Ontario's nursing crisis: Your health, your health system
The people of Ontario elect a new government on June 2, 2022.
This election comes at a critical time in the province’s future. The COVID-19 pandemic has exacted a toll on people’s health, the factors that shape one’s ability to be healthy and the health system as a whole. From the more than 12,000 deaths from the virus itself to the thousands of others who’ve died from the poisoned drug crisis, and the lives lost due to cancelled or delayed surgeries or treatments, the pandemic has exposed inequities and failings in our system and institutions. It has affected how people access care, impacted how nurses and health providers can deliver care and raised questions about how we can provide better care.
Nurses know what factors influence and shape people’s health. That’s why RNAO has developed a set of recommendations that cover the environment, the social determinants of health, nursing, care delivery and fiscal capacity.
RNAO asks all political parties to adopt our recommendations because they address the economic and social inequities exposed by the pandemic, and will protect the vulnerable.
RNAO urges nurses and all Ontarians to vote for candidates that will set the province on a path that addresses these economic and social inequities – unacceptable in a province as rich as ours.
Environmental determinants of health
The need to conserve and protect the environment – land, air and water – for future generations is linked to health and requires urgent action. Temperatures are rising faster in Ontario than the global average. Human activity is driving climate change with increasing greenhouse gas emissions. Uncontrolled urban sprawl and insufficiently regulated resource extraction is eliminating water sources and productive land, and diminishing nature’s capacity to sustain life.
Implement a comprehensive plan to meet a 2030 greenhouse gas emissions target of 60 per cent below 2005 levels that includes:
- carbon pricing, energy conservation and renewable energy resources
- investment in transit and active transportation infrastructure
- a green infrastructure fund to support, preserve and manage the natural environment including water and green space
- equitable distribution of transition costs and benefits
- a commitment to report annually on progress
Our planet is warming at an alarming rate. Unprecedented growth in greenhouse gas emissions is to blame. As a result, people across the province are experiencing more severe weather, such as flooding, heat waves, wildfires and poorer air quality. These changes affect our health. More people are dying of heat-related illnesses. Air pollution affects those with respiratory and cardiovascular disease. And vector-borne diseases such as Lyme disease and West Nile virus are becoming more prevalent, disproportionately affecting vulnerable populations.
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Our Green New Democratic Deal lays out a plan to reduce Ontario’s GHG emissions by at least 50 per cent below 2005 levels by 2030 and achieve net-zero emissions by 2050, targets consistent with the Intergovernmental Panel on Climate Change.
We will enshrine our GHG reduction targets, and interim targets, into law. We’ll use a carbon budgeting process to ensure we reach our 2030 and 2050 targets, consulting with climate scientists, workers, industry and other experts. We will make large polluters pay for their emissions, with proceeds funding policies and programs that help Ontario get to net-zero, while ensuring hard-working Ontarians in rural areas and in the trades and industrial sectors are not unfairly penalized. In full consultation with industry, municipalities, First Nations, and communities across the province, an NDP government will develop a new, equitable, cap-and-trade system to replace the federal carbon backstop in Ontario.
An Ontario Liberal government will cut greenhouse gas emissions by 50% below 2005 levels by 2030 and achieve net-zero emissions by 2050. Our comprehensive and modelled plan can be found at https://ontarioliberal.ca/environment-plan/. We will achieve this reduction by taking the following sets of actions:
- Require heavy industrial sectors to cut their emissions by strengthening the Emissions Performance Standards in line with our 2030 target and reinvest the revenue in a Green Jobs Fund of grants, tax credits, and loan guarantees to support cleantech and deep industrial emission reductions
- Cut current methane levels in half from current levels and implement a methane performance standard for Ontario’s natural gas
- Transition as quickly as possible to a fully clean energy supply while maintaining reliability and affordability, including by banning new natural gas plants, and phasing out our reliance on gas for baseload power
- Support projects with Indigenous and Northern communities that reduce reliance on diesel and drive electrification in the remote north
- Update the Ontario Building Code to ensure that all new buildings and renovations are built to leading energy-efficiency and climate resiliency standards by 2025.
- Provide people and small businesses with interest-free loans and grants to make high-performance energy and climate-resiliency retrofits.
- Make a record-level investment in building new public transit infrastructure, lowering the cost to a buck-a-ride and improving the frequency of transit services
- Introduce a rebate of up to $8,000 on the purchase or lease of a non-luxury electric vehicle and $1,500 for charging equipment and mandate that at least 60% of all new passenger vehicles sold in Ontario are zero-emission by 2030 and 100% by 2035
- Plant 800 million trees over the next 8 years and invest $250 million annually to restore and expand natural infrastructure such as wetlands as well as to support communities in becoming more resilient to extreme weather.
- Demonstrate transparency in our progress and accountability for our results through an independent Environmental Commissioner, and create an all-party Cabinet committee to find new ways to tackle pollution to accelerate the path to reaching emission reduction targets
Ontario Greens are the only party who will reduce climate pollution enough to protect a stable climate and keep it below 1.5 º warming. Our Roadmap to Net Zero outlines how Ontario can cut greenhouse gas emissions 51.2% by 2030, 70.2% by 2035, and 100% (net zero) from 2045, including:
● Increasing the price on carbon by $25/tonne per year, reaching $300/tonne in 2032.
● Doubling Ontario’s electricity supply by 2040 and increasing renewable energy to 60% of the supply by 2030.
● Tripling transit use by 2030 by making transit convenient, affordable and accessible.
● Stopping sprawl and not building new highways.
● Creating new jobs by retrofitting existing homes and workplaces to net-zero by 2040.
● Eliminating fossil fuels from electricity generation the fastest way compatible with our fair share carbon budget, aiming to phase out fossil gas by 2030.
● Providing incentives for up to $10,000 for buying a fully electric vehicle and $1,000 for an e-bike or used electric vehicle.
● Phasing out the sale of new gas and diesel-fueled passenger vehicles, medium-duty trucks, and buses by 2030.
Develop a comprehensive water policy to ensure clean, safe water for all Ontarians.
