Pre-Budget Consultation 2016 - Doris Grinspun and Kim Jarvi (Ottawa)
My name is Doris Grinspun and I am the CEO of the Registered Nurses’ Association of Ontario (RNAO), the professional association representing registered nurses, nurse practitioners and nursing students in Ontario. Joining me today is Kim Jarvi, RNAO's senior economist.
The Canadian economy is experiencing turbulence. Nevertheless, Ontario is in reasonably good shape.
Thanks to continuing low interest rates, now is a good time to invest in rebuilding the economy. Enhanced revenue measures, such as reducing tax avoidance, more green taxes, prices on carbon and surcharges on those better able to pay, will help us reduce the deficit and restore Ontario’s fiscal capacity.
RNAO urges the government to ensure that sustainable fiscal capacity exists to deliver all essential health, health care, social and environmental services by also building a more progressive tax system. Our message is simple: Do not cut taxes. And, reject fire sales of publicly-owned Crown Corporations and assets to fund government programs, including halting further sale of hydro one shares.
Nurses know that health expenditures are rising. This is partly due to changing demographics and an historical focus on illness-based care. We need to think differently and implement measures that will keep people longer in their communities. RNAO strongly rejects efforts to privatize our cherished publicly-funded and not-for-profit health system. Instead, we must build Medicare's second phase, to sustain it for generations to come. First, by introducing a pharmacare program. Public drug spending in Ontario currently consumes 9% of the health budget - up from 1.2% in 1975. Even though, prescriptions account for a growing share of the health budget, only a small proportion of the population receives public drug coverage. Including private expenditures, drugs consume 16.7% of overall health expenditures. Yet, the evidence is conclusive: a national pharmacare program would save billions for Ontarians and for the public and private sectors. Polls show strong public support. Health Minister Eric Hoskins is a pharmacare champion, and RNAO is fully on-side. Let's together advance a universal pharmacare program that does not involve co-payments or user-fees. Ideally, a national pharmacare program. But, in the absence of progress on a national program, Ontario should take the lead and develop its own as it has on pensions.
RNAO and others have spoken eloquently against inbound Medical Tourism, whereby hospitals in Ontario lure foreigners to receive care in our public health facilities in exchange for hefty payments. This practice undermines the integrity of Medicare. We were pleased when Minister Hoskins placed a moratorium. We now call on the Minister and Premier Wynne to legislate -- in 2016 -- a full ban on inbound medical tourism in Ontario.
RNs are being replaced with less qualified providers in attempts to save money. It angers RNAO because it is not good for patients. The research consistently shows that having more RNs results in fewer complications, lower mortality and morbidity rates, improved patient safety, and a higher quality of care. As the government transforms our system and hospitals become centres for the sickest of the sick, you must ask: does it make sense to have fewer RNs?
To avoid a crisis, RNAO calls for a moratorium on RN replacement until the province conducts a robust interprofessional health human resource plan that considers the health needs of our population and the full utilization of all members of the interprofessional care team.
There is some good news to share. The province is close to achieving its goal of having 70 per cent of nurses working full-time, and we urge the government to send a clear message to employers that we must reach the set target for all nurses in 2016. Because patients need continuity of care and continuity of care giver.
Another area of good news is the funding on 2015 for 30 attending nurse practitioner positions in long-term care homes. NPs in LTC homes will improve the quality of resident care and increase the capacity of the sector to respond to rising resident complexity. However, we are not done yet. The government committed to fund 75 positions and we expect them to deliver the remaining 45 in 2016. A real game changer for nursing home residents, will be when we have one attending NP for every 120 long-term care home residents - that is RNAO's goal.
You may be asking, where is the money to deliver on these requests? We say there are enhancements that do not cost more money. RNAO was pleased when Minister Hoskins released a discussion paper before the holidays outlining a vision for health system realignment. This proposal is a good first step, however, the ministry must go all the way in its vision to put patients first. RNAO urges the government to expand the mandate of Ontario’s 14 LHINs to include planning, funding allocation, monitoring accountability and evaluation of an entire regional health system, including public health units, primary care, hospitals, community and long-term care. We reject however, the idea that LHINS may deliver health services. That will short-change their role and weaken the health system.
