Health Bulletins

The Patients First Act

Frequently Asked Questions

December 7, 2016

Ontario passed legislation, The Patients First Act, that will help patients and their families obtain better access to a more local and integrated health care system, improving the patient experience and delivering higher-quality care.

The Patients First Act is part of the government's ongoing work under the Patients First: Action Plan for Health Care to create a more patient-centered health care system in Ontario.

How does the Patients First Act benefit patients?

The legislation will support the Patients First: Action Plan for Health Care and ensure that Ontarians' health care will be easier to navigate, better co-ordinated, more open and accountable:

Who was consulted on the Patients First Act?

Since December 2015, the province engaged and consulted with more than 6,000 patients, health care providers, caregivers, stakeholder groups, Francophone Ontarians, Indigenous peoples and other partners in the health care system to get feedback.

The ministry regularly engaged with physicians and the Ontario Medical Association (OMA) in the development of the Bill and other elements of the ministry's Patients First strategy and will continue to do so.

The ministry also consulted closely with key affected stakeholders on proposals to strengthen the Bill and made a relatively small, but important, number of amendments to Bill 41 (formerly Bill 210), which resulted in the Patients First Act, 2016. The ministry consulted stakeholders including hospitals, physician groups, community health organizations, the Information and Privacy Commissioner of Ontario and French Language Services Commissioner of Ontario. More than 25 stakeholders recommended enhancements to the Bill at Standing Committee.

Will I have to change doctors or home care providers? Will access to my doctor be decided by government employees?

No part of the Patients First Act, 2016 would change the control that patients currently have over all aspects of their healthcare. Patient choice remains paramount and health care will not be disrupted. Patient care and treatment will, as always, be decided by doctors and other front-line health care professionals together with patients.

How are you going to make sure that essential services like home and community care are not disrupted? Are the LHINs ready to take on home care?

Patients will not experience a disruption to their health care services during the transition of home and community care services from Community Care Access Centres (CCACs) to the Local Health Integrated Networks (LHINs). Frontline CCAC employees, including care coordinators and support staff, will continue to coordinate and contract home and community care in Ontario when these services are transitioned to the LHINs. Home care providers that were contracted by CCACs, including nurses and personal support workers, will be transferred to the LHINs and continue to provide patient care.

LHINs have a decade of experience in the planning and integration of health care delivery in their local communities and will build on this to deliver home and community care services. The LHINs are already working with their CCAC partners and the ministry to support a smooth and seamless transition.

Will this legislation result in cost savings? Will health care decisions be more about saving money instead of better patient care?

Patient care and treatment will, as always, be decided by the appropriate front-line health care professionals together with patients.

No funding will be removed from frontline health care. There is no added bureaucracy. Financial savings from reducing administrative and management costs will be reinvested in patient care.

How are LHINs accountable to patients?

LHINs are already responsible for planning and funding hospitals, long-term care homes, community services and mental health and addiction services. Under the Patients First Act, 2016, LHINs will also be responsible for home care and primary care planning so that it will be integrated with the rest of Ontario's health care system.

The legislation also ensures that local communities have a strong voice and the patient perspective is part of local health care planning, by requiring that each LHIN establish patient and family advisory committees. The health needs of the local population will also be addressed through formal engagement between the LHINs and their local boards of health.

LHINs are already accountable to the Ministry to ensure their decisions and operations are transparent. LHINs are governed by boards of directors from the community. Under existing legislation, LHIN board meetings are required to be open and key agreements, business plans and reports are publicly available on LHINs' websites. The Patients First Act, 2016, will strengthen the LHINs' accountability for local health service planning and performance as well as support the goal of providing care that is more integrated and responsive to local needs.

Will this legislation make the health care system more bureaucratic? Will there be more paperwork for patients and doctors, and more bureaucrats hired? Will bureaucrats be setting medical standards?

The Patients First Act, 2016 is about making a system that is better integrated and focused on patient and community needs to ensure health care resources are used effectively and efficiently, in the public interest.

There will be no added bureaucracy and any financial savings from reducing costs through combining the management and administration of the LHINs and CCACs will be reinvested in patient care.

Patient care and treatment will, as always, be decided by the appropriate front-line health care professionals together with patients.

Will this legislation give government bureaucrats access to private medical records and a patient's medical history, without a patient's permission?

The Patients First Act, 2016 will continue to protect privacy of personal health information. All existing privacy legislation remains in place and continues to ensure that medical information is kept private and secure. Patients' health records will not be accessible to government staff or LHIN.