Access to clean water is a universal right. Clean water is necessary for drinking, growing food and ensuring food security and the health of marine life. Human activity including residential sprawl, industrialization, agriculture and expropriation is threatening Ontario’s water sources.
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An Ontario NDP government will never put the interests of companies over Ontarians’ needs. We’ll make sure everyone in Ontario has access to clean drinking water and clean water for sanitation and growing food. We’ll launch a provincial water strategy based on the principle that decisions about water must be based on the public interest, and we will guarantee public access to sustainable water sources. We will ensure source water protection plans are implemented so everyone has access to reliable, safe drinking water, to put an end to drinking advisories for good. We’ll launch a transparent, public review of the Permit-To-Take-Water process, especially for bottled water, to protect public use and good watershed management.
An Ontario Liberal government will be steadfast in its commitment to ensure that the people of this province have access to clean and safe drinking water. We’ll work closely with Indigenous, federal and municipal partners to end all boil water advisories in all First Nations and Northern communities in Ontario, making necessary investments in water infrastructure, operations and maintenance where needed. We’ll protect and restore Ontario’s rivers, wetlands and watersheds, including Moose Cree First Nation and Kitchenuhmaykoosib Inninuwug. Our government will also strengthen Ontario’s Conservation Authorities to prevent flooding and protect green spaces, farmland, sources of drinking water, wetland, biodiversity, and species at risk. We’ll clean up the mercury contamination in St. Clair and English-Wabigoon River system and reduce pollution in Lake Simcoe and the Great Lakes – including lowering road salt runoff harming aquatic ecosystems. We’ll also help municipalities install microplastic filtration in drinking and wastewater systems.
Ontario Greens have been strong advocates for water source protection, including our support for extending the Greenbelt to include a protected Bluebelt area.
We will restore provincial funding for source water protection under the Clean Water Act, and expand drinking water source protection to northern, remote and Indigenous communities.
We will prioritize community water supplies and ban the bulk removal of water for water bottling and gravel production.
We will keep pollution out of water by updating and enforcing standards for major sources and pollutants.
We will repeal all recent changes that limited Conservation Authorities’ authority and provide stable funding mechanisms so they can fulfill their mandate to protect our water at the watershed level.
We will support Indigenous climate leadership to protect the huge intact watersheds in the far north and properly address the mercury contamination in water and soil at Grassy Narrows.
Social determinants of health
Growing social and economic inequities have left many Ontarians in poverty. For large segments of the population, income has not kept pace with the cost of living, especially housing. These inequities are racialized with visible minorities and Indigenous peoples experiencing higher levels of poverty and housing needs.
A stagnant minimum wage, minimal employment standards and weak tenant protections have left many Ontarians vulnerable to the economic fallout of the COVID-19 pandemic. During COVID-19, the already overcapacity shelter system lost much of its capacity, and public spaces and supports were closed due to public health measures. That left individuals who need housing in dangerous circumstances.
Significant change is needed to ensure economic and social vulnerabilities are eliminated, and rights to housing and health are protected.
Address Ontario’s housing crisis by investing one per cent of the province’s annual budget ($1.9 billion) in an accessible, affordable housing plan that includes:
- support for rent subsidies and supplements
- construction of 10,000 units per year
- creation of an Indigenous-led urban and rural Indigenous housing strategy
- development of 3,000 units of supportive housing
- investments to end chronic homelessness by 2026
The COVID-19 pandemic underscored that housing is a critical determinant of health. People without housing and those who live in overcrowded conditions have been especially vulnerable to the virus because they cannot self-isolate.
Ontario has the highest percentage of households who lack access to affordable housing. Since 2011, that number has increased, while the number of households receiving support from provincial programs has decreased. The Financial Accountability Office of Ontario estimates core housing need will continue to rise despite the federal government’s National Housing Strategy.
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We’ll work with municipalities to reform land use planning rules, in order to accelerate the development of complete communities. An NDP government will bring back rent control, eliminating the financial incentive for landlords to squeeze out tenants to raise the rent. By scrapping vacancy decontrol, we’ll crack down on landlords who exploit loopholes in the law to seek unfair ‘renovictions’ and bad faith ‘landlord’s own use’ evictions, as well as above-guideline rent increases for unnecessary repairs or renovations. We will help 311,000 households pay the rent by creating a portable housing benefit, as recommended by the Ontario Non-Profit Housing Association (ONPHA) and CHF Canada, to assist tenants who can’t afford their rent in addition to basic necessities for themselves and their families.
We will also build 30,000 new supportive housing units over 10 years for people living with mental health and addiction challenges.
To meet demand, we’ll get at least 1.5 million new homes built in Ontario over the next 10 years – doubling the pace of building from the past decade. This ambitious target is what experts say we need to catch up to the rest of Canada, keep up with population growth and bring affordability back to Ontario’s housing market.
As part of these 1.5 million homes, we’ll build at least 138,000 new deeply affordable homes – including much-needed supportive housing and homes for Indigenous peoples – as well as retain and repair tens of thousands of existing affordable homes. We’ll establish the Ontario Home Building Corporation – tasking it to work with local communities, not-for-profit housing partners and developers to build and maintain affordable homes of all types, either as a primary financing source or builder. The Corporation will also develop surplus provincial lands, including safely burying more electric transmission lines underground to unlock up to 80,000 acres of land for new homes. We’ll provide the Corporation with historic capital funding subject to strict oversight – including a hard cap on administrative expenses and salaries and a 15-year mandate to ensure housing is built rapidly, cool the housing market and end the waitlist for affordable public housing. Any homes sold by the Corporation will be available only to first-time home buyers, and any proceeds will go directly back into creating more affordable homes.
Our Ontario Greens housing plan will:
● Build 160,000 affordable rental units, including 60,000 supportive housing units.
● Mandate inclusionary zoning so 20% of units are affordable units in housing projects above a certain size.
● Renew 260,000 community housing units over the next decade in partnership with the federal government under the National Housing Strategy.
● Extend financial support to 311,000 Ontario households via the portable housing benefit.
● Fund an Urban and Rural Indigenous Housing Strategy that includes 22,000 Indigenous-owned and operated permanent homes.
