• Message from the Minister
• Ministry Vision
• Core Businesses
• Annual Report On Key Achievements for 1998-1999
• Key Commitments And Strategies For 1999-2000
• Key Performance Measures
• 1998-1999 Ministry Spending by Core Business
• 1999-2000 Ministry Approved Allocations By Core Business - Plan
• Who to Call

The Ministry of Health and Long-Term Care is working to build a better health system for Ontario. We are acting now to meet the changing needs of a growing and aging population, and make better use of available resources to provide quality health services, close to home, for everyone in the province.

Reshaping the health system to ensure better and more accessible health services is a primary objective of the ministry, and part of the government's agenda to reform health services.

Our 1999-2000 Business Plan reflects these goals and outlines our plan of action. It is presented in the context of unprecedented reform in the health system. The plan shows how we are implementing changes to Ontario's health system and what we have achieved so far. It demonstrates how we will provide Ontarians with a health system that is accessible to everyone, accountable and sustainable; one that anticipates demographic changes and provides services to people when and where they need them.

Creating a modern health system has not been easy. But we are beginning to see the results and we will continue to make the necessary investments to create a better system for today, and tomorrow. A strong economy supports and strengthens our commitment to the health system, allowing us to expand services and improve access for all Ontarians.

Our record level of health care investment over the past four years has improved access to a broad range of integrated health services. Our reinvestments have resulted in improved cardiac care, cancer care, dialysis and magnetic resonance imaging (MRI).

The Ontario government is proud to have led the campaign to reverse the federal government's health care cuts. We are committed to spending every dollar of health care funding that the federal government restores to the people of Ontario on health care.

We are already directing money to five priorities: hiring more nurses, reducing waiting lists, relieving pressure on emergency rooms, expanding home care and long-term care.

Our 1999-2000 Business Plan provides a blueprint of our strategies and commitments for bringing Ontario's health system into the 21st century.

Our vision is to provide quality health care that everyone in the province can rely on.

The ministry's goal is a first class health system that provides better and more accessible health services for all Ontarians when and where they need them, at every stage in their lives.

In support of its goal, the ministry has developed a plan of action. This plan moves resources from the old infrastructure to fund new programs, health services and facilities that will help :

• keep people well;
• detect illness sooner;
• expand community health services;
• build on the strengths of our system, and
• improve quality of life for seniors.

This plan makes people the first priority. We want to promote wellness and disease prevention to keep people from becoming patients in the first place. We want to treat heart disease and cancer, and provide kidney dialysis in local communities. We want to increase long-term care services to meet the demands of an aging population. We need to modernize health services and facilities, and expand community-based services. We want to provide more information for people to make informed decisions about their health.

A strong economy has made it possible for the provincial government to increase health care spending, allowing the ministry to move ahead with its plan.

The ministry is acting now to change and redesign our health system to ensure that services are in place to meet the health needs of everyone in the province today, and tomorrow.

The Ontario Ministry of Health and Long-Term Care has four core businesses - Community Services, Professional Services, Institutional Services, and Policy and Planning - that work together to support the province's health system.

These businesses set directions and allocate resources to ensure the delivery of quality health services and to evaluate the performance of Ontario's health system. They link together to ensure that people can get the health services they need, when and where they need them. They reflect the ministry's shift in emphasis from providing services directly to providing direction to those who do.

Community Services aims to preserve the health and independence of Ontarians in their communities through prevention and early intervention programs. Keeping people healthy improves the quality of life Ontarians enjoy and lessens the need for costly health services in the future.

Community Services includes health promotion, public health, diabetes prevention programs, long-term care, home care, supportive housing, community health centres, community mental health, drug benefits, HIV/AIDS programs, substance abuse and problem gambling programs, laboratory services and emergency health services.

Creating links between community health services and institutional facilities, such as hospitals, helps people get health services when and where they need them. It also means people receive the supports they need in their communities before and after hospitalization. As medical treatments and technologies improve, people can be released from hospital earlier than ever before. So it's even more important to make health services easily available in the community.

Ontario's 43 Community Care Access Centres (CCACs) are vital to Community Services. Located across the province to co-ordinate home care in the community and placement in long-term care centres, CCACs provide one-stop access to a wide range of services.

