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Results-based Plan Briefing Book 2008-2009 
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 Results-based Plan – 2008-2009
Ministry of Health and Long-Term Care Overview
THE FOUNDATION OF HEALTH CARE When the government of Ontario first took office in the fall of 2003, it initiated the transformation of the province’s health system to establish a foundation of patient-focused, results-driven, integrated and sustainable health care services. With these goals now in place, the transformation will continue over the next four years with improved planning, management and co-ordination in building a modern health system. This transformation will continue to be anchored in a clear vision for health care: a vision that’s intended to help people stay healthy, deliver good care when they need it, and ensure the sustainability of the health system for future generations. Over the past four years, new building blocks for change have been established and fundamental change elements have been entrenched in law. Not only does this signify the level of commitment made by the government to transform and renew health care in Ontario, it also reflects the government’s determination to build a higher level of local and provider leadership in health care planning and delivery. The ultimate goal is better care for patients closer to home. Some of these building blocks for change include the establishment of 14 Local Health Integration Networks (LHINs), with legislative accountability to ensure Ontario moves to integrated health system delivery at the local level. At the same time, the government has implemented hospital accountability agreements. Community Care Access Centres have had their geographic boundaries realigned to fit those of the LHINs to enable better system connectivity for patients. The Ministry of Health and Long-Term Care is undertaking an unprecedented, multi-year restructuring to solidify its new health-system stewardship role. These changes reflect the government’s commitment to respond to the concerns of Ontarians about health care in this province. Now the system is focusing on the single most important aspect of health care – the patient. Primary amongst these concerns is access to health services. As a result, Ontario’s Wait Time Strategy, Family Health Teams, HealthForceOntario and other innovative human-resources initiatives are addressing patient priorities.
Now it’s time to assess the government’s various health care investments and zero in on patient-centered care. Patients and professionals alike are calling for improved quality, better service and accountable spending. That means we need to :
Patients – our health care consumers – are demanding more. So are our 18 expert panels, which have a combined total of some 450 front-line doctors and clinical leaders. They too are telling us to do more to improve access to health care. And they’re telling us to think at a system level to address access issues. We need to focus on :
That means thinking about what patients need – including both the quality and satisfaction of their health care experience – rather than thinking about what the system can supply. That takes us back to focusing on results. A solid investment strategy is completely dependent on clear returns on investment. Ontarians are entitled to know what they are getting for their money. That’s why we have results-based planning. The government will not spend where measurable results are not evident. TWO PRIORITIES Public confidence in our health care system is at the heart of our work. It has greatly improved over the past few years. We will do 1,000 things over the next four years, but for matters of public confidence we must continue to make key improvements in two major priority areas identified by Ontarians: reducing wait times with a special focus on emergency departments and delivering quality family health care for all. The government chose these themes as critical to the continued success of Ontario’s health system transformation as well as for the well-being of the people of Ontario. The themes reflect a focus on people using the health system at home…in a hospital…or in any number of family health care settings, such as Family Health Teams, Community Health Centres or nurse-led clinics. Addressing these issues will improve patient satisfaction and enhance Ontarians confidence in the province’s health care system. Emergency Room Wait Times The first priority is to expand Ontario’s Wait Time strategy. In particular, the government’s goal is to reduce wait times in Emergency Departments. That’s because the Emergency Department has all too often become the default portal through which many Ontarians gain access to health care, with over 5 million visits a year. The resulting Emergency Department congestion is a symptom of how the entire health system is doing. Congestion reflects an imbalance, telling us how well our family health care, community care, mental health, and hospital programs are working to serve patients. How? By going beyond the emergency rooms. Ontario’s Emergency Department strategy will be a system-based strategy, and improvements will be achieved by focusing on such considerations as :
