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 The Act calls for the current fourteen (14) LHINs along with six (6) other health agencies, to be superceded by a new, single agency, called simply, Ontario Health ("OH").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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The Chief Medical Officer of Health for Ontario has issued an updated Directive #2 (dated May 26, 2020) for Regulated Health Professionals in the province.
Pursuant to the updated Directive #2, all deferred non-essential and elective services by health care providers may be gradually restarted – subject to the rest of the requirements set out in the Directive.
The updated Directive #2 does not provide particularly detailed guidance to health professionals on how to proceed, likely because it applies to such a broad spectrum of health care and health professionals. It does, however, provide some principles to assist health care providers in making decisions as we enter this transitional period.
In addition to the mask and hand sanitizer shortages, Ontario’s response to COVID-19 highlights the need for more frontline health care workers. Each regulated health profession’s college responded differently, and we have discussed some of those changes in other posts to keep you apprised.
Today, we focus on the College of Physicians and Surgeons of Ontario (CPSO), who set out to increase the number of available and licenced physicians out on the frontlines through certificates of registration that authorize supervised practice of short duration. The temporary licences authorize practice for 30 days.
Undoubtedly, COVID-19 has affected how health professionals practice. Pharmacists across the country are not only experiencing changes in how they practice (for example, accepting emailed prescriptions, where appropriate) but the scope of their practice as well. The latter change is not permanent, although the disruptions in practice may be felt long after the COVID-19 emergency subsides.
On March 19, 2020, Health Canada issued a short-term section 56(1) exemption under the Controlled Drugs and Substances Act (CDSA) that would authorize pharmacists to prescribe, sell, or provide controlled substances in limited circumstances, or transfer prescriptions for controlled substances (the CDSA Exemption).