In the event an investigator is brought in to review a Health Service Provider, no personal health information will be accessed without the patient's consent.

With the passage of the Health Information Protection Act, 2016 (HIPA), confidential health records have never been more secure. The Act increased fines and penalties for those guilty of breaching individuals' health records and also removed the six-month limitation for the prosecution of those accused of breaching health records.

What will the ministry and LHINs do differently to improve access to primary care providers and same day/next day service? How will the legislation also address access to specialists, imaging and operating rooms/wait times?

The Patients First Act, 2016 will help the province improve access to family doctors and nurse practitioners, by supporting the province's commitment that all Ontarians who want one will have a primary care provider. It will also improve access to care when patients need it, including on the same or next day when sick, as well as after hours and on weekends.

The Act will also enhance the mandate of LHINs so that they are better able to ensure that local services meet the needs of the local population and by empowering LHINs to support patients in improving access to primary care. A number of initiatives are underway to reduce wait times and support appropriate and transparent referrals for specialist care, including bringing down wait times for specialists by improving the referrals process, better co-ordinating care and improving access to the right providers.

How is Ontario addressing concerns that Community Care Access Centres provide inconsistent services across the province?

The Patients First Act, 2016 will support improved consistency by strengthening oversight of home and community care and improving its integration with system planning and delivery.

The Patients First Act, 2016 complements Ontario's Roadmap to Strengthen Home and Community Care, under which initiatives are underway to ensure that Ontarians receive equitable and high-quality care based on their needs, regardless of where they live. As CCAC functions and staff are transferred to Ontario's 14 LHINs, the foremost priority will always be to ensure that patient care is maintained through this transition.

What changes are being made with regards to Franco-Ontarians or French Language Services?

The legislation will reinforce the expectation that LHINs comply with the French Language Services Act in the planning, design, delivery and evaluation of services. To recognize the importance of French Language Services to Ontarians within all LHINs, the legislation emphasizes LHINs' responsibility of promoting health equity and diversity, including respect for the diversity of French-speaking communities.

The legislation also ensures that the LHINs' planning and community engagement responsibilities include priorities and directions that foster health services according to the French Language Services Act.

Ontario will continue working with French language health leaders to ensure their voices are heard, in particular with respect to equitable access to services that meet their unique needs.

How will this help LHINs be more responsive to local needs?

The Patients First Act, 2016 will provide tools and guidance to support LHINs in their role in making health care easier to navigate, better co-ordinated, more open and accountable, locally. LHINs will have accountability to the communities they serve, including advice from a patient and family advisory committee and a formal linkage to leverage local population health knowledge and expertise from local boards of health.

LHINs will also establish sub-regions - smaller geographic planning regions within each LHIN - to help them better understand and address patient needs at the local level. By looking at care patterns through a smaller lens, LHIN staff will be able to better identify and respond to community needs and the LHIN will be able to ensure that patients across the entire LHIN region will be able to access the care they need, when and where they need it. This approach will not restrict Ontarians as they make their health care decisions and it is not an additional layer of bureaucracy.

A key priority of LHINs will be to ensure that every resident who wants a primary care provider has one, and to ensure that patients have timely access to those providers when they need it including on the same or next day when sick, as well as after hours and on weekends.

What is the purpose of sub-regions? How will they work?

A. A sub-region is a smaller geographic planning region within each LHIN to help LHINs to better understand and address patient needs at the local level. By looking at care patterns through a smaller lens, LHIN staff will be able to better identify and respond to community needs and the LHIN will be able to ensure that patients across the entire LHIN will be able to access the care they need, when and where they need it. This approach will not restrict Ontarians as they make their health care decisions.

Sub-regions are a planning tool - not additional bureaucracy. Some have been in place informally for many years. They were established based on existing care patterns to enable health planners and providers to better identify and respond to the health care needs of local communities, to ensure that patients are able to access the care they need, when and where they need it. A sub-region is not a boundary. They will not restrict Ontarians as they make their health care decisions.

What is the rationale for creating sub-regions?

A. Currently, each LHIN encompasses approximately 1-2 million Ontarians, making these regions both populous and diverse. By viewing health care planning at a sub-regional level, sub-regions provide a local lens that will help LHINs better address patients' needs at the local level.

A greater local focus will ensure that patients can access the health care services they need closer to home. Sub-regions were established based on existing care patterns in order to achieve this more local approach that will better serve Ontarians by ensuring that services reflect the unique needs of patients and communities.

Meeting the distinct health care needs of a community, and providing focused care to patients within that community, requires a tailored approach.

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