The current system of health care administration in Ontario is governed by the Health System Integration Act ("HSIA") passed in 2006. The Act created fourteen (14) Local Health Integration Networks ("LHIN’") each covering their own geographical portion of the province. Each LHIN had an Integrated Health Services Plan ("IHSP"). The Ministry responsible is the Ministry of Health and Long Term Care.
The goal of the Ministry in 2006 was a transformation of Ontario's health care system to achieve their vision of a health care system that helps people stay healthy, delivers good care, and will be there and available for the long term. The motivation stemmed from an ongoing concern about the long term sustainability of a publicly-funded health care system. The simple fact was that while health care costs were always on the increase, the ability of the province to fund proper and adequate care from the available revenues was diminishing.
The plan then was to achieve this desired transformation through:
The thrust of the plan was to allow the LHIN's to assume the critical responsibilities of the Ministry concerning the provision of health care in Ontario. This step would mean and allow for local control. This delegation was felt to be the best way to manage health care cost-effectively and at the same time provide the required level of adequate health care uniquely suited to each LHIN.
The current government has now announced its plan for the reform of health care administration and governance in Ontario. The new legislation will be known as the Connecting Care Act ("CCA"). The Act calls for the current fourteen (14) LHINs along with six (6) other health agencies, to be superceded by a new, single agency, called simply, Ontario Health ("OH"). This change has no timeline, and the implementation of the plan will likely take place over the next several years. To date, the introductory Bill, Bill 74, has only passed the first reading.
The CCA delineates a new framework for the provision and management of health care in the province. Strategies are to be developed by the Ministry which in turn will then be implemented and managed by OH. OH will have a website to announce the strategies as developed and as well to post an accountability agreement between the Ministry and OH. The agreement is expected to set out the goals, objectives, performance standards, targets, measures, spending plan, and reporting requirements.
The goals of the new plan appear similar to the existing program which is the provision of good health care at an affordable cost. The concern is still with the ever increasing cost of health care and the government's ability to sustain the health care system in the future. The focus, however, is no longer on the local provision of such care but instead a province-wide integration management system. Integration is the keyword. Funding will be dependant on such a province-wide combination being achieved. The concept is meant to result in the following:
A further new concept is the ability of the Ministry to designate the person(s), companies, or groups of persons and/or companies, as an Integrated Care Delivery System ("ICDS"). To be granted such status, the person(s) or group must demonstrate their ability to deliver no less than three of the following services:
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In December 2019, Ontario’s Attorney General introduced Bill 161, the Smarter and Stronger Justice Act (the “Act”), which became law on July 8, 2020. The Act hopes to simplify a complex and outdated justice system by bringing changes to how legal aid services are delivered, how class actions are handled, and how court processes are administered.
Of note, the Act has amended the Judicial Review Procedures Act (JRPA) to establish new rules as to when an application for judicial review may be brought.
Any decisions made on or after July 8, 2020 are now subject to a 30-day limit for bringing an application for judicial review unless another Act provides otherwise. Courts, however, retain powers to extend the time for making an application for judicial review if satisfied that there are apparent grounds for relief and that no prejudice or hardship will be incurred by the delay. Before these amendments, the JRPA did not set out any time limits for bringing an application, but courts had powers to extend the time to bring an application if another Act prescribed the limit.
In early August 2020, the Federal Minister of Health granted an exemption under the Controlled Drugs and Substances Act (CDSA) to four terminally ill Canadians to use psilocybin in their end of life care.
Psilocybin is one of the active ingredients/chemicals in “magic mushrooms,” the other is psilocin. Both psilocybin and psilocin are controlled substances under Schedule III of the CDSA. The sale, possession, production, etc. are prohibited unless authorized for clinical trial or research purposes under Part J of the Food and Drug Regulations. Both have been illegal in Canada since 1974. According to Health Canada, there are no approved therapeutic products containing psilocybin in Canada. However, the purified active ingredient, i.e. psilocybin, is being studied in supervised clinical settings for its potential to treat various conditions such as anxiety and depression.