March 18, 2010
Hon. Madeleine Meilleur
Minister of Community and Social Services
Hepburn Block, 6th Floor
80 Grosvenor St.
The Nurse Practitioners’ Association of Ontario (NPAO) and the Registered Nurses’ Association of Ontario (RNAO) are extremely concerned about a recent directive on the Special Diet Allowance (SDA) issued by the Director of Ontario Works Branch. As the professional associations representing nurse practitioners and registered nurses across Ontario, we have significant concerns about the rationale for this decision, the lack of consultation with professional associations and the dangerous precedent it establishes. This directive is clearly unacceptable as it enables non-health care professionals to contradict clinical recommendations that are in clients’ best interests by disregarding the knowledge, skill and judgment of regulated health professionals.
We understand that the directive issued from the Ontario Works Branch and your Ministry on December 18, 2009, requires front line social service administrators to overturn the clinical judgment of health care professionals authorized to complete this form if the administrator feels eligibility for the SDA has not been met.
Nurse practitioners practice in a wide variety of health care settings in both urban and rural communities. Many work exclusively with clients who live in poverty and are consequently at higher risk or already diagnosed with chronic diseases. Not only do people living in poverty have poorer health outcomes, they often face greater challenges in accessing health care services. The overwhelming research demonstrates that nurse practitioners offer high quality, comprehensive and client-specific health care to individuals and families and this translates to improvement in health outcomes for those at highest risk in our society. The process for obtaining much needed Ontario Works benefits including the SDA for those who qualify is already time consuming and stressful for both the client and health care professional to ensure the information on the application for these benefits meets provincial criteria.
Authorizing administrators from non-health care backgrounds to second guess and overturn the clinical judgment of nurse practitioners or any regulated health care professional erodes client-centred care for individuals and undermines the effectiveness of the health care system by
challenging the expertise, authority and professional integrity of health care professionals.
Most importantly, the Special Diet Allowance is intended to add an additional allowance to basic social assistance benefits for those who have higher food costs as a result of identified health conditions. It is a vital and longstanding part of the social assistance system. As the Human Rights Tribunal of Ontario recently found, the Special Diet Allowance provides substantive equality in basic social assistance benefits by relieving, in part, the disadvantage faced by those with health-related food costs. When front-line workers unqualified in health sciences question a regulated health professional’s signed declaration of a patient’s health condition, this is not only an affront to the professional expertise of the NP who completed the form, but it could also cause real hardship and risk to health to the patient. With the inequitable access to primary health care providers for people living in poverty, this imposes an unfair and unacceptable restriction on those with special diet needs.
For these reasons the NPAO and RNAO strongly urge you to withdraw the directive and respect the professional opinion of authorized health professionals, including nurse practitioners, in those cases where, in their clinical judgment, a social assistance recipient’s condition entitles them to the Special Diet Allowance.
Thank you for your urgent attention to this matter.
Wendy Fucile, RN, BScN, MPA, CHE Paula Carere, NP-PHC, BScN, MEd
President, RNAO President, NPAO
cc: Hon. Deb Matthews, Minister of Health and Long-Term Care
College of Nurses of Ontario (CNO)