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Making Healthy Change Happen: Ontario's Action Plan for Health Care - Year Two Progress Report

THE HONOURABLE DEB MATTHEWS
MINISTER OF HEALTH AND LONG-TERM CARE

January 27, 2014

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Well thank you Noble and thank you to the Empire Club and a special thank-you to all of you for being here today. It's a real pleasure for me and I have to tell you there's a whole table of my family right here so.... it's great to have them, the support of the people I love and who love me.

I'm here to talk about a big Canadian project, one that impacts every one of us and the people we love. It's the sustainability of our uniquely Canadian precious universal health care system.

You may have seen a TV commercial recently of our Premier Kathleen Wynne. She's running uphill in the very early morning and it's a cold wet day. She tells us that she sets goals, really hard to accomplish goals and I can vouch for that.

I can tell you that in health, we've also set some really hard to accomplish goals. Two years ago that's what we did when I released Ontario's Action Plan for Health Care. It sets out an ambitious agenda to transform our health care system.

We all know that transformation is necessary. Our fiscal and demographic realities demand it. Indeed our fiscal reality is further challenged by 640 million dollars in cuts to transfers from the federal government and we're getting 300 million less in federal health care transfers than we should when compared with other provinces.

However, despite the challenges our resolve is not shaken; quite the opposite... because if we lose our resolve and if we fail in transformation, it would mean the end of universal health care and that's not OK. That's not OK for me, not for our parents, not for our grandkids. It's just not OK.

I knew when I released the Action Plan that transformation would be tough, that it would challenge relationships, but I also knew that together we could make it happen and that is, in fact, what we are doing thanks in large part to many of the people who are here today and I want to say thank you to all of you who have played a part in transformation and an especially big thank-you to former Deputy Saad Rafi who has really made this happen.

And I must mention Saad Rafi's team as well. At the time of the Action Plan's launch two years ago, I pledged to report back annually on our progress and that's why I'm here. So we're two years in. I can report to you that transformation is well underway. It's in full swing.

We've made fundamental improvements and changes to how we deliver health care especially for our growing population of Ontario seniors and at the same time we're doing something that many people said was impossible - we're significantly bending the cost curve.

We used to see annual growth of about six to seven percent in our health care budget. We are now down to just over two percent. We hit our fiscal target last year. We did it this year and we're going to do again next year. We're going to stay on track for the foreseeable future. That is the new normal.

And this is the remarkable thing. At the same time as we're bending the cost curve, we're measurably improving the quality of and the access to health care. We're able to do both because people who work in health care are demonstrating extraordinary leadership and innovation.

They're challenging the status quo. They're showing us how we can do things differently and that we can do them better -- for patients. So instead of asking does this change benefit me? Does this benefit my organization, my profession? Health care leaders at all levels are asking how can we make it better for patients? How can we get better value for money?

I'm reminded of the New Zealand physicist, Ernest Rutherford, who once said, "Gentlemen, we are out of money. Now it's time to think". I think that perfectly describes health care, not just in Ontario, but everywhere.

So if it's better for patients and it's better value for money, and often it's both, then it's up to us, all of us, to make that change happen. It is not always easy. We've had to make some pretty tough decisions. There has been noise. There has been opposition. There has been fierce opposition, but it's worth it.

Other provinces are following our lead when it comes to prescription drug reform. Here in Ontario our reforms mean that we can reinvest 500 million dollars a year in more drugs, for more people and more services that pharmacists can offer like the flu shot and consumers are also saving with lower prescription drug costs.

We're working with doctors to align the care we pay for with evidence based best practices and to share in the benefits of technology improvements, meaning that we can now reinvest 400 million dollars a year in new doctors and care for more patients.

Hospital leaders are helping us move from a global hospital budget to a funding model whereby funding follows the patients and last year we reformed how physiotherapy and seniors exercise classes are delivered. And as a result 200,000 more people can get the care they need to be strong and healthy. I can assure more reforms must and will be made when they're better value for money and when they're better for patients.