Essentially we need to set up, or further promote, other accessible portals to health care so that Ontario’s hospital Emergency Departments don’t become the catch-all of our health system. The resulting success will be measured by the reduction in ER wait times and increased public satisfaction. Furthermore, reductions in the rate of Emergency Department visits will also be achieved. For example, it’s anticipated that visits by seniors to Emergency Departments will drop significantly thanks to such programs as Aging at Home, which is being established to ensure the availability of appropriate community-based health services to enable elderly Ontarians to stay in their own homes. Services such as meals, transportation to appointments, shopping, snow shoveling, home care, health and wellness programs to meet the needs of isolated seniors and caregiver supports, will also lead to a reduction in the overall need for long-term-care home admissions, and an increase in seniors’ satisfaction with the health services available to them. Family Health Care for All The second priority area is to provide family health care for all Ontarians. This is an important priority in helping to ensure that people have access to health care in their community virtually around the clock, as opposed to having to rely on hospital Emergency Departments for non-emergency health care. Over the past four years, the government has made significant strides in increasing Ontario’s health human resources, particularly in family care and nursing. There are more Family Health Teams, more Community Health Centres and thousands and thousands of more nurses working on the frontlines. However, there’s still a significant number of Ontarians seeking a family doctor – particularly Ontarians in disadvantaged populations and those with special needs. That’s why family health care is of paramount importance. The government will:
The government will create a provincial unattached patient registry to identify Ontarians seeking a family health care provider. Our government will work closely with our health care partners and use all the tools at our disposal to help ensure those patients are provided with family health care. Family Health Teams are a particularly successful model of improving access to family health care. They stress health promotion and disease prevention, as well as treating ailments and managing serious chronic diseases. And this is health care that’s reducing wait times. By providing comprehensive care close to home, and thereby reducing the need for Emergency Department visits, Family Health Teams will increasingly ease the strain on our hospitals. That means our hospitals can deliver the acute care they were designed to deliver. And they can deliver it faster. Above all, Family Health Teams are improving access to doctors and nurses. Now, thousands of Ontarians previously without access to a family doctor will not only have access to health care professionals including a doctor, a nurse, or a nurse practitioner, but also a whole complement of other health care professionals such as dieticians, mental health and social workers. The government has also committed to establishing 25 nurse practitioner-led clinics over the next several years. Nurse practitioners will be working in collaboration with family doctors to provide health care to many Ontarians who previously have not had access to family health care. These clinics will not only focus on providing better care to patients but also they will work with patients to educate them on disease prevention and health promotion. The clinics will also be linked to specialists, interdisciplinary health care providers, hospitals and laboratories, as well as other health care organizations, offering patients a comprehensive approach to health care. The government has also committed $154 million over three years to build on Ontario’s cancer-screening program to increase early detection and treatment of breast, cervical and colorectal cancers. That funding covers the costs of Prostate-Specific Antigen testing to diagnose and monitor treatment of prostate cancer, and extending the Human Papillomavirus vaccination against cervical cancer. ENABLERS Both the wait times and the family health care priorities will be supported by :
Local Health Integration Networks, as managers of local health systems, will ensure delivery of services toward implementation of these priorities. With the establishment of Ontario’s 14 Local Health Integration Networks, the government has enhanced the capacity for more dialogue at the local level. This dialogue is helping to zero in on what’s needed to ensure a patient-centered health system, one that’s responsive to local health care needs. Meanwhile, Ontario will begin to implement the electronic health record for its residents, which will help transform Ontario’s health care system, reduce wait times for services, and improve access to family health care. Ontario continues to build an information-management system, enabling health care providers to produce better data. This will make it more likely to align performance measurement across the health system and help track how the system is performing. This is the people’s health care system and to ensure the delivery of health services reflects the reality of today’s diverse population, the government is seeking input through various bodies such as the Citizens’ Council on Drug Policy and the French Language Health Services Advisory Council. As always, the Ministry will continue to support the enhancement of the health of Ontarians in all of life’s stages. This role reflects public expectations while delivering on the government’s commitments to advance patient-centered health care across the province.