We also urge the minister to completely dissolve Community Care Access Centres (CCAC) as structural entities and re-allocate their functions to other areas of the system. This has the potential to produce savings of nearly 200 million dollars annually, which can be reinvested into direct health service delivery. The first step to get us there involves reallocating the 3,500 care co-ordinators from CCACs, of which approximately 3,000 are RNs, into primary care settings. Interprofessional primary care is the hallmark of a high performing health system, and it must be the foundation of Ontario’s health system.
To help improve the capacity of primary care, it is critical that in 2016, the government follow through on its commitment to expand the scope of practice of RNs by endorsing an independent prescribing model. This means that RNs -- with an added certificate as prescribers - can prescribe, not based on restrictive lists, protocols or agreements, but in accordance with principle-based practice standards, employer policies and self-assessment. It also means that RNs could diagnose illness and conditions within their scope. Long a success in the UK, RN prescribing will be transformative for Ontarians and their health system as it will unlock timely access to care, and it will result in system-wide improvements such as reducing reliance on costly walk-in clinics and emergency departments.
But that’s not all that we need to do to improve the capacity of primary care. Nearly 50,000 Ontarians are receiving care in nurse practitioner-led clinics and many more receive care from NPs in family health teams, community health centres and aboriginal health access centres. The scope of practice of NPs has grown dramatically. However, their compensation has remained flat for the past nine years. This creates a crippling effect on the sector, as hospitals and CCACs lure NPs with much better salaries that, in some cases, are up to 20-thousand dollars higher. RNAO demands immediate action to stabilize the primary care NP workforce by harmonizing upwards in this budget the compensation of NPs in primary care.
Let me speak about social determinants of health. Nurses know that a person’s ability to be healthy involves a complex interplay between physical, mental, social, cultural, economic and historical factors. Offering a health system is part of the solution to keeping Ontarians healthy. Reducing poverty is vital. For this to happen Minister Matthews must show us a detailed implementation plan with targets and funding. It should also include dedicated funding to meet the commitment to end homelessness within 10 years. Nurses ask to dedicate 1% of the budget to address the backlog of existing affordable housing units in need of repair and to create new affordable housing stock.
The government should also raise the low social assistance rates and then index them to inflation. It can achieve this by setting up an expert panel inclusive of people with lived experience. Ontario must also make sure that any increases to the Canada Child Benefit will actually enhance the income of families and aren't clawed back.
To further support poverty reduction, RNAO urges that the minimum wage be immediately increased to at least $14 an hour to build a better pathway out of poverty.
Just as social conditions influence health, nurses know the environmental determinants play a huge role in each community’s overall health and well-being. Access to clean air, a safe environment, and reliable and sustainable forms of electricity help preserve our planet and secure the future.
We recommend that the government deliver effective carbon pricing by moving on the promised cap-and-trade program. To be effective, pricing must cover as many emissions as is feasible. Exemptions and free emission permits should be strictly limited.
Lastly, we insist that the government use the 2016 budget to take steps that ensure sufficient, dedicated and sustainable revenue sources are able to pay for a substantial expansion of transit and active transportation.
In conclusion, there is no question that fiscal deficits and debts must be taken seriously. But deficits must be understood as constraints and not as principal objectives. The objective is to harness physical, human and natural resources in a way that builds a healthy, dynamic, sustainable, inclusive society. Runaway fiscal debts and deficits could limit capacity to pay for needed services in the future. But growing social, infrastructure and environmental deficits have immediate and long-term consequences that are not top-of-mind when planning budgets , and that must change. We can deal with the manageable fiscal deficit on a schedule that doesn't harm the economy while getting the right mix of expenditures and revenues.
On behalf of all RNs, NPs and nursing students, we wish you well on your deliberations and look forward to seeing many of our recommendations reflected in your decisions. Thank you.