We've looked back after two years and see that the Action Pan is the right plan. We continue to implement it and I can assure you we're not deviating from it. Our work is far from done, but today I can report that we've made significant progress on all of the initiatives set out in the Action Plan. I'm sure will come as some relief to you that I'm not going to list them all. That information is in the material at your, at your table.

But I do want to talk to you about some of the results that we've achieved and I want to talk about some of the next steps in transformation. I also want to show you some of faces of this transformation, people who have inspired us, who are driving this change or who we hope to help with the change that is underway because health is about people. It is only about people.

The Action Plan is built on three pillars. The first pillar, keeping Ontario Healthy. We're focussing on preventing the diseases that have the greatest cost to people and to the system. One of those diseases is cancer.

This is Kate Neale. She's a young woman from Belleville. She worked in a tanning salon and she was told that she had to tan and she had to tan often and she had to tan regularly and then she developed melanoma, a deadly disease. Thanks in part to Kate, last year the Legislature passed the Skin Cancer Prevention Act so hopefully there will be no more stories like Kate.

Protecting our kids from cancer also means taking strong action when it comes to smoking. Our smoke free Ontario strategy is already a North American leader and it's helped bring smoking rates from a high of about 25 percent to about 19 percent. In the Action Plan we set a goal of having the lowest smoking rates in the country.

That's a distinction currently held by British Columbia. They're at 15 percent so that means we need to do more. So we're proposing to double penalties for selling tobacco to minors, banning the sale of flavoured tobacco and banning smoking on bar and restaurant patios and on sports fields.

The Action Plan also identified childhood obesity as a major driver of future health care costs. There's no question that kids are less active and less fit and less healthy than they were just a generation ago and that something needs to be done to reverse that trend.

So we established the Healthy Kids panel to follow the research and provide us with advice. They told us that action needs to begin at birth and even before birth. I was surprised to learn that supporting breast feeding is perhaps the most important thing we can do to reduce childhood obesity. That's why we're offering every new mom access to breast feeding supports, including 24\7 access to lactation consultants through Teleheatlh Ontario.

The Healthy Kids panel also told us that access to healthy food is a big part of the answer so now 33,000 more kids in higher need communities, including our First Nations communities, are getting access from to expanded student nutrition programmes.

Making a difference in kids' health means we all have to make healthier choices and we need to have the information to make those healthier choices. That's why we're going to introduce new legislation which will have passed requiring the posting of calorie counts on the menus of large chain restaurants and other chains where ready-to-eat food is sold.

But if we're going to make a measurable difference in our kids' health, we know we can't do it alone. Legislation and regulation alone won't do it. We need all hands on deck. We need engagement and partnership from everyone in our communities, municipalities, businesses, non-profits and families to get our kids healthy and active.

That's why last week the Premier and I, along with Pan Am, Para Pan Am Games mascot Pachi the porcupine, launched the healthy kids community challenge to invite communities across Ontario to partner with local organizations to promote healthy active living amongst our kids.

This is based on research. It's based on the EPODE model that has demonstrated great results in France and around the world. I hope that some of you might consider playing a leadership role in your community by being part of the healthy kids community challenge.

So let's move to the second pillar of the Action Plan, faster access and stronger links to family health care. When it comes to faster access, to family health care, we've come a long way and we have a long way to go.

As you may have seen in the news last week, Canada trails the pack in patient access to same day and next day appointments with their family doctor. We need to do better. As long as people can't get timely access to their family doctor or their nurse practitioner, they'll turn to a much more costly alternative - the hospital ER.

There are some exciting things happening in primary care, especially when it comes to people with the greatest health care needs. Now here's a statistic that really grabbed my attention. One percent of us account for one-third of all health care spending. Five percent of us account for two-thirds of all health care spending. So we really need to focus on people who have significant health care needs.