● Reinstate rent controls on all units and implement vacancy control to limit rent increases between tenancies.
● Provide nonprofit housing providers with the support needed to buy rental buildings to maintain affordability permanently.
● Create a seed fund of $100M for co-operative housing.
● Allow triplexes and fourplexes within urban boundaries and midrises on transit corridors.
● Create a task force to address the financialisation of housing.
Immediately increase the minimum wage to $17 per hour and index it to inflation.
Approximately one in nine Ontarians lives in poverty. Although the minimum wage was recently increased from $14.35 to $15 per hour, it is not a living wage. Without substantial and further increases, indexed to inflation, workers and their dependents will continue to fall deeper into poverty and suffer poor health outcomes.
Provide 10 permanent paid sick days for all employees and an additional 14 paid sick days during a public health emergency.
The COVID-19 pandemic exposed the need for paid sick days for all employees. Without them, workers are forced to choose between making a living and looking after their health. The absence of paid sick days threatens the health of workers and their colleagues, family, friends and community.
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We know that people’s health and well-being depend on a good job that pays the bills. We will take immediate action to improve and enforce employment standards and protect people on the job. Andrea Horwath and the NDP have already announced their plan to increase the minimum wage to $20 an hour by 2026 through a series of predictable annual raises. The NDP will also will amend the Employment Standards Act to provide 10 paid sick days, plus 14 additional days during a public health crisis. We will close loopholes in the Employment Standards Act that allow workers to be misclassified as contractors and exempted from provisions.
As we navigate our way out of the pandemic, we’ll provide 10 paid, job-protected sick days for all workers. Paid sick days can be used for getting tested, vaccinated, isolating or providing care to others. The days can also be used for major life events that require stepping back from work, like a death in the family or pregnancy loss. We’ll also reintroduce a ban on employers making their workers produce a sick note in order to access the leave they need, and give businesses who need it up to $200 a day to compensate for the costs of workers taking more sick days.
We will modernize the definition of "employee" to include those in the gig economy so that they can get better access to benefits and protections such as sick days, workplace insurance, holiday, and severance pay. We’ll do this in a way that ensures workers can maintain the flexibility and independence many enjoy. We’ll bring back the basic worker protections that Ford Conservatives scrapped including one that ensures everyone is paid equally and fairly for the work they do regardless of gender or employment status – including part-time, casual, and temporary workers. Our government will require companies that have production or ‘piece rate’ quotas, such as parcel delivery services, to disclose these quotas to employees and we’ll help ensure these quotas are reasonable and don’t violate occupational health or safety standards. Finally, we’ll help make it easier to organize and join a private-sector union through amendments to the Employment Standards Act and Ontario Labour Relations Act.
Ensure that all workers have the right to at least 10 paid sick days.
● Ban employers from requiring a sick note from a medical practitioner.
● Introduce a living wage for all Ontario workers.
Implement the Gig Workers Bill of Rights.
● Restore and improve workers' rights to collective bargaining and immediately repeal Bill 124.
● Provide all workers with equal access to employment rights and benefits programs like EI, CPP, and WSIB, as well as equal pay for equal work.
● Close the loopholes that can lead to precarious work, including stricter regulations relating to the temp agency industry.
● Work to address violence in Healthcare workplaces.
● Allow fair and free bargaining, and support outcomes that would lead to fair working conditions and equitable pay across settings.
● Guarantee access to the most appropriate safety equipment in all healthcare facilities and use the precautionary principle when protecting workers.
● Ensure equal pay for equal work.
Negotiate an agreement with the federal government for $10 per day child care.
Ontario is the only province that has not signed the federal government’s plan for $10 per day child care. As of 2018, child care costs in Ontario were the second highest in the country – 40 per cent more than the national average. This means some working parents - mostly women - have no choice but to leave the labour force.
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Families in Ontario are draining their bank accounts to pay for child care. With fees so high, some are putting off starting or growing their family, and for many parents, particularly women, it is cheaper to stay at home than return to work. Andrea Horwath and the NDP will work with the federal government to implement the new national plan for $10-a-day childcare. That means reducing fees – but that alone isn’t enough – families need to actually have a space for their child. That’s why we need a workforce strategy to retain and recruit ECEs and child care workers, one that pays them fairly. NDP Leader Andrea Horwath would introduce a $25 minimum wage for registered early childhood educators and $20 for other program staff, as well as implement a salary grid. As premier, Andrea Horwath will work with sector leaders to design and implement a workforce strategy, including benefits, pensions and support for workers to upgrade their qualifications.
Under the Ford Conservatives, Ontario became the very last province to sign the national childcare agreement. Parents should not be punished for the Ford Conservatives’ failure to act. Therefore, we’ll make child care discounts retroactive to January 1, 2022 – giving families back an average of $2,750 per child. We will reduce average fees for licensed child care to $10 a day from over $50 dollars a day – saving parents about $10,000 per child a year. We’ll also move quickly to reduce fees for before and after-school care by over half to $10 a day by September 2022. We’ll create 30,000 new jobs for early childhood educators and other child care staff to build capacity, provide them with better pay and benefits and bring in a compensation grid in line with full-day kindergarten. We’ll offer free tuition for all ECE programs at Ontario’s colleges and professional development opportunities to encourage lifelong learning.
We’ve heard from new parents who want to stay home with their kids longer. We’ll give these parents more economic stability and valuable time with their growing families by topping-up the 18-month parental leave so they can stay home longer without their EI benefits being reduced – and we’ll work with the federal government to fill gaps for new parents who don’t qualify for EI.
When parents do go back to work, they need more than a one-size-fits-all child care plan. We’ll expand not-for-profit child care and provide child care for parents working shifts and non-traditional hours. For families choosing caregivers outside of licensed child care, we’ll bolster the CARE tax credit by 50% to an average of $2,000, provided in regular advance payments. And we’ll work to ensure parents have flexible and inclusive care options, including licensed home care, First Nations-led child care and child care for diverse families and for kids with special needs.
Ontario Greens support universal access to high-quality, affordable, flexible childcare across Ontario. We will work with the Federal government to ensure that $10 a day daycare becomes a reality for Ontario families.