Ministry of Health and Long-Term Care Organization Chart [PDF]
Acts Administered by the Ministry of Health and Long-Term Care Alcoholism and Drug Addiction Research Foundation Act Audiology and Speech Language Pathology Act, 1991 Trillium Gift of Life Network Act All laws can be accessed by browsing www.e-laws.gov.on.ca
Agencies Boards and Commissions
Financial Information
Table 1 : Ministry Planned Expenditures 2008–09
Table 2 : Ministry of Health and Long-Term Care Operating and Capital Summary by Vote [PDF]
APPENDIX I : Annual Report 2007-08
Ministry of Health and Long-Term Care Four-Year Achievements
In 2007-08, the Ministry of Health and Long-Term Care continued its work to establish a patient-focused, results-driven, integrated and sustainable publicly funded health system. This work was anchored with a clear vision for health care in Ontario. This broad vision was intended to help people stay healthy, deliver good care when they need it and ensure that the health system is there for their children and grandchildren. To make that broad vision of Ontario's health care future a reality, the Ministry focused on three strategic areas. These included :
The first strategic direction was to improve the delivery of health care in Ontario, with major changes in three key results areas :
1) Reducing Wait Times : The government's Wait Time Strategy is designed to improve timely and appropriate access and reduce wait times for five major health services, including :
During 2007-08, the government added pediatric surgeries to the Wait Time Strategy, providing for more than 10,000 surgeries over four years. To do so, $5.5 million was committed in 2007-08 to provide over 2,000 additional surgeries. Through the Wait Time Strategy, Ontarians received more of these critical procedures faster. Ontario developed a comprehensive system to monitor wait times and help ensure that Ontarians receive timely and appropriate access to five select services. The Wait Time Information System continues to be expanded in order to capture all surgeries in hospitals currently receiving wait times funding. 2) Improving Access to Physicians, Nurses and Other Health Professionals This entailed increased access to doctors, nurses, and other health care professionals at the local level. This occurred through such initiatives as Healthforce Ontario, implementing a comprehensive nursing strategy and increasing medical school enrolment as well as through a variety of integrated recruitment and access support initiatives offered through the Underserviced Area Program (UAP) and the Northern Health Travel Grant (NHTG) Program. 3) Keeping Ontarians Healthy An important part of the Ministry's plan for health care is about preventing people from getting sick in the first place. This involved giving some of Ontario's most vulnerable citizens a healthy start in life by :
The Ministry continued to rebuild Ontario's public health system through Operation Health Protection. As of January 1, 2007, the government's share of public health unit funding increased to 75 per cent, compared to 50 per cent in 2004. The cost share shift is an important component in the government’s action plan to revitalize Ontario’s public health system. In 2007, the government also committed $459.9 million to Ontario’s public health units to support the provision of 17 mandatory health programs and services. In addition, the government provided funding for related programs, such as West Nile virus and infectious diseases control. Operation Health Protection also focused on :
The second strategic direction was to manage the delivery of local health services. On April 1, 2007, the province’s 14 LHINs assumed their full responsibilities of funding, planning and integrating health care services at the local level. LHINs are ensuring greater community involvement in local health care decisions. LHINs are essential to the management and co-ordination of health care services at the local level. They are helping provide an integrated and patient-centred health care system -- one that is responsive to local health care needs. On April 1, 2007, the LHINs assumed responsibility for the following programs and services: public and private hospitals, divested psychiatric hospitals, long-term care homes, Community Health Centres (CHCs), community mental health and addictions agencies, Community Care Access Centres (CCACs) and community support and service agencies. Some provincially oriented or claims-based programs remained with the Ministry. Part of the LHINs’ mandate is to negotiate service accountability agreements with health care providers. The government assigned to LHINs the existing service agreements between the Ministry and health service providers within LHIN-managed sectors, including hospitals. As of April 1, 2007, LHINs took on the responsibility of undertaking all future negotiations with hospitals. The Ministry developed a regulation that will phase in the requirement for LHINs to negotiate new service accountability agreements with health service providers in various sectors over a number of years. The schedule for LHINs negotiating these agreements is as follows :
These agreements will clearly establish service standards and targets that providers are expected to meet, and will also include protocols for monitoring and reporting as well as possible strategic interventions by LHINs if and when improvements are deemed necessary. In June 2007, the first Ministry-LHIN Accountability Agreement was approved. It sets out the Ministry and LHIN funding, planning targets and performance obligations for the 2007-08, 2008-09 and 2009-10 fiscal years. LHINs also submitted their initial Annual Service Plans to the Ministry in August 2007, laying out how the LHINs will spend their allocations in order to implement their Integrated Health Service Plans. Finally, the LHINs prepared and submitted their second annual report to the Legislature in summer 2007. The Ministry continued to build an information management system to enable and manage effective delivery of care. Overall, Ontarian's information management strategy will improve the ability of health care providers to produce better data. The strategy will align performance measurement across the system. With better information and enhanced information management, Ontario can accurately track how the health system is performing, so that people can assess its quality and progress and see evidence of value for money. The third strategic direction was reporting on results to demonstrate accountability. One example of how the Ministry is continuing to build accountability into the system is through the Wait Time Information System. In 2005, the Ministry launched a comprehensive website that for the first time allowed Ontarians to track and compare wait times for five key services. Wait times are categorized on the website by procedure, hospital and LHIN. The publication of wait time information became more timely. As of November 2007, the Ministry began updating wait time data on a monthly basis. The public and health care providers now have access to more current information that’s so vital in making important health care decisions. The Ontario Health Quality Council was established in September 2005 and is an independent body formed to monitor the health care system and report to the public on the performance of the health care system in Ontario.
