RNAO unveils ECCO 4.0 report: A roadmap to transform Ontario’s health system through community care

The Registered Nurses’ Association of Ontario (RNAO) is proud to announce the release of ECCO 4.0: Enhancing Community Care for Ontarians. The report is a blueprint for an equitable health system anchored in primary care and integrated community care. It calls for a faster shift from hospital-centric services to prevention-focused, people-centred care that meets the needs of Ontarians.  

Released on the first day of National Nursing Week (May 12-18, 2025) at Queen’s Park, ECCO 4.0 updates ECCO 3.0, published during the peak of the COVID-19 pandemic in 2020.

RNAO President NP Lhamo Dolkar says that “COVID-19 exposed the fragility of Ontario’s health system and how ill-equipped it was to meet community needs, and in the grip of a relentless health human resources shortage – especially nurses. Ontario’s hospital-centred response sidelined primary and home care, turned long-term care (LTC) into a site of tragedy, and left hospitals overwhelmed.” Dolkar adds: “The pandemic exposed deep structural inequities affecting seniors, racialized communities, Indigenous Peoples and those living in poverty. This is why equity, diversity and inclusion (EDI) must be front and centre in every step of health system transformation, and as nurses we insist that it be.”

“Since then, the province has worked with RNAO and many others to make progress towards health system transformation,” says Dr. Claudette Holloway, RNAO’s immediate past president. This includes the establishment of 58 Ontario Health Teams (OHT) and advancing the integration of home care. The government is also investing in team-based primary care to ensure every Ontarian is attached to a nurse practitioner (NP) or physician, with strong leadership from Dr. Jane Philpott at the Ministry of Health. In LTC, there is a commitment to meeting new direct care hour standards and enabling NPs to serve as clinical directors – championed by RNAO and fulfilled by Minister of LTC Natalia Kusendova-Bashta. Holloway adds: “Under the leadership of Minister of Health Sylvia Jones, the government has also expanded the scope of practice for registered nurses (RN) and NPs, is increasing nursing education seats, and accelerating registration for internationally educated nurses residing in Canada – all critical steps to strengthen Ontario’s health workforce.”

“Much more needs to be done,” cautions Dolkar. In preparing ECCO 4.0, RNAO found concerning indicators across the province’s health system. Hospitals remain overwhelmed, with one in five beds occupied by patients waiting for alternate levels of care and average emergency department wait times exceeding 20 hours. In primary care, 2.5 million Ontarians currently lack a regular provider – a number projected to reach 4.4 million by 2026 if we fail to act fast. Home care is underfunded and fragmented, resulting in extended hospital stays, high readmission rates, and frequent returns to the emergency department. LTC remains stretched beyond capacity, with more than 45,000 people on waitlists, rising acuity and inadequate staffing. In Dolkar’s view, “This is the result of an unsustainable, hospital-first model. Our report’s first lesson is clear: we must urgently rebalance investments – to strengthen primary care, home care and LTC, and to address the social and environmental determinants that help keep people healthy in the first place.”

Dr. Doris Grinspun, RNAO CEO, says “while RNAO supports the vision behind Ontario’s health system transformation, it remains deeply concerned that chronic underfunding continues to derail progress. Despite the positive steps the government has taken, the transformation remains incomplete. Key components such as transparent funding models and primary care networks remain insufficient. Moreover,” emphasizes Grinspun, “Bill 60’s expansion of for-profit care risks undermining core transformation goals by placing investor interests above public need – a direction that must be reversed. Let me reiterate – for-profit private investors have no role in how we transform our system and pose a risk to patient safety.”

“The challenges we confront today are compounded by the government’s broader neglect of social and environmental determinants of health,” warns Grinspun. Ontario spends less per capita on both health care and public programs than almost any other province, contributing to a housing crisis that is getting worse, deepening food insecurity, and severe poverty. Grinspun says, “more people will die in the streets from a toxic drug supply because of the closure of supervised consumption services sites. Added to this are the mounting health threats posed by climate change – an emergency driven by policy inaction and fossil fuel dependence in Ontario and elsewhere in Canada.”

RNAO calls for urgent course corrections to Ontario’s health reform efforts and a recommitment to public investment in health, social supports and climate action – all within an across-the-board commitment to EDI. ECCO 4.0 offers a clear, evidence-informed roadmap to achieve this vision and build a healthier, more equitable future for all Ontarians.

Divided into five subcategories, the report’s recommendations for government and health system partners to improve Ontario’s health system include:

Sectoral

• align public health and primary care
• expand the reach of and access to primary care, and ensure attachment for all Ontarians
• provide primary care through an interprofessional team-based model
• increase access to integrated home and community care services
• integrate long-term care homes into enhanced community care plans and funding

Cross-sectoral

• establish person-centred approaches to care
• ensure comprehensive and effective care coordination
• commit to evidence-based care across the health system
• optimize digital health technologies
• enable full scope of practice of RNs, NPs and other regulated health professionals

Nursing careers in Ontario

• implement retention and recruitment initiatives
• ensure fair compensation for nurses, harmonizing wages upwards

Health system transformation

• strengthen primary care leadership, coordination and social service integration in OHTs
• engage mental health and addiction networks in OHT planning and decision making
• fund OHTs in ways that advance the Quintuple Aim (improve patient experience, improve staff experience, improve population health, lower the cost of care, and advance health equity)

Determinants of health

• increase the fiscal effort of government to address the social determinants of health
• mitigate climate-related impacts and strengthen climate resilience and health equity

ECCO 4.0 is available online for free download.

The Registered Nurses’ Association of Ontario (RNAO) is the professional association representing registered nurses, nurse practitioners and nursing students in Ontario. Since 1925, RNAO has advocated for healthy public policy, promoted excellence in nursing practice, increased nurses’ contribution to shaping the health system, and influenced decisions that affect nurses and the public we serve. For more information about RNAO, visit RNAO.ca or follow us on X (formerly Twitter), Facebook, Instagram and LinkedIn.

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