Community health links are a brand new, made in Ontario innovation that wraps care around our most complex patients and puts their family doctors or nurse practitioners at the centre of a single unified plan of care. Most of these patients are seniors with complex needs. We're also finding that many, if not most, have mental health challenges as well. So rather than explaining here's a two-minute video that describes how health links help patients like Mary.

(VIDEO)
Can we provide better care for our most complex patients, including seniors with multiple needs? Meet Mary, with diabetes, a bad hip and emphysema. Mary has a lot of appointments, doctors and medications. Lately she's in and out of hospital too. It's hard on Mary and her daughter spends a lot of energy trying to find her way around the health system to help her mother get the right care.

Mary is anxious. She just wants to be able to play with her grandchildren and visit friends. Mary's family doctor is frustrated. He's not always up-to-date on what's happening with Mary's care. Has she been to the ER? Has someone prescribed new medication? Is she eating properly?

With Health Links things are changing. Mary and her daughter are a key part of the care team including her family doctor, nurse practitioner, personal support worker, physio therapist, pharmacist, Meals on Wheels and diabetes educator. Together they create a care plan based on what's important to Mary, feeling well enough to play with grandchildren and visit friends and Mary is assigned a care co-ordinator.

Now when Mary has a problem she has someone to call so she doesn't need to go to the ER every time, but when she must go to the hospital, staff have her care plan and know her medical history so they can provide the best care for Mary.

Through Health Links everyone in Mary's care team shares information about Mary's health in a timely way. Now Mary's family doctor knows what's going on with every part of her care and when to follow up. The care team has even arranged for Mary to be taken to a diabetes programmes each week.

Mary and her daughter spend less time in hospital and at appointments and more time enjoying life. Everyone is feeling more confident about Mary's care. Mary's doctor and the whole care team are connected through the health link and feel like they're truly helping Mary and her family.

Now Mary's getting better care in a health system that's more efficient and effective and there for others who need it. Health Links is one way everyone in the health care system is working together to make healthy change happen. To find out more visit Ontario.ca/healthy change.

(END OF VIDEO)

So we now have 47 health links covering almost half the province and in coming months we hope that we'll have the whole province with access to health links. The establishment of health links isn't the only innovation that has shown me just how much providers at all levels of our system are thinking differently about how to provide better care.

Here's a picture of Deb Wicks from Toronto EMS. Our paramedics are on the front lines. They see close up when the health care system is failing people because those folks call 911, sometimes dozens of time a year... dozens of times a year.

Paramedics would rather prevent the call to 911 than respond to that call and they found ways to offer the familiar faces better ways to get the care they need often by referring them to other community services and sometimes just by dropping by for an unannounced call rather than waiting at the station for the phone to ring.

This is called community para medicine. It's a very exciting innovation. You may have seen a story recently on CBC that highlights the results of community para medicine in Renfrew County. A recent Toronto EMS study showed that community para medicine resulted in a 50 percent decrease in the number of repeat calls to 911 and a 65 percent decrease in the number of transportations to the emergency department.

So over a period of six months, they saved 300 thousand dollars in reduced transports alone and they reduced congestion in hospitals. In Deb's words they've barely scratched the surface. This is better care and this is better value for money and that's why last week I announced plans to provide support for community para medicine across the province.

This is the kind of silo busting, responsive, innovative patient centered care we want to be encouraging and I'm delighted that Norm Gale is here. He's the president of the Ontario Association of Paramedic Chiefs who has been a real champion of community para medicine. Thank you Norm.

The third and final pillar of the Action Plan is right care, right time, right place. Getting the right care at the right time is why we've expanded scope of practice for registered nurses and registered practical nurses so they can dispense drugs in certain circumstances and now nurse practitioners can prescribe drugs and admit or discharge patients from hospitals.

Let me give you another example of the importance of getting care at the right time. This little boy is named Ethan Peters, a charmer of a little boy. His big sister, Brooklyn, died from a rare disease called SCIDS, severe combined immunity, immune deficiency syndrome, some know it as bubble boy disease.