Ministry of Health and Long-Term Care Achievements for 2007-08
The Ministry worked on the following top commitments in 2007-08 to achieve the government's key results and priorities for the health care agenda :
Reducing Wait Times The Ministry's Wait Time Strategy further improved access to health care. On April 27, 2007 the government announced an investment of $281.8 million for 465,000 additional procedures. In 2007-08, the investment resulted in :
Then on May 10, 2007, $5.5 million was announced for over 2,000 additional pediatric surgeries in fiscal 2007-08. The pediatric procedures in 2007-08 included :
Since the launch of the Wait Time Strategy, the government has invested over $895 million for about 1.27 million procedures, including :
Emergency Department Action Plan In partnership with the Ontario Medical Association, the Ministry developed a package of new incentives and programs designed to enhance emergency department (ED) coverage across Ontario. The Emergency Department Coverage Incentive represents a positive first step toward developing longer-term solutions to ensure emergency rooms stay open and increase capacity in the health care system to meet the needs of Ontario patients. An ED leader was also appointed in each of the LHINs to assist with local implementation initiatives. In October 2007, the government announced that ED wait times would be part of Ontario’s Wait Time Strategy. As a first phase of the work, the strategy will implement an Emergency Department Reporting System (EDRS) for Ontario. These initiatives build on the October, 2006 announcement of a three-point ED Action Plan, investing more than $142 million in three critical areas – health human resources, hospital ED services and efficiency improvements and community-based services. All EDs in the province have remained opened since October, 2006. Improving Access to Physicians, Nurses and Other Health Professionals The Ministry improved access to health care professionals :
Human Resources Strategy HealthForceOntario In May 2006, the government announced the launch of HealthForceOntario, its health human resources strategy designed to make Ontario the employer-of-choice in the health care field and to ensure the right number and mix of health care providers, where available when and where they are needed. Initiatives implemented in 2007-08 as part of the HealthForceOntario Strategy include :
Keeping Ontarians Healthy A strong public and community health system is important in preventing illness and promoting wellness. Among the projects this year :
Hepatitis C Funding The total Hepatitis C funding for 2007-08 was $6.4 million, which supported a number of initiatives, including :
Building a System to Manage the Delivery of Services Implementation of Local Health Integration Networks (LHINs) As previously identified, the LHINs are now operating within the full scope of their authority under the Local Health System Integration Act, 2006. Through their own planning and funding processes, and in conjunction with Ministry funding initiatives such as Aging at Home, they are building local health systems based on priorities identified through engagement with their communities. Ministry Restructuring The Ministry continued to implement its transition to a new organizational structure, consolidating functions and increasing system and financial accountability. The organizational design has been completed and nearly implemented for two key divisions based on a stewardship functional model. These divisions are: Health System Strategy and Health System Information Management and Investment. Organizational design work for the Health System Accountability and Performance Division, Public Health, and some parts of the Corporate and Direct Services Division commenced in 2007-08. Other aspects of the transition work continue with the goal of strengthening the Ministry’s position as effective and efficient stewards of the health system—now and in the long-term. Health System Strategic Plan The government continued to work on developing a 10-year strategic plan—a commitment it made under the Local Health System Integration Act, 2006, to develop and publish a strategic plan for health care. e-Health Strategy The Ministry continued to provide leadership in the integration and co-ordination of e-Health by putting the building blocks in place for a provincial electronic health system that will be patient-centred and clinically focused. The emphasis over the next four years will be the ability to manage chronic diseases, starting with diabetes. The key components of the government’s approach to e-Health are :
e-Health achievements in 2007-08 include :
Reporting on Results to Demonstrate Accountability The Ontario Health Quality Council was expected to publish its third annual report in March, 2008. The council was set up in September, 2005 to track performance of the health system, help Ontarians to better understand and benefit from their health system and to support continuous quality improvement. Other Achievements Aging at Home Strategy On August 28, 2007, the government announced the Aging at Home Strategy. The government will invest more than $700 million over the next three years to provide seniors and their caregivers with an integrated continuum of community-based services to enable them to stay healthy and live more independently in their homes. The Aging at Home Strategy will offer new possibilities for Ontario’s culturally diverse population that will emphasize community-based partnerships and an integrated continuum of services and supports for seniors and their caregivers. LHINs are taking a leadership role to plan, integrate and fund services at the local level to create significant change in the range of health and community care services available for seniors in Ontario. Alternative Levels of Care Strategy (ALC) The government committed to invest $45.2 million in its ALC strategy. The strategy includes three complementary programs :