Nurses are a valued part of community services and Ontario's health system. They are essential providers of compassionate and quality care to patients in virtually every health care setting in the province. From hospitals and long-term care centres to public health units, private homes and doctors' offices, nurses are vital, looking after people 24 hours a day.

Government-funded services are available to Ontarians under the Ontario Health Insurance Plan (OHIP). Professional Services ensures that health service professionals are available throughout Ontario. It also monitors OHIP billings to prevent, detect and deter fraud.

Professional Services improves access to health services with programs for underserviced areas and Northern Health Travel Grants. Clinical education funding for resident training at medical schools ensures the continued availability of new doctors.

For better patient services, Professional Services encourages health professionals, agencies and facilities to work more closely together.

Institutional Services ensures that hospitals and long-term care centres respond to the changing needs of Ontarians. For example, when the provincial Nursing Task Force made a series of recommendations, we responded by providing funds for more nurses to look after patients and provide additional quality care. Hospitals include community hospitals, specialty hospitals, such as psychiatric hospitals, and academic health science centres. Long-term care centres include homes for the aged and nursing homes.

Long-term care centres provide health services for people who are no longer able to live independently in their own homes and who require nursing and personal care. People who would once have gone to a hospital can now live in long-term care centres and enjoy a more comfortable, home-like environment.

The ministry does not directly manage institutions. They are independent corporations run by independent boards. The ministry regulates and funds hospitals and long-term care centres and operates nine psychiatric hospitals in Ontario.

Policy and Planning creates health care policies to meet the needs of a growing, changing and aging population. It also measures the performance of Ontario's health system.

The ministry funds research to improve the delivery of health services, and along with 21 professional regulatory bodies, ensures professional standards and patient safety.

Policy and Planning also co-ordinates policy with the federal government and other provinces and territories.

Ensuring that all Ontarians can rely on quality health care has required a modernization of our health system to meet the needs of an aging and growing population. Creating a modern health system has not been easy. But we are beginning to see the results.

A strong economy has made it possible for the provincial government to increase health care spending by $1.5 billion since its 1995 commitment of $17.4 billion, as well as offset the effect of federal funding cuts. In fact, we will increase funding by another 20 per cent over the next five years to meet future needs. A strong economy supports and strengthens our commitment to the health system, allowing us to better expand services and improve access for all Ontarians.

Our seniors population, which was about 1.4 million in 1998, will grow by 160,000 over the next five years and by 360,000 over the next decade. In 1998-1999, the ministry began a major expansion of long-term care and community health services.

For the first time in 10 years, the government is increasing accommodation in nursing homes and homes for the aged. In 1998, the ministry awarded 6,700 beds across the province. In 1999 we have awarded 846 beds to four former chronic care hospitals in Toronto, Hamilton and Thunder Bay to support people with higher care needs, and 64 beds to the Bob Rumball Centre to support people who are deaf or who have an acquired hearing loss. The remaining 5,790 beds will be awarded this winter.

We are building 175 new centres to provide a comfortable home-like atmosphere for everyone who will live there. More than 100 older facilities are also being renovated to modern standards - this will benefit more than 13,500 residents.

As an alternative to hospitals and to long-term care centres, we fund a number of supportive housing projects operated by community-based service agencies. Supportive housing provides people living in special accommodation on-site, 24-hour access to personal support, emergency response and homemaking.

To continue to provide quality health care close to home, we are expanding community services such as Meals on Wheels, day programs, visiting nurses, therapists and homemakers.

Nurse practitioners provide services such as examining babies and children, monitoring chronic illness, leading health promotion groups and offering primary care. The ministry provided funding so that community health centres, nursing stations and Aboriginal health access centres could hire nurse practitioners to deliver health services to underserviced areas and high-risk populations.

Many people in rural and Northern Ontario have found their access to health services limited in the past. We're working to ensure that rural and remote communities have better access to quality health services and links to specialized care. General practice doctors in 24 isolated underserviced communities and doctors providing specialist services in Northern Ontario have alternate funding agreements. The Northern Group Funding Plan has been offered to general practice doctors in 22 eligible northern communities.

The Ministry of Health and Long-Term Care, together with three other Ontario ministries, renewed the Aboriginal Healing and Wellness Strategy for another five years. The strategy supports programs to improve the health of Aboriginal people and promote family healing.

Prior to restructuring provincial psychiatric hospitals, we are strengthening community-based mental health services.

