The Ontario government is in the midst of making significant changes to the province’s health care system that build off of previous reforms, in an effort to create a more integrated system that provides higher quality of care to Ontarians through improved access and accountability.
CMHA Ontario is continuously monitoring changes in the health care system and their impact on people with mental health and addictions issues. As the health care system changes, we are committed to working to ensure that changes are in the best interest of the mental health of Ontarians.
Current System Transformation
In 2019, the government passed new legislation, the People’s Health Care Act, which supported the establishment of a new Crown agency, Ontario Health:
Ontario Health will take on the programs and operations of six health agency transfer partners, including Cancer Care Ontario, Health Quality Ontario, E-Health, Health Shared Services Ontario, Trillium Gift of Life, and Health Force Ontario Marketing and Recruitment Agency
- The new agency will aim to enable:
- Expansion of the current exceptional clinical guidance and quality improvement practices in existing agencies into other critical areas of the health care sector
- Application of current best-in-class models to parts of health care that have been historically left behind (such as mental health and addictions supports)
- Consistent oversight of high-quality health care delivery across Ontario, including a more efficient approach to coordinating services for patients and enabling innovation
- Advancement of digital first approaches to health care, such as virtual care, and improving the integration and efficiency of digital assets across the entire health system
- Clear accountability for monitoring and evaluating the quality of health care services, and providing clinical leadership, consistent clinical guidance, knowledge sharing, and support for providers
- Elimination of duplicative back office infrastructure and administration
People’s Health Care Act (2019), marks the reorganization of Ontario’s 14 Local Health Integration Networks (LHINs) and their functions. The government also plans to establish a single province-wide supply chain management model for the entire health care sector. Providers and patients will also be engaged on the procurement of medical products and services to help ensure those that are used are delivering the best outcomes for patients.
The legislation gives authority to the minister to integrate the health system through integration orders to health service providers or integrated care delivery systems that are funded through Ontario Health. The minister is given the power to dissolve organizations, transfer assets, liabilities, such as agencies within an integrated care delivery system.
The proposed legislation will also support the establishment of Ontario Health Teams:
- Ontario Health Teams will represent the organization of health care providers into coordinated teams that are focused on patients and specific local needs
- Ontario Health Teams will aim to provide seamless access to various types of health services, including primary care, hospitals, home and community care, palliative care, residential long-term care, and mental health and addictions
- As Ontario Health Teams are established, Ontarians will continue to be able to choose who provides their care, and are expected to have even more care choices available through technology
- Ontario Health Teams will be established in phases across the province, with information on how providers can become an Ontario Health Team being made available beginning in April
- Ontario Health Teams will focus on existing local health care providers partnering or working together to provide coordinated care, or teams of providers serving a specialized patient population such as specialty pediatric or patients with complex health needs
- The new teams are expected to provide patients, families, and caregivers help in navigating the public health care system 24/7 and will aim to improve patient transitions from one health provider to another with one patient story, one patient record, and one care plan
- Ontario Health Teams will be rewarded for fiscal responsibility, such that any funding surpluses that result from efficiencies will be directed back into patient care provision
- The creation of Ontario Health Teams will rely on leadership already existing in the community, rather than dramatic change within existing health care providers, and a suite of supports aimed at removing barriers to innovation and encouraging digital practice will be available to early Ontario Health Teams
The provincial government:
- Intends to take a long-term approach to health system transformation, with the entire process being phased in so that Ontarians can continue to contact their health care providers as usual throughout the transition
- Does not plan to change the central tenets of Ontario’s publicly funded health care system, and does not envision any additional privately delivered, for-profit care above what already exists
- Aims to spend money more efficiently in health care, rather than spend less money on health care overall
- Consulted with a range of stakeholders prior to the drafting of the new legislation, and looked to other jurisdictions to determine what would work best for Ontario
- Expects that this legislation and its associated system transformation will lead to a rebalancing of roles in health care that will shift more individuals into front line roles
- Has no intention of dismantling agencies that focus on French language services and wants to ensure that the needs of all Franco-Ontarians are met
- Plans to implement safeguards to protect private information, so that patients can safely access online health services, including their personal record
Past System Transformation
Ontario’s Patients First: Action Plan for Health Care was released in 2015 and was the previous blue print for shaping the province’s health system transformation with an emphasis on ensuring a patient-centered approach to health care delivery throughout the province. There were four priorities of focus for this action plan. The government was committed to improving access, connecting services for more integrated and coordinated care, informing patients and people how to make the right decisions about their health, and protecting our universal public health care system by improving value and quality of care to sustain the system.
A major goal of this government’s transformation agenda for health was to make the health system more accountable for health outcomes. The Excellent Care for All Act (2010) established requirements for health care organizations, starting first with hospitals then into the community sector, to monitor the quality of care provided to their clients. Health Quality Ontario was also formed as an arm’s length government agency responsible for monitoring and reporting on health care system performance, creating evidence based standards of care, and supporting quality improvement efforts within health care service organizations across the province.
Furthermore, to enhance accountability and create a more integrated system, in 2005 the provincial government began restricting the provincial health care system into 14 regions called Local Health Integration Networks or LHINs, which are responsible for the day-to-day management of the health system, the funding and monitoring of the health system in their geographic area. By bringing planning and funding down to a more local level, the goal was to make the health system more accessible, easier to navigate, and more responsive to the needs of the people who live in the LHIN areas.
In June 2016, Ontario introduced new legislation, The Patients First Act, which gave the LHINs an expanded role in primary health care and home and community care, to continue to enhance the integration of services throughout the province.
Past Health transformation and mental health
Through system transformation has come increased awareness and investment in mental health and addictions services throughout Ontario. Through the previously discussed health system initiatives and strategies, mental health and addictions services and program gaps are becoming more and more prevalent as an unmet health need for Ontarians.
Because of this growing and recognized need to improve mental health and addictions within Ontario, the province developed a strategy specifically to address the growing gaps and needs of the mental health and addictions services across the province. Open Minds, Health Minds: Ontario’s Comprehensive Mental Health and Addictions Strategy was launched in 2011 as a 10-year comprehensive approach to transforming the mental health and addictions system. The four guiding goals of the Strategy are as follows:
- Improve mental health and well-being for all Ontarians;
- Create healthy, resilient, inclusive communities;
- Identify mental health and addictions problems early and intervene;
- Provide timely, high quality, integrated, person-directed health and other human services.