LHINs developed innovative and collaborative ALC solutions by taking advantage of $13.7 million announced in 2007 and $15.3 million announced in October 2006 to provide support for patients that don’t need to be in hospital. The funding distributed by the LHINs is being used to :
Long-Term Care The Long-Term Care Homes Act 2007 received Royal Assent on June 4, 2007. It is a focal point of the Government’s strategy for improving the quality of care for residents in Ontario’s LTC homes while strengthening public accountability and enforcement. The Act will provide the legislative framework for improving and strengthening the care provided to residents and for managing approximately $2.8 billion annually in public funding to over 600 homes. In September 2007, the Ministry increased the raw food allowance by more than 25 per cent ahead of the rate of inflation to $7 a day per resident. In 2007-08, the LTC home program funding was $2.8 billion. As of February 14, 2008, the following beds have opened since October 2003 (new, redeveloped, retrofit, upgrade) :
In the summer 2007, 2,412 new LTC beds were awarded to meet the growing demand in key communities across the province. The government committed to the hiring of 1,200 registered practical nurses for long-term care homes. The government will also be redeveloping 35,000 older LTC beds over the next 10-years to support access to quality LTC homes. The renewal strategy will address the differences between older and newer long-term care homes so that more residents can access quality services and home features. This will result in:
HIV/AIDS Funding Enhancements The total HIV/AIDS funding for 2007-08 was $55 million. The investment included funding for community-based AIDS education and support programs, and AIDS education and support programs to enhance HIV prevention initiatives in priority populations – gay and bisexual men, Ontarians from Africa and the Caribbean, people who use injection drugs and Aboriginal peoples in Ontario. The government launched a groundbreaking HIV testing program – the first of its kind in Canada. The free point of care test screens for antibodies of HIV in the blood and initial results are available within 60 seconds. The government announced 24 new anonymous testing sites with an emphasis on northern and rural communities, increasing to 50 the number of anonymous HIV testing sites across Ontario. The point of care HIV testing program will be available in designated anonymous HIV testing sites, sexually transmitted infections clinics and community health centres around the province. End-of-Life Care Strategy In October 2005, the government committed $115.5 million investment over three years to an End-of-Life Care Strategy to improve care services at home as well as in the community. The achievements under the strategy in 2007-08 included :
Drug Programs In 2007-08, Ontario Public Drug Programs was created under the leadership of an executive officer and assistant deputy minister. Ontario Public Drug Programs assumed responsibilities once covered by two separate functions, formerly within the Drug Programs Branch, Drug Programs Management and Pharmaceutical Services. The former Drug System Secretariat has also been rolled into the Ontario Public Drugs Programs. Other functions formerly within the Drug Programs Branch (Drug Payment and Control, Individual Clinical Review Operations and Benefit Systems Operations) were transferred to the newly-created Individual Eligibility Review Branch. Together, Ontario Public Drug Programs and Individual Eligibility Review Branch are accountable for six public drug programs :
Through these drug programs, the Ministry provides coverage to 2.9 million Ontarians, with a budget of about $3.4 billion in 2007-08. The changes to the drug system came about due to the Transparent Drug System Patients Act, 2006 becoming law in June 2006. The legislative changes strengthen the governance, accountability and transparency of the public drug system. This means :
MedsCheck The MedsCheck medication review program was launched on April 1, 2007. Its purpose is to help patients use their prescription drugs more effectively, which results in improved patient safety and treatment. Patients taking a minimum of three chronic prescription medications can get a one-on-one consultation with a pharmacist for about 30 minutes once a year to help them comply with their prescription and better understand the medications they are taking. On November 30, 2007, “Follow-up” MedsCheck was launched to give patients with additional needs a second MedsCheck review during the annual timeframe. Over 175,000 Ontarians have used MedsCheck and some 98% of the province’s pharmacies have performed medication reviews. Capital Program – Hospitals and Community Ontario invested almost $660 million in 2007-08 to help modernize the province’s health infrastructure and to expand capacity to cope with a growing and aging population. The fiscal year’s investment included more than $630 million to expand, renew and modernize hospitals and nearly $25 million for long-term care and community programs. The new initiatives to provide additional hospital service quality and expansion projects included :
Health System Improvements Act The Health System Improvements Act received royal assent on June 4, 2007. Portions of the Act were proclaimed into force on August 7, 2007. The Act will serve to improve Ontario’s health system in a number of areas including :
The Health System Improvements Act also provides for the transfer of responsibility for five categories of non-residential and seasonal residential drinking-water systems from the Ministry of the Environment to the Ministry of Health and Long-Term Care.
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