In 1998-1999, the ministry invested in programs that focus on wellness and keeping people healthy in the first place by expanding prevention programs and helping people identify problems early. Provincial funds are helping 37 boards of health and over 700 community partners expand local health promotion and disease prevention activities. We continued to immunize people at high risk for pneumonia and school-aged children for measles and Hepatitis B.

The Ontario Heart Health program is now operating across the province. This program promotes physical activity, healthy eating and quitting smoking to reduce risk factors associated with cardiovascular disease and cancer.

The ministry continued its efforts to reduce tobacco use by appointing a panel of experts to review key aspects of the Ontario Tobacco Strategy and advise on specific measures Ontario can take to increase the effectiveness of our tobacco control program. We supported tobacco reduction and cessation initiatives including a toll-free telephone counseling pilot program, a program to train doctors to provide routine smoking cessation advice to patients and local community education campaigns about the health effects of tobacco use. We worked with boards of health to enforce the Tobacco Control Act, prohibiting the sale of tobacco to minors.

Along with the Ministry of Community and Social Services, we deliver Healthy Babies, Healthy Children, a prevention and early intervention program for children under age six. Screening of newborns and home visits are now taking place in all areas of the province. The program has been expanded to allow every new mother to receive a phone call and the offer of a home visit, as well as more intensive home visiting for those who need additional support.

Early detection of an illness - whether it's heart disease, cancer or diabetes - means better, more timely treatment. The Ontario Breast Screening program in 1998-1999 screened over 104,000 women. Nine new screening sites opened, bringing the total number of sites in the province to 37.

The ministry is not only expanding our health system but strengthening core services that are vital to serving the medical needs of Ontarians. That's why we are improving and modernizing Ontario hospitals to better meet the needs of people in the 21st century. Across the province, we are reducing duplication of services and ensuring the most appropriate use of hospitals, long-term care centres and community services.

To provide better emergency services, we have updated emergency department standards and guidelines for waiting times and redirecting ambulances. Anyone registering in an emergency department in any Ontario hospital will be assessed, through a triage system, by a registered nurse within 15 minutes.

The ministry invested in priority programs such as cancer and cardiac services, dialysis, joint replacements, organ transplants and increased access to MRI services. Since 1995, the number of Ontarians getting better access to these services has increased by about 29,800. In 1998-1999, there were 2,900 more cardiac procedures, and 250 more dialysis patients treated than in the previous year.

We provided funds to treat 1,800 chemotherapy patients, provide 80 additional bone marrow transplants and reduce radiation treatment backlogs. The ministry also invested funds to improve the recruitment, training and retention of cancer care professionals and to maintain the excellence of our medical equipment.

We continued to work with communities to implement hospital restructuring and have expanded priority programs as part of our goal to achieve a modernized and sustainable hospital system that provides better health care for everyone.

We also provided additional funds to address emergency care demands in Ontario. We funded additional staff and medical and critical care beds in Toronto, Hamilton, London and Ottawa, and additional resources in hospitals across the province to discharge patients into home care and long-term care centres seven days a week.

Nurses are a valued part of Ontario's health system and vital to providing quality patient care. That's why we established a Nursing Task Force and made a commitment to hire more than 10,000 nurses over the next two years, in addition to the estimated 2,000 nurses that have been hired over the past year, bringing the projected total number of new nurses to 12,000.

The ministry established a Women's Health Council to act as a catalyst for change and to make our health system more sensitive to women's unique needs. Council members will advise the minister on how to improve health services and standards for women in Ontario.

In 1998-1999, the ministry was a major partner and contributor in the establishment of the Canadian Blood Services, which replaces the Canadian Red Cross as the collector and distributor of the national blood supply.

Ontario launched its own compensation plan for people infected with Hepatitis C through the blood system prior to 1986 and after 1990. Ontario is also participating in a national assistance plan to provide payments to those infected between 1986 and 1990.

We are working with the Ontario Medical Association to develop solid clinical practice guidelines and communicate them to doctors. We have published four sets of guidelines including The Guidelines for the Diagnosis and Pharmacological Treatment of Depression, January 1999.

In 1998-1999, we established a fraud programs unit to prevent and detect health care fraud and a proceeds of crime initiative in conjunction with the Attorney General. We are using the OPP to conduct criminal investigations into allegations of fraud and support the prosecution of people committing health care fraud.