Work with the federal government to ensure the 94 calls to action of the Truth and Reconciliation Commission (TRC) are implemented.
The province has an important role to play in implementing the TRC’s calls to action. A lack of action has led to tragic consequences. The infant mortality rate is two times higher among Indigenous people compared to non-Indigenous people. And, the probability of living to age 75 is approximately 20 per cent lower in First Nations communities.
Collaborate immediately with the federal government to enable Indigenous communities to search for unmarked graves on the sites of former residential schools in Ontario and obtain the records of all missing children who attended residential schools in the province.
Indigenous communities in Ontario have not had the support or funds to search for unmarked graves on the sites of former residential schools. Communities want and need to search for their children. RNAO echoes the call of Indigenous leaders to work with urgency on the issue of burial sites and support communities as they work to heal. The findings will allow these young children to be honoured during ceremonies, and be put to rest in a manner consistent with their communities’ traditions and beliefs.
Make permanent the 50 community wellness nursing positions supporting First Nations communities.
First Nations communities are in need of additional public health supports that address their unique circumstances and needs. Embedding community wellness nurses in First Nation communities permanently better addresses the public health needs of remote communities than school-based public health nursing.
Increase and sustain funding and resources to all First Nation communities to ensure their public health needs, as determined by the communities, are met. The government should transfer the necessary resources, funding and authority to all First Nations communities who opt to exercise their inherent right to determine and control their own public health programming and services.
Self-determination is recognized as a First Nations right and the most important determinant of health among Indigenous people. It influences all other determinants of health including education and housing. The reclamation of traditional approaches to health and healing have helped to improve and promote mental, physical, emotional and spiritual health within Indigenous communities.
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First Nations, Inuit and Métis people in Ontario continue to face barriers to basic rights others in Ontario take for granted. It is time to honour the inherent rights, treaties, and ways of life of Indigenous Peoples. We will work with all levels of government to implement outstanding recommendations of the Truth and Reconciliation Commission and support Indigenous communities to search for unmarked graves on the sites of former residential schools in Ontario. We’ll work with Indigenous primary health care organizations to expand services to more communities, ensure health care delivery is culturally sensitive and that Indigenous health professionals are recruited and properly compensated.
We are committed to implementing the Truth and Reconciliation Commission Calls to Action by working with and learning from Indigenous peoples and First Nations, guided by the principles of self-determination, reciprocity, and mutual recognition of nationhood. An Ontario Liberal government will:
- Increase support for the option to learn First Nations languages, allow Indigenous elders to teach Indigenous language classes and mandate the inclusion of the painful history of Canada’s residential schools across the K-12 curriculum
- Expand and strengthen Ontario’s Indigenous Institutes to increase opportunities for diplomas, certificates and degrees in culturally enriched settings with permanent funding
- Invest $2 million in First Nations Public Libraries since only 30% of First Nations reserves have libraries
- Support the investigation and commemoration of former residential school sites across Ontario and make September 30th – National Day for Truth and Reconciliation – a statutory holiday
- Invest in Indigenous-led culturally competent and trauma-informed mental health supports for Indigenous peoples, including for residential school survivors and their families
- Support the reform of child welfare for First Nations and the development of more Indigenous long-term care homes
- Help more Indigenous parents participate in the workforce by ensuring Indigenous child care needs are met, and by providing $25 million to increase access to training for Indigenous entrepreneurs and small business owners
- Complete the Wataynikaneyap Transmission Project, one of the largest First Nations-led infrastructure projects in Canadian history, and support Indigenous-supported projects that drive electrification in Northern Ontario
- Work collaboratively with Indigenous housing providers and federal partners to develop a distinct housing strategy for off-reserve Indigenous peoples – including creating 22,000 new homes for Indigenous families, while scrapping Ministerial Zoning Orders and requiring transparent consultations with affected Indigenous communities
- Bring back a stand-alone minister focused on Indigenous reconciliation and honour the United Nations Declaration on the Rights of Indigenous Peoples, the duty to consult, data sovereignty and Jordan's Principle – as well as strengthen revenue sharing agreements, such as with mining and forestry taxes
Ontario Greens know the time for meaningful action towards reconciliation is now. The government has a legal obligation to consult with and to work with First Nations – with full partnership, participation, and respect. Reconciliation with Indigenous Peoples is essential and includes acknowledging that traditional knowledge must contribute to climate and energy solutions.
Federal and provincial governments and the public must uphold Indigenous rights to self-determination and collaborate fully with Indigenous Peoples on decisions around placement, ownership, development, and operation of any infrastructure on Indigenous land.
One key step will be to implement the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) as called for by the TRC Call to Action #43 and develop an action plan in concert with Indigenous leaders.
Ontario entered the pandemic with 22,000 fewer RNs on a per capita basis compared to the rest of Canada. Throughout the pandemic, nurses have continued to provide care while working under Bill 124’s wage restraint provisions and despite experiencing high levels of burnout, exhaustion and stress. But having been on the front lines of this pandemic for more than two years with excessive workloads and insufficient government and workplace supports, nurses – in particular RNs – are leaving their jobs and the profession.
Nurses are the backbone of Ontario’s health-care system. Ontario’s RN shortage threatens a health system collapse and government must act quickly. There are solutions to address this crisis.
