Registed Nurses' Association of Ontario

Ontario Pre-Budget 2016 - A Time to Change the Channel

Ontario Pre-Budget 2016 - A Time to Change the Channel

RNAO Pre-Budget Submission 2016 - Moving Forward on Deficits: Social, Health, Environment and Infrastructure

The Registered Nurses’ Association of Ontario (RNAO) is the professional association representing registered nurses (RN), nurse practitioners (NP) and nursing students in all settings and roles across Ontario. It is the strong, credible voice leading the nursing profession to influence and promote healthy public policy. We know that public policy is a major influence on health, and that it is largely determined by budgets. Thus, we welcome this opportunity to participate in the pre-budget consultation.

Fiscal Capacity

  1. Ensure the fiscal capacity to deliver all essential health, health care, social, and environmental services and infrastructure by building a more progressive tax system. Do not cut taxes.
  2. Increase revenue sources that encourage environmental and societal responsibility. Begin by phasing in environmental levies and implementing a cap-and-trade program for carbon emissions. Make the program as comprehensive as is feasible, and maximize the share of permits that are auctioned. Allow issuing of free permits only in instances where producers would be put at a demonstrable disadvantage relative to other competitors in other jurisdictions without similar carbon pricing, taking into account other factors influencing competitive advantage, such as the exchange rate.
  3. Update the gasoline tax by making it a tax on value rather than on volume.
  4. Reject fire sales of publicly-owned Crown Corporations and assets to fund government programs [e.g., Hydro One, Ontario Power Generation, and the Liquor Control Board]. Halt the further sale of Hydro One shares.

    Medicare: Fiscal Issues
  5. Reject efforts to commercialize or privatize health-care delivery by a. legislating a complete ban of inbound Medical Tourism. b. prohibiting new P3 negotiations and contracts.
  6. Work with the other provinces, territories, and the federal government to negotiate a Health Accord and bring back the Health Council of Canada.
  7. Expand our publicly funded, not-for-profit health system to all medically necessary areas, starting with universal pharmacare and home care. Preferably, the province would work with its partners to implement these programs at the national level, but in the absence of progress on national programs, the province should lead with its own provincial programs, as it is with the provincial pension plan.
  8. Advance evidence-based clinical practices to optimize the health outcomes of people, families, communities, and the province.

    Medicare: System Improvements
  9. Anchor the health system in primary care and expand access to interprofessional care for all Ontarians.
  10. Support Local Health Integration Networks (LHINs) to achieve regional health system planning, integration, funding allocation, monitoring and evaluation for all health sectors. But do not engage in service delivery.
  11. Phase out Community Care Access Centres (CCACs) and locate the 3,500 care co-ordinators in primary care, maintaining their current compensation (salary and benefits). a. Reallocate administrative savings from CCACs, around $200M, into direct patient care, including home health-care delivery and improve the capacity of primary care to deliver palliative care and mental health services.
  12. Follow-through on the government’s promise to expand the scope of practice of the registered nurse (RN) to include prescribing, through an enabling framework (independent RN prescribing) and authorize RNs to order diagnostic testing and communicate a diagnosis.
  13. ridge the compensation gap that exists between nurse practitioners (NP) in primary care and those in hospitals/CCACs by providing equitable salary and benefits.

    Nursing Care
  14. Narrow the gap with the rest of the country of about 16,659 registered nurse (RN) positions as quickly as possible by creating more positions.
  15. Place a moratorium on any nursing skill mix changes until a comprehensive and robust interprofessional health human resource plan is developed by the province, in partnership with nursing and other health professions.
  16. Put a stop to "team-based" or "functional" models of nursing care and embrace "total patient care or primary nursing" models.
  17. Follow through on the commitment to create 75 new attending NP positions to work in nursing homes by funding the remaining 45 positions in 2016.
  18. Ensure 70 per cent of all nurses work full-time so patients have continuity in their care and care provider.

    Social Determinants of Health
  19. Update and strengthen Ontario's Poverty Reduction Strategy with a detailed implementation plan, complete with targets and timelines, accompanied by substantive public investment.
  20. Improve access to affordable housing and stimulate job creation by investing one per cent of Ontario's budget to address the backlog of existing affordable housing units in need of repair and to create new affordable housing stock.
  21. While the provincial government's commitment to end chronic homelessness in 10 years is a promising start, it is imperative that Ontario invest new money to make this plan a reality.
  22. Immediately raise the minimum wage to at least $14/hour
  23. Ensure that all workers, regardless of form of work, are protected by inclusion in and enforcement of the Employment Standards Act. Two specific actions related to the Act are:
    a) repeal the exemption for employers of 49 or less workers from providing personal emergency leave; and
    b) employees shall accrue a minimum of one hour of paid sick time for every 35 hours worked or about 7 paid sick days per year for a full-time employee.
  24. Provide sufficient targeted funding to allow proactive enforcement of the Employment Standards Act.
  25. Raise and index to inflation the dangerously low social assistance rates to reflect the actual cost of living by setting up an expert panel that includes people with lived experience.
  26. Ensure that all Ontario children, regardless of the source of their parents’ incomes, get the full benefit of any new federal child benefit that is created by continuing to specifically exempt federal child benefits from social assistance incomes.

    Environment
  27. Deliver effective carbon pricing by moving on the promised cap-and-trade program. To be effective, pricing must cover as many emissions as feasible. Any exemptions must be temporary and targeted to transitioning producers who suffer demonstrable net competitive disadvantages as a result of implementing carbon pricing (taking into account other factors such as exchange rates).
  28. Set ambitious toxics reduction targets. Ensure people have the right-to-know about the existence of toxics in the environment, in their homes, in their workplaces, and in consumer products.
  29. Ensure that implementation of the neonicotinoid regulation achieves a 15 per cent over-winter honeybee mortality rate by 2020, as a first step towards a complete ban.
  30. Minimize the energy footprint by: focusing first on conservation and energy efficiency, and increasing reliance on renewable energy.
  31. Take all necessary steps to: a. ensure sufficient dedicated revenue sources to pay for a substantial expansion of transit and active transportation, and b. support cost-effective and expeditious delivery of those expansions, implemented by transparent governance and informed expert opinion.

Download the full submission with references below.

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RNAO Submission on Pre-Budget Hearings 2016910.25 Ko
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Submission