Over the past four years, the Ontario government has made some tough decisions about health care in the province. Now the Ontario health system is pointed in the right direction and with renewed economic strength, we have the ability to continue to invest more in health care.

To provide a health system accessible to everyone that offers quality service to people, where and when they need it, we are continuing our efforts in health reform. We are putting resources into new programs, health services and facilities that keep people well, detect illness sooner and treat it closer to home. We are building on the basic strengths of Ontario's health system and anticipating the needs of people in the 21st century.

Our strategies for 1999-2000 reflect our commitment to health and health reform.

We will co-ordinate changes to the health system and make it easier for people to use all parts of the health system.

In 1999-2000, we will, in partnership with the Ontario Medical Association, continue setting up pilot projects in our primary care network. This new way of providing medical care and around-the-clock patient services lets people have access to other doctors when their family doctor is not available. Because these doctors are part of the family doctor's team, they know a patient's medical history and medications, and are better able to make a diagnosis and provide treatment.

We will strengthen the mental health system to ensure that adequate community and general hospital services are in place before restructuring provincial psychiatric hospitals.

• continue to award new long-term care beds. By March 31, 2000, an additional 2,050 long-term care beds will be in operation;
• increase professional nursing staff in long-term care centres ;
• support additional community care nurses and homemaking, personal support and therapy services in Ontario's Community Care Access Centres;
• continue the legislative review for mental health;
• provide additional in-patient psychiatric services, including forensic beds in Toronto and Hamilton;
• provide supportive housing for people with serious mental illness including those who are homeless or at risk of homelessness.

We will continue to consult, listen to, and work in partnership with people who are concerned about health care.

Our goal is to provide health care where people need it - in their communities and in their homes. We will continue to support Community Care Access Centres, which co-ordinate acute and long-term health services, including services for seniors and people with disabilities to help them live independently in their own homes as long as possible.

With input from our newly established Women's Health Council, we will continue to invest in specific programs for women. By renewing our Ontario Tobacco Strategy and building on the success of the provincial Heart Health Program, we will continue to promote health and disease prevention.

• decrease the number of days spent by patients in an acute care hospital when another type of facility would be more appropriate;
• enhance the Ontario Tobacco Strategy;
• continue the Heart Health Program;
• establish Home Care Connect to give Community Care Access Centres a common case management and referral system;
• begin to implement a secure health information exchange system for health service providers.

We will target services and resources to meet the changing needs of a growing and aging population.

In 1999-2000, we will continue to strengthen core services that are vital to serving the medical needs of Ontarians. By investing in key priority programs such as cancer and cardiac services, dialysis and MRI services, we can ensure better access.

About 10 per cent of Ontario's pre-school children have speech and language disorders that can lead to behaviour and mental health difficulties, learning disabilities, poor academic achievement and school drop-out. We are continuing to expand our pre-school speech and language program so that more children across the province will have access to these programs sooner and at an earlier age.

• establish three new cardiac centres to provide cardiac services closer to home;
• expand the cardiac information system to include catheterization and angioplasty;
• provide additional funding for MRI services;
• reduce waiting lists to ensure faster access to life-saving medical care for cancer, heart and kidney dialysis treatments;
• introduce a new emergency room services standard so that anyone registering in an ER is assessed for urgency of treatment required within 15 minutes;
• provide funding to allow mothers the option of remaining under hospital care for 60 hours after childbirth;
• provide funding to Toronto neo-natal intensive care units to minimize transfers to other areas of the province;
• reduce the average age for identifying children with speech and language problems;
• provide funding to hospitals to increase the number of nurses and nurse-to-patient ratios;
• continue to review new drugs for mental illness as they emerge.

We will improve the health of Ontarians by expanding health promotion and illness prevention activities.

One of the goals of the Ministry of Health is to keep people healthy in the first place. That's why we are continuing to invest in programs that focus on wellness such as heart health, healthy eating and active lifestyles. We are also investing in programs like Healthy Babies, Healthy Children that ensure Ontario's children get the best possible start in life. We will review the recommendations of the prenatal Best Start demonstration project, which reduces the incidence of low birth-weight babies.

Early detection of an illness means better, more timely treatment. For example, once fully implemented, Ontario's Breast Screening Program could reduce breast cancer deaths by 30 per cent.