Building RN careers
Build RN careers in Ontario by:
- repealing Bill 124 and refraining from extending or imposing any further wage restraint measures on public and broader public sector workers
Increasing the supply of RNs:
- increase enrolments and corresponding funding in four-year baccalaureate (Bachelor of Science in Nursing or BScN) programs, second entry/compressed programs and RPN-to-RN bridging programs by 10 per cent per year for seven years
- compress RPN-to-BScN bridging programs to two years in length
- expedite applications and fund multiple pathways for internationally educated nurses (IENs) to become NPs, RNs and RPNs in Ontario
- developing and fund a Return to Nursing Now Program to attract RNs back to Ontario’s nursing workforce
- supporting nurses throughout their careers by expanding the Nursing Graduate Guarantee, reinstating the Late Career Nurse Initiative and bringing back retired nurses to serve as mentors to new graduates and IENs
- establishing a nursing task force to make recommendations on matters related to recruitment and retention of RNs, including:
- increasing full-time employment opportunities
- offering competitive salary and benefits across all sectors
- reducing workloads
- increasing opportunities for mentorship and professional development
- increasing occupational health and safety measures and enforcement
The COVID-19 pandemic has resulted in a full-blown crisis in RN staffing. Nurses have endured stress and burnout throughout the pandemic, and have had to find ways to adapt and reach out for help when necessary. Yet, there are limits to what nurses can endure, and for how long. Many RNs have reached or crossed that threshold and left their jobs. Some have left Ontario or the profession altogether, and others say they plan to leave the profession after the pandemic. RNAO insists on urgent action from the government and health-system employers. At risk is the effective functioning of Ontario’s health system, people’s health and the future of nursing in Ontario.
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A New Democrat government will put an end to any further cuts to nurses and health care workers. We will immediately start working to raise standards in the sector. As noted, we will repeal Bill 124 and develop a comprehensive staffing and HR framework working collaboratively with all health care professionals to help them practice to their full scope and serve Ontarians to the very best of their abilities. By freeing health care professionals to do their jobs, patients and clients will experience better, faster and more convenient care.
Providing the people of Ontario with high-quality health care services requires health care professionals to be compensated fairly. Before the pandemic, less than 6% of nurses left the profession each year. Today, that’s more than doubled to 15%. The same trends are happening across all healthcare roles. We’ll make sure that healthcare professionals are valued, dignified, and paid more by repealing the wage-capping Bill 124. We will increase the minimum wage to $25 for personal support workers (PSWs). We’ll also provide additional wages for every person on a short-staffed shift – as well as deliver fair and consistent pay for workers across home and community care, long-term care, and hospitals and a fair wage differential between PSWs, Registered Practical Nurses and Registered Nurses.
Nurses deserve better compensation which is why we are committed to repealing Bill 124 and coming to the table to negotiate fair and equitable pay and improved working standards.
Increase the number of NPs in Ontario by 50 per cent by 2030 and develop a comprehensive health human resource plan for NPs across all sectors of the health system.
A significant increase in the supply of NPs is needed to meet the needs of vulnerable and marginalized populations as well as regions of the province struggling to access primary care. The United States employs almost three times the number of NPs as Ontario.
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The COVID-19 pandemic has made Ontario’s nursing shortage into a crisis. Health professionals are leaving the field in growing numbers. A first step towards reversing this trend is treating nurses with respect by improving quality of the job: repealing Bill 124 which has held wages beneath the rate of inflation, making more nursing positions full-time instead of part-time or temporary. Support must also be in place: free, in-person mental health supports for all frontline health care workers, 10 permanent paid sick days, plus 14 during a pandemic, full access to PPE, including N95 masks. We also need to invest in our health care system to ensure that registered nurses have the support they need, whether that means moving quickly towards four hours a day of hands-on care in long-term care homes or ensuring that hospital funding meets needs or investing in community health centres and nurse practitioner-led clinics. We will also fund more university seats for nursing programs.
An Ontario Liberal government will increase admission in nursing programs by a minimum of 10% each year – which will add 2,000 additional nurses. We’ll also cover tuition costs for any nursing students in Ontario who commit to working long-term in a 5 rural or remote community. We’ll also provide additional wages for every person on a short-staffed shift – as well as deliver fair and consistent pay for workers across home and community care, long-term care and hospitals and a fair wage differential between PSWs, Registered Practical Nurses and Registered Nurses. Our government will fund more team-based primary care clinics, including Nurse Practitioner-Led Clinics.
The Ontario Greens’ will establish a nursing task force to make recommendations on matters related to the recruitment and retention of nurses. However, immediate plans include:
● Immediately repealing Bill 124.
● Allowing nurses fair and free bargaining and support fair and equitable wages and working conditions
● Bolstering admissions to nursing baccalaureate programs by 10 per cent in each of the next four years and increase the supply of Nurse Practitioners by over 50 per cent by 2030, as per RNAO’s recommendation
● Expediting the credentialing of international nurses, expanding the scope of nurses and creating fast-tracked bridging programs.
● Providing guaranteed access to mental health services for all nurses.
● Expanding nurse-practitioner-led clinics across the province.
Access to nursing
Improve access to nursing care by:
- requiring that all first home care visits be provided by an RN
enshrining RNAO’s Nursing Home Basic Care Guarantee in legislation, ensuring a minimum of four hours of nursing and personal care per resident per day, including a minimum of 48 minutes of RN care
- making permanent the 625 public health nurse (PHN) positions in Ontario schools
- expanding the scope of practice of RNs and NPs by:
- providing RNs with the authority to prescribe common medications and order and perform diagnostic testing for non-complex conditions
- providing NPs with the authority to order MRIs, CT scans, EEGs and ECGs (in all situations) and perform point-of-care testing
Ontario’s population is aging, meaning more people with complex health conditions. RNs and NPs are trained to provide person-centred care for patients with the most complex health needs. Evidence shows employing RNs improves patient health and financial outcomes for the health system. RNs with authority to prescribe medications and carry out common diagnostic tests can enhance care quality and accessibility. Increased access to RNs and NPs working at full and expanded scope also makes Ontario’s health system more effective.
An Ontario Liberal government will aim to hire 100,000 healthcare professionals over the next six years to replace retiring workers and ensure guaranteed home care for seniors and access to primary care within 24 hours across the province. To help achieve this goal, we'll get more internationally-trained nurses and other healthcare professionals working in Ontario. We’ll do so by replacing unnecessary requirements for Canadian experience – focusing instead on competency-based assessments and bridge training.
COVID-19 has exposed the shortcomings of Ontario’s health system. The public health sector was not prepared for a pandemic. More than 4,200 nursing home residents died from COVID-19 as the chronically short-staffed and underfunded long-term care sector was essentially abandoned. Intensive care units and emergency departments were stretched beyond capacity and a three-year backlog of surgeries and treatments continues to accumulate. The primary and home care sectors of the system that should have been at the forefront of Ontario’s pandemic response were often inaccessible when they could have played a greater role.