It is deadly if it is not caught early, but if it is caught early it can be treated successfully. So when Ethan was born, because there was a family history, he was tested for SCIDS. He tested positive, but because it was caught early he was successfully treated with a bone marrow transplant and now he is doing great.

So now we test all newborns for SCIDS so hopefully we won't have another tragedy like Brooklyn who didn't get the right care at the right time and Ontario now has the most comprehensive newborn screening programme in Canada. Just 10 years ago we tested for only two diseases. Today we screen for 29. So kids can get the care they need at the right time, sometimes in time to save their life.

Innovations help us support kids like Ethan. New health care treatments and technologies are constantly emerging providing new ways to improve care and get better value for health care dollars. Ontario has a thriving exciting life sciences industry employing thousands of people and exporting Ontario innovation around the world.

We also have an excellent health care system. We're determined to bring the two closer together to make sure they benefit each other and learn from each other. In short we want to harness the potential of Ontario made discoveries because patients will get better care faster and new jobs will be created here in Ontario.

So if there are barriers to innovation I want to know about them so we can take them down and that's why my colleague, Reza Moridi, the Minister of Research and Innovation, and I have created the Ontario Health Innovation Council. They'll provide advice on how to bring Ontario innovations to market. I think there's a huge potential there.

A big focus of our Action Plan is to get ahead of the demographic shift and re-imagine how we can provide care, the best possible care, to the growing number of older Ontarians. That's why we turned to Dr. Samir Sinha to give us advice. Dr. Sinha is with us today. Thank you and there's the picture of him with his grandfather.

Expanding community para medicine and improving access to physiotherapy, exercise and falls prevention programmes were recommended by Doctor Sinha on his report, "Living Longer, Living Well", which incidentally has been downloaded 25,000 times by people around the world.

He made 134 health recommendations and those were only the health recommendations. He made others to other people as well, but I am proud to say we are implementing, or have implemented, two-thirds of those recommendations.

At the core of transformation and at the core of Dr. Sinha's report is the notion of a shift from care in institutions, like hospitals and long term care homes, to care at home or in community settings because it's what people want and it's less costly.

The shift became very real to me when my friend, Ken, had a stroke. He was in his 80s, a widower, active, a father to a large closely knit family. He still lived in the seven bedroom home in which he raised his family. After his stroke, many of his kids and his doctors wanted him to move into long term care.

But Ken had another idea. Home is where he wanted to be. Home is where he was going. He put his foot down, end of discussion. So the Southwest Community Care Access Centre went into action. Through their Homes First programme, they arranged for Ken to be cared for 24\7 in his own home.

He got better, He got stronger and within weeks he needed less and less home care. He kicked them out.... He didn't need that home care and he didn't need to be in long term care. A year later Ken had another stroke and he passed away, but he lived at home where he wanted to be until the very end.

Ken's story is transformation in action and I think that's what we all want for ourselves and it also has ripple benefits throughout the system. Stories like this are why Ontario's long term care wait lists are getting shorter. It's why there are fewer hospital beds being occupied by people who could be better cared for elsewhere. That's better care and that's better value.

Now here's the picture of Pearl. Pearl is a home care client in Kingston. Like Ken she wants to stay at home as long as possible. Ken and Pearl are why we're holding the line in other areas of our health care budget so we can invest any scarce new dollars to support our seniors at home.

Last year we allocated 260 million dollars, by far our biggest new investment in the home and community sector. It means we've been able to expand access to home care to 76,000 more seniors and we've expanded community support services like Meals on Wheels. We're caring for more people in supportive housing and in day programmes and we're supporting dedicated care givers through respite programmes.

But there's a big problem we must address in order to have high quality home and community care for our parents and for our grandparents and for us when our time comes. Here's Juliette. Juliette is a personal support worker in Milton. I spent a morning job shadowing her.

