Policy and Political Action

Policy & Political Action

Ontario’s Readiness for Infectious Disease Threats

On behalf of the Registered Nurses’ Association of Ontario (RNAO), the professional association representing registered nurses (RN), nurse practitioners (NP) and nursing students, we extend our gratitude to the Ministry of Health and Long-Term Care for the opportunity to provide feedback on a proposed framework for infectious disease threats.

December 1, 2015

Dr. David Williams
Interim Chief Medical Officer of Health
21-393 University Ave
Toronto ON M5G 2M2

RE: Ontario’s Readiness for Infectious Disease Threats

Dear David:

On behalf of the Registered Nurses’ Association of Ontario (RNAO), the professional association representing registered nurses (RN), nurse practitioners (NP) and nursing students, we extend our gratitude to the Ministry of Health and Long-Term Care for the opportunity to provide feedback on a proposed framework for infectious disease threats.

RNAO applauds the ministry for its preparedness efforts in response to the global threat of Ebola virus disease (EVD). This was a significant improvement from the challenges that were experienced during the SARS epidemic of 2003. Although not without some stumbling blocks, Ontario is in a good position to respond to EVD. RNAO credits Minister Eric Hoskins and his team for assembling the EVD Advisory Table, maintaining dialogue with stakeholders, issuing regular communications and promptly developing EVD directives.

Moving forward, Ontario is under constant threat of emerging infectious diseases that carry significant health, economic and social impacts. The world is a smaller place with the advent of modern transportation technologies and this serves as a mechanism for infectious disease spread. RNAO is pleased that the ministry is trying to foster a resilient health system that routinely incorporates mitigation, preparedness, response and recovery.

Kruk et al (2015) define health system resilience “… as the capacity of health actors, institutions, and populations to prepare for and effectively respond to crises; maintain core functions when a crisis hits; and informed, by lessons learned during the crisis, reorganize if conditions require it.” It is critical that the lessons learned through Ontario’s preparedness for EVD be used to stimulate greater health system resiliency within Ontario.

RNAO is pleased to offer the following recommendations to help foster health system resilience given our most recent involvement with EVD:

1) Health-Care Worker Safety

It was encouraging to hear Minister Hoskins and Deputy Minister Bell re-affirm at the 2015 Infectious Disease Summit that protecting the safety of health-care workers, protects the safety of Ontarians. RNAO supports the precautionary principle and feels that the occupational protection of nurses and other health-care providers is of paramount importance. Future planning efforts must ensure the safety of health providers continues to be a top priority.

2) Implementation of Directives

While the directives being issued by the Ministry for EVD provided consistent messaging and direction, it became apparent that there was inconsistent implementation across health-care organizations. RNAO encourages the ministry to identify the reasons for this inconsistent implementation. One potential solution involves further engagement of Local Health Integration Networks, in partnership with public health units, to ensure more consistent implementation across regional health systems.

3) Collaboration and Partnership

Ontario’s experience in preparing for EVD highlights the strength of collaboration and partnership. The minister’s EVD advisory table was an important forum for dialogue and discussion. This type of partnership should continue throughout periods of stability to advance health system resilience and should be elevated when significant threats are identified. One method of continuing our partnership is through regular simulated exercises that bring together system stakeholders to test our integrated capacity to respond to various threats. These valuable learning experiences can be implemented during periods of stability to maintain ongoing vigilance and growth.

4) System Capacity

In her presentation at the ministry’s 2015 Infectious Disease Summit, Dr. Margaret Kruk spoke about the important role that a co-ordinated primary care system plays in building health system resiliency. RNAO fully agrees with this assertion and continues to recommend that primary care be enabled to serve as the anchor for Ontario’s health system. Significant capacity can be generated in the sector through the full and expanded utilization of health human resources, including authorizing an expanded role for RNs that includes prescribing. Dr. Kruk identified that a committed health workforce is a necessary pre-requisite for health system resiliency. The ministry must take immediate action to address the compensation and benefit inequities being experienced by NPs in primary care. Failure to do so will present a significant retention and recruitment challenge that will hinder the ministry’s attempt to put patients first through improved health system access.

5) Role of Public Health Nurses

RNAO’s vision for the future of Ontario’s health system includes the full utilization of public health nurses (PHN) throughout the system. Although our vision for PHNs extends beyond preventing and managing infectious disease, it is worthwhile emphasizing the important role that PHNs play in advancing health system resiliency. PHNs are at minimum, baccalaureate prepared RNs and NPs who are uniquely equipped with the knowledge, skills and competency to effectively manage infectious disease programs. PHNs directly apply interventions that span across the mitigation, preparedness, response and recovery pillars. While PHNs often work in interprofessional teams, it is imperative that the role of PHNs is sustained and expanded in the future. RNAO has received concern from members around the impact of public health funding reform on the presence and role of PHNs. RNAO is approaching these concerns with great diligence and will be closely monitoring the situation. We seek assurances from the ministry that PHN positions will not be negatively impacted by any funding reforms.

6) Reporting

RNAO encourages the Chief Medical Officer of Health to release a public report annually on the state of resiliency within Ontario’s health system. This report should provide details on the activities that have occurred during the year to enable resiliency and to identify areas of emerging concern/threat. RNAO would like to see the 2015 Infectious Disease Summit offered annually and the resiliency report can be released to coincide with this summit.

RNAO is privileged to enjoy a collaborative relationship with the Ministry of Health and Long-Term Care in a number of areas including infectious disease prevention and control. It is our pleasure to provide the ministry with feedback to support the development of a framework to promote health system resiliency and the management of infectious disease threats. RNAO remains open to further dialogue and appreciates all opportunities to collaborate and partner with the ministry.

Please let me know if you have any questions regarding this letter.

Warm regards,
Doris Grinspun, RN, MSN, PhD, LLD(hon), O.ONT.
Chief Executive Officer
Registered Nurses’ Association of Ontario

c. Hon. Eric Hoskins, Minister of Health and Long-Term Care
Dr. Bob Bell, Deputy Minister of Health and Long-Term Care
Roselle Martino, Executive Director, Public Health Division

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