The lessons learned from the pandemic must inform the ongoing transformation of Ontario’s system to an integrated model of care. An accessible, equitable, person-centred, integrated and publicly-funded health system, delivered primarily on a not-for-profit basis, can only be realized when Ontario has a robust community care sector. This transformation must be led by primary care and aligned with a fully-funded public health system.
Seniors' care (long-term care, home care and retirement homes)
Implement a comprehensive seniors’ care strategy to ensure that every senior has timely access to high-quality, dignified care. This strategy should include:
- reducing the wait list for long-term care (LTC) through not-for-profit LTC expansion
- enshrining RNAO’s Nursing Home Basic Care Guarantee in legislation to ensure: a minimum of four worked hours of direct nursing and personal care per resident, per day including a minimum of 48 minutes of RN care, 60 minutes of RPN care and 132 minutes of PSW care; a skill mix of 20 per cent RN, 25 per cent RPN and 55 per cent PSW; one NP and one RN infection prevention and control (IPAC) lead per 120 beds; and an average of one hour of care per day per resident from allied health professionals
- embedding RNAO's best practice guidelines in a LTC resident's electronic medical record (EMR)
- increasing home care funding to support an expanded publicly-funded basket of home and community services, ensuring improved and equitable home care access, and promoting adequate staffing, skill mix and compensation
- transferring regulatory oversight of retirement homes to the Ministry of Long-Term Care, given the complex health-care needs of retirement home residents
The number of Ontarians aged 75 and up is increasing rapidly. Yet, there are 38,000 people on the wait list for an LTC bed. An increasing number of seniors are being treated in hospitals because home care is underfunded. And, more than one-quarter of retirement home residents are on the waiting list for a nursing home while many more have chronic health conditions that require care and attention. The pandemic has highlighted the devastating effects of underfunding seniors’ care. The government needs to ensure that seniors receive the right care in the right settings.
To be received
We will fix home care and long-term care, so that everyone can stay in their home for longer, and all Ontarians are treated with dignity and respect as they age. We will work with sector leaders to establish provincial standards for home care services by creating a basket of core services Ontarians are entitled to receive, such as help with meal preparation, or nursing care to help with medication management. We’ll hold service providers accountable to ensure they meet the provincially regulated criteria for basic services. We’ll create culturally appropriate resources and training for home and community care programs and develop a provincial jobs-matching program to attract and match PSWs and other home care workers to communities where they have shared cultural and linguistic knowledge.
An Ontario Liberal government will increase income support for eligible seniors through a top-up to Old Age Security by $1,000 more per year and make sure more seniors qualify for this help by increasing the income threshold to $25,000 for single seniors and $50,000 for couples. We’ll expand and make permanent the Seniors’ Home Safety Tax Credit. We’ll make the Ontario Caregiver Tax Credit refundable, tax-free and paid out throughout the year. We’ll guarantee home care for seniors by increasing the annual budget for home and community care by over $2 billion resulting in 400,000 more seniors being able to get not-for-profit home care by 2026. We’ll also fund 15,000 new assisted living homes – including small, accessible and community-based residential services – as well as “hub and spoke” care that provides a comprehensive continuum of care.
We’ll end for-profit long-term care as quickly as possible with a target of 2028. We’ll also improve conditions for seniors in long-term care homes by enhancing inspections. We’ll prevent homes from admitting new residents when they’re not appropriately staffed and repeal the Ford Conservatives’ rules that protect long-term care companies from legal liability. We’ll build 30,000 new long-term care spaces by 2028 and redevelop 28,000 existing spaces to modern standards. We’ll do this by providing capital, operating, and governance support to non-profit groups that want to build long-term care homes, with an emphasis on building smaller homes that reflect their communities, rather than institutional warehouses. We’ll give funds to non-profit long-term care homes to provide at least an average of 4 hours of direct care per day, as well as provide pharmacy services, high-speed wi-fi, air conditioning, and other standards of excellent care.
Ontario Greens will advance long-term and home care by:
● Ending new for-profit facility licensing.
● Implementing an expanded choice, patient-centred continuum of care framework for seniors that respects and recognises residents’ social, cultural, religious, and spiritual practices.
● Building 55,000 new beds by 2033 and 96,000 by 2041, with a focus on smaller, community-based homes
● Legislating a minimum of one nurse practitioner for every 120 residents, including 20% RNs, 25% RPNs, and 55% PSWs in LTCs.
● Mandating a minimum of four hours of care per resident per day in LTC, including a minimum of 48 minutes of care provided by a registered nurse and 60 minutes provided by an RPN.
● Improving access to allied health professionals for a minimum of one hour per day.
● Ensuring LTC staff facilities have resources to appropriately address complex care needs. ● Investing additional resources to improve the availability of assisted and transitional living for seniors.
Maintain and extend the current level of public health surge funding.
Public health is the first line of defense against infectious diseases and the best health investment for Ontario. Chronic underfunding of the province’s public health system affects the health of all Ontarians and puts everyone at risk during health crises. The funding cuts that immediately preceded the COVID-19 pandemic compromised the province’s ability to respond effectively.
To be received
We will launch a full, independent, judicial public inquiry in all aspects of Ontario’s COVID-19 response – from failures in long-term care to the lack of protective equipment – to ensure we’ll be ready for any future health crises. We will introduce a new Emergency Management and Civil Protection Act and other pandemic legislation to strengthen our ability to respond to crises. We will require annual reporting to the legislature of public health emergency preparedness. We’ll make sure sufferers of long COVID are supported by their primary care providers and broader health teams in their path to recovery and invest in research to better understand causes, symptoms, and treatment for long COVID.
We will ensure Ontario is prepared for future public health emergencies, with measures including expanded paid sick days, retention pay, proper stockpiles of PPE, triage protocols that are accountable to vulnerable communities, suspension of evictions, and protection for health workers from harassment.