Personal support workers, PSWs, in the home and community sector are at the front line of our health care system. They are the people who deliver care to the most vulnerable in their own homes. They are the very foundation of our transformation efforts. Make no mistake about it. Without home care PSWs we cannot continue with our transformation agenda. We might not even be able to sustain the progress that we've made.

Last week the Premier and I met with a group of PSWs who work in the home care sector. They told us about the patients they care for and how much those patients mean to them. These PSWs told us about the length they go to make sure the people they care for are getting the care that they need.

But they also told us that they're struggling. In that meeting I met Rachel, a 28 year old woman who loves her work as a home care PSW. Last year she made 16,000 dollars, no benefits, no guaranteed hours. That's why she still lives at home with her parents.

Rachel told me she'd make more money working at Tim Horton's and she'd make a lot more as a PSW in long term care or in a hospital, but she wants to build her career as a home care PSW and we need her to, but she'd like to have her own place one day.

I don't think that's too much to ask and the system is struggling too because each and every year there's about a 60 percent turnover of PSWs in the home care sector. Sixty percent leave for other opportunities, better paying opportunities. That's highly disruptive for patients as their care giver's constantly changing. Clearly there's something wrong.

If we are to do better by our patients who need home care, we need to do better for the PSWs who are caring for them. In coming weeks I'll be speaking more about this. We will build on our home care PSW recruitment and retention strategy, including better supports for our PSWs.

To tackle a challenge this significant will take time. It won't happen overnight, especially in the face of a tight health budget and growing demands for care, but we need to address it as the urgent priority that it is.

From the start, our Action Plan has been obsessively patient focussed, but if we are to keep making progress, it's not good enough to just ask ourselves is this change better for patients? We need to ask patients because the system is their system. It's there for them, not to mention they're paying for it.

Meaningful patient engagement improves quality of care, improves patient satisfaction and is cost effective. When patients are listened to and patients are heard, hospital stays are shorter, patient outcomes are better. Let me give you one example.

The Toronto CCAC has introduced a new approach to home care. When a PSW enters a client's home, they no longer use a list of pre-determined tasks that they're required to do. Rather they ask the client, what are your top needs for today? They started doing this because they've listened to patients and as a result outcomes are better and this is an approach that's moving to other CCACs.

This is just one of many examples across Ontario that show how we're moving from a system where we provide care for patients to a system that provides care with patients and most importantly that we're listening to, and learning from patients. That's why, working with our partners, including most importantly patients, we will embed meaningful patient engagement in the health care system through the Excellent Care For All Act.

One of the most beautiful things about a focus on patient engagement, and acting on their feedback, is that people are happier with the care they receive. It leads to fewer complaints, but complaints do happen. We have a large and complex health care system. It doesn't always work perfectly for everyone.

We need to think of complaints as opportunities to improve quality. So just as we set standards now for hand washing and infection control, we're going to set standards when it comes to patient relations. That means hearing complaints in a clear, structured and consistent way right across the health care system in responding to those complaints in a respectful way.

Patients also need to know that they can turn to a third party patient advocate when all local complaint resolution processes have been exhausted, someone who will advocate on their behalf to facilitate and help resolve complaints and concerns as they arise and also drive system wide quality improvements. So we will establish a new patient advocate after engaging with providers and patients alike on the best way forward.

So ladies and gentlemen we have a plan. Transformation is well underway. Patients are benefiting. We're on the right track and we're going to keep going. We're going to keep on setting really hard to accomplish goals and just like the Premier says, we won't stop until they're done.

This transformation plan will be put to the test in coming months I expect. I'm proud to defend it. There are some who would put the sustainability of our universal health care system at risk by spending more than we can afford and avoiding tough decisions.

Others have an agenda of across the board cuts that would inevitably harm the quality of patient care. What we will do is keep improving the care we deliver to the patients of Ontario and we will keep driving better value for our precious health care dollars so that our treasured universal public health care system will be there for the patients depending on it tomorrow.

It's going to be an interesting year and I very much look forward to being back for our third annual report back on our Action Plan. Thank you.

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