AFHTO’s Submission on Bill 74: The People’s Health Care Act, 2019

April 03, 2019

On April 2 AFHTO presented its submission to the Standing Committee on Social Policy on Bill 74: The People’s Health Care Act, 2019. Our key recommendations are:

1. That Bill 74 require primary care to be part of an Ontario Health Team (OHT). It is also recommended that primary care teams be the lead of an OHT in areas with highly functioning teams who can continue to be leaders in delivering truly integrated care. Primary care is the entry point to the health care system. These are the health care providers who know the patients and their families the best.

2. That Bill 74 (Part IV – Definitions) be strengthened by including the vision of the Patient’s Medical Home when speaking about the Integrated Care Delivery Systems, with specific notation made to the Minister’s Patient and Family Advisory Council Patient Declaration of Values. While there is notation in the preamble about the importance of the patient in the development of Bill 74, it is important that there also be a strong vision for this health system restructuring, especially with the creation of the local level Ontario Health Teams. The Patient Medical Home encompasses that vision – it puts the patient and the family in the center of care while also recognizing the importance of the Quadruple Aim through its pillars.

3. That there be an addition in Part IV of the Bill under Integrated Care Delivery Systems that specifically outlines governance of integration, including principles of collaborative governance and what the requirements will be of the Boards of the HSPs that are coming together to change the way care is being delivered in their community. For integrated health care systems, it is truly placing the patient at the center of care – not the organization where the care is being delivered. And that, for many, will require a tremendous amount of change management support. Health care organizations have been funded in siloes for decades with targets and indicators that are very specific to their funding. A move towards a shared budget will require a shift in thinking, new partnership building and, fundamentally, trust.

4. a)  As Ontario Health starts becoming operational, we recommend it stay true to Part II (The Agency) Objects and General Powers and support the health service providers in the sector as outlined in the Bill and NOT be involved in direct service delivery, including in the area of home and community care.
b)    We ask that the relationship between primary care and home and community care be strengthened by transitioning the function and associated resources of care coordination to primary care.
c)    It should also be noted that in any application for an OHT, there should be concerted effort made to ensure that primary care and mental health and addictions supports are integrated and it is our recommendation that this is a priority for each integrated care delivery system in the province.

AFHTO is pleased to see the government’s commitment towards truly integrated patient-centred care. Health care providers in interprofessional team-based primary care have been working in integrated systems of care for years but have felt that there is still fragmentation in the care they are able to provide, mainly because of the disconnect between the siloes of care, from acute to home care, from mental health and addictions to long-term care. Primary care is the entry point to the health system and for many patients in the province, the relationship they have with their family physician or nurse practitioner is everlasting and built on trust. A truly effective, high quality health care system needs to be coordinated, integrated and foundationally built in primary care, which will ensure we are delivering a sustainable health system for the future.

Team-based primary care is popular with its 3.5 million patients because it provides a better patient experience, helping people avoid long and confusing waits for referrals and getting lost navigating our complex system. We need to expand this experience so that every Ontarian can get access to the care they need when they need it. We look forward to working with the government as it starts the journey on implementing this very important health restructuring plan and creating a new integrated system of care that is focused around the patient.

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