We absolutely must learn the lessons from this pandemic to build up our resilience in the face of future threats and rebuild trust in evidence-based decision-making. We’ll do this by improving access to PCR testing today while permanently increasing laboratory capacity for future testing. We’ll also make sure Ontario has a robust stockpile of free in-home rapid tests and high-quality masks. We’ll conduct an independent public inquiry to review what happened during this pandemic, building on the reviews done to date – establishing an all-party committee to lead the response. This will result in an Ontario pandemic plan that will receive regular mandatory and public reviews and updates, led by a new pandemic resilience hub. The pandemic has shown the absolute necessity of public health, so we’ll also reverse the Ford Conservatives’ planned cuts and strengthen governance of public health.
We know that COVID-19 put enormous strain on our healthcare system. Our public health teams have been essential during the pandemic. We will make the position of Chief Medical Officer of Health independent and ensure that public health units are provided with adequate and predictable funding. The Ontario Greens will maintain and extend the current level of surge funding for public health beyond the pandemic. We will guarantee access to the most appropriate safety equipment in all healthcare facilities and use the precautionary principle when protecting workers. Additionally, we will request a commission on the pandemic to provide feedback for preparedness for the current and future pandemics.
Mandate a one-to-one RN-to-patient ratio in intensive care units (ICU) and a one-to-two RN-to-patient ratio in ICU transfer units.
COVID-19 revealed a dangerous level of RN understaffing in ICUs and ICU transfer units. The specific skills and expertise of RNs are necessary to care for ultra-complex and unstable patients in these units.
COVID-19 induced backlogs
Provide surge funding and staffing to safely clear pandemic-induced surgical and diagnostic backlogs and safe discharge from hospital.
Backlogs in Ontario’s health system threaten to increase deaths and illnesses not related to COVID-19. Based on data from September 2021, surgical and diagnostic backlogs will take more than three years to clear.
Ensure that wait times for children and youth mental health services are less than 30 days.
Families have long struggled to access children’s mental health services in Ontario. Mental health hospitalization rates for young people are skyrocketing. The pandemic has increased levels of depression, anxiety, suicidal ideation and attempts, making timely access to these services even more necessary.
To be received
We’ll identify and publicize the number of delayed procedures and publish regular progress reports. We’ll expand operating room hours over the evenings and weekends to increase hospital capacity, engage in a health care worker hiring blitz, and create a centralized referral system. We’ll make sure this gets done without privatizing our health care system.
An Ontario Liberal government will clear the surgical and diagnostic backlog with a $1 billion investment in additional capacity – empowering hospitals to operate significantly above pre-pandemic volumes and expand operating rooms, MRI and CT operations – including into evenings and weekends. We’ll also establish and publish maximum wait times for all surgeries and return to pre-pandemic wait times for those beyond the maximum by the end of 2022. We’ll create a centralized electronic surgical waitlist – requiring all specialists to use e-referrals to shorten wait times and maximize scheduling efficiency. We’ll invest in new minimally-invasive surgery approaches that help people recover more quickly and shorten hospital stays. The Conservative playbook has always been the same – starve public services with cuts, then call on the private sector to fix it. We’re seeing the same approach now with their calls for for-profit private hospitals to address the surgery backlog. Ontario Liberals believe in public health care. We’ll support the creation of not-for-profit surgery centres managed by local hospitals to more sustainably maintain higher surgical volumes.
We need to put more resources into clearing the surgery backlog as well as funding public health so Ontario is prepared for the next crisis. We will work with the Federal government to provide surge funding to address the backlog. We are also committed to hiring more nurses to offset the shortages.
Respond to the toxic drug overdose crisis by:
- supporting and funding overdose prevention and supervised consumption sites in every community in need
- amending the Ontario Drug Formulary to support safer supply programs
- decriminalizing simple drug possession
The overdose crisis continues to escalate due to a toxic drug supply. It claims more than six lives per day on average in rural and urban communities across the province. Since the onset of the COVID-19 pandemic, the rate of fatal overdoses has increased by 60 per cent in Ontario –Black, Indigenous and other racialized populations are disproportionately impacted. Nearly all overdose deaths related to toxic drugs are preventable through decriminalization and harm reduction measures.
To be received
We will provide an immediate funding boost for frontline addictions support organizations to provide ongoing sustainable funding and introduce targeted hospital funding to increase the number of Tier 5 treatment beds for people with complex needs.
We’ll declare the opioid crisis a public health emergency, invest in addiction rehabilitation, detox centres, and harm reduction strategies. We’ll remove the cap Doug Ford placed on supervised consumption sites, expedite approvals for supervised consumption sites in the north, and provide safer alternatives to the current toxic and deadly supply of drugs available on the street. We will also work with the federal government to reduce the stigma of drug addiction and decriminalize personal drug use, so people can get the medical help they need. Countless racial justice advocates and community leaders have called for a commitment supporting people who use drugs to achieve a stable and healthy lifestyle.
An Ontario Liberal government will invest $300 million over the next four years across the addictions sector to prevent, intervene and treat opioid addiction and overdoses – including providing an ample supply of naloxone kits, fentanyl testing strips, and harm reduction supplies at pharmacies, and community spaces, and with first responders. We’ll target organized crime groups that produce and traffic illicit drugs while ensuring those with drug-use disorders receive support. We’ll make the pharmaceutical industry and opioid manufacturers pay for deceptive marketing practices. We’ll lift the arbitrary cap on new Consumption and Treatment Services sites, which includes safe injection programs, approving applications from unserved areas, and those offering culturally-competent programs. We’ll also support the 24/7 operation of these sites in key locations and provide additional support to safely reduce needle debris. We’ll reactivate the Opioid Emergency Task Force – which didn’t meet once during the Ford Conservatives’ four years in office – and invest in research on the opioid crisis’ impact on different communities, as well as new harm reduction and pain management approaches.
As detailed in our mental health and addiction plan, Ontario Greens will:
● Coordinate with public health units to collect and release data on the overdose epidemic.
● Declare the opioid crisis a public health emergency.
● Reboot the Ontario Emergency Opioid Task Force to address the urgency and complexity of the drug poisoning crisis.
● Establish mental health-focused crisis response teams in all communities across Ontario to be deployed when people are experiencing drug poisoning.