These programs go hand-in-hand with our Ontario Tobacco Strategy that focuses on smoking prevention, and support for those who want to quit smoking. The strategy involves several approaches including legislation and public education.

The ministry continues to support boards of health by providing advice on disease control, health hazards, emergency response, non-communicable diseases, and health protection and promotion.

As one of the ministries covered under the Environmental Bill of Rights, the ministry has an obligation to consider and incorporate environmental concerns into its policy decision making. This commitment is laid out in the Ministry of Health's Statement of Environmental Values document.

• contact all new mothers within 48 hours of the day of leaving the hospital to offer public health nurse visits;
• expand the Healthy Babies, Healthy Children program to include families expecting babies;
• expand the role of nurse practitioners by funding new positions in long-term care centres and underserviced areas;
• expand the Ontario Breast Screening Program to screen 170,000 women in 1999-2000, an increase of about 50% over the number screened in 1998-1999;
• fund the annual external monitoring and evaluation of the Ontario Tobacco Strategy to improve the effectiveness of tobacco use reduction activities;
• apply the ministry's Statement of Environmental Values when making policy decisions that might significantly affect the environment and the health of Ontarians.

We will increase the effectiveness and efficiency of the health system by monitoring performance and making decisions based on results.

In order to sustain the health system for future generations, we must increase its efficiency, ensuring that the best services are available to patients where and when they need them. To do this, we are using benchmarks, external reviews and expert panels.

We will continue to increase the use and further development of prescribing guidelines for the Ontario Drug Benefit program.

• oversee the development of 10 sets of prescribing guidelines;
• continue to work with the Ontario Medical Association to identify needs and distribute guidelines to doctors and to develop a joint web site with assessments of existing guidelines;
• assess the results of the HIV prenatal testing program.

We will be flexible in using resources to make sure the health system works today and in the future.

Ontario's health system needs to change in order to meet the new demands placed on it by a growing and aging population. As well, we need to keep pace with the extraordinary advances in medical technology and pharmacology. Advance planning and flexibility are key to ensuring a sustainable health system in the 21st century.

In 1999-2000, we are investing in more front-line nurses and in training, recruitment, research, data collection and measuring results. We are providing training grants to support newly hired and reassigned nurses in expanding areas such as critical care and emergency services.

We are also working to ensure that rural and remote communities have better access to quality health services and links to specialized care.

• create over 10,000 new nursing jobs over the next two years (in addition to the 2,000 nurses hired over the past year);
• increase support for recruiting and retaining specialists and general practitioners in rural and northern communities;
• continue to pursue agreements with doctors in northern, rural and remote communities.

We will continue to ask for, evaluate and act on feedback from people using Ontario's health system and services.

We have been working in partnership with people who are concerned about the future of health care - including doctors, nurses, hospital administrators and citizens across the province. We will continue to include patients in the planning and delivery of health services. We are committed to common service standards and we will continue to consult and seek feedback from all Ontarians.

We have now explored options for providing patients with statements after receiving health services and will be starting a pilot project in 1999-2000.

• establish a Patients' Bill of Rights so people will know what they are entitled to;
• initiate a pilot project promoting the availability of itemized patient statements;
• evaluate customer satisfaction with the ministry's accessibility, timeliness and courtesy in providing health cards.

We will continue to monitor institutional and professional health care providers.

Health care providers, health service administrators and the ministry are all accountable for the services provided through our health system. We are putting clear accountability mechanisms in place to make sure that institutions use funds appropriately.

• develop a joint accountability framework for hospitals and the ministry, in partnership with the Ontario Hospital Association.

We will modernize the Ministry of Health and Long-Term Care's organizational structure to make the most effective use of health resources and to continue to ensure high quality services for all Ontarians into the next century.

The Ministry of Health and Long-Term Care is moving towards a more customer-focused dynamic organization that sets broad, integrated policy directions; ensures the system is accountable; enables the system rather than delivering services itself; operates locally with delegated decision making; and, is more sensitive to the needs of customers and communities.

NOTE :   Staff numbers are shown as full-time equivalents.
* PSAB-based (Public Sector Accounting Board)
** Excludes health care restructuring and major one-time costs

NOTE :   Staff numbers are shown as full-time equivalents.
* PSAB-based (Public Sector Accounting Board)

December 1999