the key to lowering overall health care expenditure while improving population health and access.
  • Make primary care coverage universal through geographic health homes
  • Provide incentives to Primary Care Teams to experiment with ways to improve working conditions, better meet their patient’s needs, and manage costs to the system. This includes nurse practitioner-led teams.
  • Reinstate virtual care options.

Team-based care is widely considered by health-system experts to be the best way to deliver primary care. The Canadian Medical Association has named “expanding team-based care” as one of its top recommendations for solving the country’s health care crisis.

Our goal should be to expand the number of teams serving Ontarians, but welcoming experimentation in how teams are organised, including nurse practitioner-led teams, to improve working conditions and productivity of staff, and to manage costs to the system. The government needs to come to a renewed and updated agreement with the medical profession on the role of and expectations for these teams in the healthcare system.  

Geographically based health homes, which ensure that everybody in a geographic region can access a health team, should be piloted.

After-hours access to some form of primary care should eventually be the norm, as long as this does not cause burnout, or loss of control of work-life balance for primary care providers. 

We should encourage virtual care as a means of making healthcare more accessible when it is otherwise difficult, especially in rural and remote areas (while being aware that it cannot replace in-person care in many cases). The agreed upon structure of teams should also include direct support (administration, scribes, data standardisation, eventually artificial intelligence) to reduce the administrative burden on doctors and allow them more time to see patients. 

Primary Care Teams should be multidisciplinary and be allowed to experiment with expanding scopes of practice. For example, nurse practitioners could integrate their work with physicians to make both more efficient and effective. We should encourage other professionals such as physiotherapists, occupational therapists, social workers, community and home care coordinators, and mental health workers to be part of primary care teams. Pharmacists’ scope of practice has been expanded recently and their integration into primary care teams should be examined.

Key takeaways:

  • Mental health is a pillar of healthcare
  • Address the shortage of mental health professionals
  • Expand access to mental health services in schools, at-risk communities and for trauma related professions

Mental health is an important pillar of healthcare policy. Dealing with the long wait times in this sector are as important as in any other sector.

To improve the system, let’s not forget data collection and digital records for mental health. There should be a centralized system for health providers to access mental health history and records, and a privacy framework to allow this data to be used for planning and improvements to the system.

Psychiatrists are in shortage, just as family doctors are. Not enough medical students are choosing it as a specialty. The government should make mental health a more attractive specialty, and increase the number of psychiatry residency positions. 

Mental Health services fall off a cliff as you move away from urban centres. We should offer fair incentives to mental health professionals with a particular emphasis on improving service in rural, northern and other underserved areas.

We can encourage more psychiatric collaborative care teams providing both rapid consults and follow-up care, ideally supported by psychiatric nurses, psychologists and social workers. Mental health professionals can be part of primary care teams.

Lack of access to mental health services, especially acute in rural areas, is not only a humanitarian crisis, but also an economic problem. The Ontario Chamber of Commerce estimates that on average, mental health issues cost businesses almost $1,500 per employee, per year. Surveys show that diagnosed, and undiagnosed but suspected, mental health conditions affect many frontline workers as well as students and teachers. A cost-benefit analysis of investments in mental health should also recognize the economic paybacks from the health and well-being of Ontarians, including the benefits of early diagnosis and intervention. 

Given the importance of addressing mental health conditions in youth, we should ensure that teachers are adequately trained to identify problems in the classroom and have access to mental health professionals as necessary, including for themselves.

Multiple and/or complex needs, including autism and fetal alcohol syndrome disorder, is an area where delays in diagnosis and intervention can have a high human cost. Needs based programs are essential. Generally, the transition from child to adult mental health services continues to need work. The government should continue to coordinate supports for people undergoing this transition. It should also be noted that one of the goals of the 2018 Ontario Special Needs Strategy, integrated rehabilitation services available year-round instead of only during the school year, has yet to be implemented.

Housing is a huge determinant of mental health. Please see my vision for housing policy

The opioid crisis that our province is experiencing is significant enough to warrant a separate statement, which will be released later.

Key takeaways:

  • Regional health authorities with global budgets
  • Restore funding for public health
  • Focus on supports requested by Indigenous communities for public health
  • Prepare for the next pandemic

As I’ve travelled across the province, I’ve seen that health care challenges are different in different parts of the province. The practice of medicine varies as a result. As we reconstruct primary care, mental health services, acute care and other parts of the system, we’ll look at regional health authorities with global budgets to hold providers to account for access and outcomes while adjusting the mix of facilities, staffing and services to best meet the needs of the region.

Our best investment in healthcare is prevention of ill health. Public health can prevent chronic disease and its costs, for example by addressing alcohol and tobacco use, physical activity and poor diet. The Ford government’s 2019 Budget cut public health funding by 27%, before inflation. Responsible for everything from food and water safety, STDs/AIDS education, parenting classes, disease prevention and immunization, to overdose prevention, public health gives us the most return on the dollar. Cutting spending on prevention will cost more in the long run. I’ll restore funding for public health.

There are many social determinants and supports requested by Indigenous communities which should be a focus of public health. Many of these are the most cost-effective ways of improving health and well-being in our province.

Lastly, the lessons learned from the COVID-19 pandemic should inform preparations for the inevitable next pandemic. These include:

  • robust primary care and public health systems to detect and respond to outbreaks. laboratory capacity
  • government readiness to provide a coordination and policy function
  • legal and regulatory tools to protect the population from outbreaks
  • well-functioning supply-chains
  • stockpiles of essential equipment and supplies