Health system integration
Enhance health system integration by:
- increasing Ontario Health Teams (OHT) or integrated health system models throughout the province so all Ontarians can access services offered through an OHT
- ensuring that nursing homes are incorporated into community care plans and funding rather than absorbed into acute care hospital management/administrative structures
- providing access to non-urgent care within 24 hours, seven days per week by expanding interprofessional models of primary care such as family health teams and community health centres and doubling the number of NP-led clinics
- locating RN care coordinators in primary care settings to integrate patient care needs across the health system and link patients to needed social services
- providing every Ontarian access to their own personal health record
- implementing a universal, single-payer pharmacare program that covers all medically necessary prescriptions without deductibles, co-payments, user fees and means testing
- expanding government-funded oral health programs to cover all low-income Ontarians
As RNAO’s Enhanced Community Care for Ontarians (ECCO 3.0) outlines, a fully integrated health system anchored in primary care will improve patient experience and health outcomes as well as increase access to care and lower health system costs. RN care coordinators have broad health and health system knowledge. When located in primary care settings, they can play a central role in navigating and coordinating person-centred care across the health system. Giving patients access to their personal health records also results in better system integration and person-centred care.
To be received
Too often, healthcare is siloed, yet the COVID-19 pandemic has confirmed the need for a much more integrated approach to healthcare, ideally rooted in primary care. We will work to expand access to primary care, with a special focus on interprofessional models like community health centres and nurse-practitioner-led clinics. We will also lead efforts to build a universal, single-payer pharmacare program that covers medically necessary prescriptions without user fees or means testing. We will work with the federal government on the expansion of publicly-covered dental care services. We will create Mental Health and Addictions Ontario to coordinate services across ministries to offer support for housing, employment, and other social services. We will restore Ontario’s public health system by properly funding and supporting public health units.
The pandemic shook up Ontario’s health care system, proving it could adapt to new challenges quickly. As we build capacity in and better fund health care, we’ll continue that spirit of innovation by making care more modern, integrated, flexible and accessible for all as they move through the health system. This includes making the option for video, phone, email and text visits with primary health care providers permanent and universal when appropriate – always giving the option for in-person care. We’ll also embrace approaches and technologies that enhance patient experiences, improve efficiency and reduce burdens on health care providers – including ending the use of fax machines.
Our government will fund more team-based primary care clinics, including Family Health Teams and Nurse Practitioner-Led Clinics. We’ll also create 15 new community health centres across the province. We’ll also expand pharmacists’ scope of practice to include prescribing for minor ailments (like pink eye, urinary tract infections, and insect bites) and allow them to administer more vaccines.
Ontario Greens plan to embed the principles of the social determinants of health in our approach to health care. We will prioritize prevention through a robust system of primary care. To do this we will:
● Expand access to family health teams in communities across the province and expand opportunities for physicians to join team-based models of care. Include a diverse array of healthcare providers in the teams to ensure a holistic, connected, comprehensive approach to health.
● Expand access to non-urgent care within 24 hours, 7 days per week, by expanding primary care models such as community health centres and doubling the number of clinics led by nurse practitioners.
● Improve integration and connectivity across healthcare service providers through the use of digital data sharing and patient health coordinators.
● Better integrate long term care, homecare, and caregiver services within the healthcare system to properly provide for the complex needs of residents.
The lack of investment in Ontario’s health system and the other factors that determine peoples’ health have left too many Ontarians vulnerable to illness. For many years and under successive governments, Ontario has had one of the lowest revenue-to-GDP ratios and one of the lowest program expenditures-to-GDP ratios among the provinces. The government has the capacity to do more to invest in people’s health and improve their health outcomes.
Implement a more progressive tax system to better fund essential health, health-care, social and environmental services.
Taxes support infrastructure and services that improve people’s wellbeing. Ontario is failing to provide essential infrastructure and services because it does not collect enough revenue. The province collects the second lowest revenue as a percentage of gross domestic product (GDP) compared to other provinces. Ontario also ranks among the lowest in per capita health expenditures and in program spending as a percentage of GDP.
To be received
Ontario is a prosperous province but for too many years, governments have focussed on the wrong priorities - reducing taxes for the wealthy and profitable corporations while investments in our healthcare, schools and public services faced cuts or prolonged restraint. An NDP Government will have different priorities. We will protect low and middle-class families from tax hikes and fee increases but we will also ensure the wealthiest people and most profitable businesses pay their fair share for the services that make their success possible. We will make investments that make life better for everyone but we will cancel risky and wasteful projects like the multi-billion dollar sprawl-inducing Highway 413. We will make sure our investment in services is financially sustainable, so we stop the decades-long pattern of cuts and funding freezes.
Leadership is about priorities, values, and choices. Ontario Liberals value publicly-funded healthcare and education. We believe in sustainable growth and shared economic prosperity. Unlike the Ford Conservatives who have the wrong set of priorities such as building Highway 413, our focus is on creating a more equitable Ontario. As a result, our fully-costed platform offers a roadmap to strong post-pandemic economic recovery and a balanced budget in the final year of our term (with a healthy contingency fund) without having to cut funding for, privatize or compromise the quality of our healthcare or education system.
The Ontario Liberal plan uses defined fiscal anchors to reduce the debt burden and put Ontario’s finances on a sustainable path, consistent with the Budget 2022-23’s fiscal plan, including a commitment to keep the net debt-to-GDP ratio below 42.0% and the net debt-to-revenue below 250%.
The Ontario Greens know that budgets are about priorities. We will cancel frivolous spending such as the $10 billion 413 Highway and use the funds for important programs for the people of Ontario. With a focus on prevention, our investments will save us money in the long term. The initial investments outlined in our mental health, housing, and climate plans will come from:
● Reversing the $1.1B/year decision to eliminate license sticker fees.
● Using $4 billion in Green Bonds to make loans for green technologies.
● Redirecting $8 billion currently used to subsidize electricity that mostly benefits high-income households.
● Ending $2.5 billion in fossil fuel subsidies.
● Creating a 1% climate surcharge levy on the province’s top 10% income earners