Policy and Political Action

Policy & Political Action

Ontario Pre-Budget Submission 2018: Improving Ontarians' health and healthcare Submission to Standing Committee on Finance and Economic Affairs

The Registered Nurses' Association of Ontario (RNAO) is the professional association representing registered nurses (RNs), nurse practitioners (NPs), and nursing students in all settings and roles across Ontario. Since 1925, RNAO has advocated for healthy public policy, promoted excellence in nursing practice, increased nurses' contributions to shaping the health system, and influenced decisions that affect nurses and the public they serve. A key determinant of public policy is the budget, as it allocates resources between different and competing ends. Accordingly, RNAO welcomes this opportunity to present the views of its members on Ontario's spending priorities to the Standing Committee on Finance and Economic Affairs.

RNAO continues to advocate for the upstream allocation of Ontario's resources. The best public investments proactively keep people healthy and productive. We subscribe to a "Health in All Policies" approach, which the World Health Organization describes as "...an approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve population health and health equity. It improves accountability of policymakers for health impacts at all levels of policy-making. It includes an emphasis on the consequences of public policies on health systems, determinants of health and well-being."

Our recommendations are organized around five themes: improving access to quality nursing and health care, improving our medicare system, improving living standards, improving the environment, and paying for these improvements. These are familiar RNAO themes, but the current economic situation makes them more feasible and more compelling. Ontario's economy is growing, unemployment has fallen markedly, and the provincial budgetary deficit will soon disappear. However, the employment rate has yet to fully recover and Ontario lags the other provinces in program and social spending. Ontario has fixed the budgetary deficit at the expense of an infrastructure and social deficit, and switching the focus to the latter deficits is long overdue. There has been some progress on infrastructure spending, but Ontario needs to do more, and make a point to address social deficits.

Summary of RNAO Recommendations

Improving Ontarians' access to quality nursing and health services

Recommendation 1. Locate LHIN care co-ordination and care co-ordinators in primary care settings.

Recommendation 2. Enable nurse practitioners (NP) to work to their full scope of practice by allowing them to: perform point-of-care testing, order all diagnostic imaging, order ECGs in all situations, certify a death, and complete legal forms for mental health services.

Recommendation 3. Immediately mandate that any new nursing hires in tertiary, quaternary, and cancer care centres be registered nurses (RN), with the long-term goal of having an all RN-workforce in these settings within three years and in large community hospitals within five years.

Recommendation 4. Require that all first home health-care visits be provided by an RN.

Recommendation 5. Review and transform funding models in long-term care (LTC) to support improved resident care. In particular, consider putting resident improvement funding in place to encourage and enable – rather than penalize – improvements in resident outcomes.

Recommendation 6. Legislate minimum staffing and skill mix standards in LTC, accompanied by the necessary funding to support this change. There should be no less than one attending NP for every 120 residents, and a staff mix consisting of 20 per cent RNs, 25 per cent registered practical nurses (RPNs), and no more than 55 per cent personal support workers (PSWs). This ratio would ensure all LTC residents receive care when they need it from the most appropriate provider.

Recommendation 7. Mandate professional models of nursing care that advance care continuity and avoid care fragmentation (primary or total patient care) across all sectors of the health system.

Improving our medicare system

Recommendation 8. Proceed with a universal, single-payer pharmacare program in Ontario covering all medically necessary drugs and associated products, with no means testing, co-payments or deductibles. This will deliver equity, compliance with prescriptions and the efficiency of a single-payer system.

Recommendation 9. Invest $10 million to support the first phase of a public program to provide oral health care to adults and seniors living with low income across the province.

Recommendation 10. Mandate that electronic personal health records (PHR) be made available to patients in order to increase access to medical information and encourage patient participation in health-care decision-making. Patients, families, caregivers, RNs, NPs, and other health-care providers must be consulted in the development of a provincial PHR plan so that it reflects what patients need and want.

Improving living standards

Recommendation 11. Increase the minimum wage to $15 per hour on Jan. 1, 2019 with annual inflation adjustments every year thereafter, without exemptions by age or sector.

Recommendation 12. Invest one per cent of Ontario's budget ($1.5 billion) to address the backlog of existing affordable housing units in need of repair and to create new affordable and accessible housing stock.

Recommendation 13. Amend the building code to require that all new multi-unit buildings incorporate the principles of universal design for accessibility and visitability.

Recommendation 14. Create at least 30,000 units of supportive housing for people with mental health and addiction issues over ten years.

Recommendation 15. Work with other levels of government to ensure adequate shelter space in communities across the province to address the crisis of homelessness.

Recommendation 16.  Invest in mental health and addiction services as well as harm reduction, supervised injection services, and overdose prevention services to address chronic homelessness and the current overdose crisis. Ensure these services are also available in our shelters and drop-in centers.

Recommendation 17. Partner with Indigenous nations to address the urgent health needs they identify, including the ongoing crisis of child and youth suicide.

Improving environmental protection

Recommendation 18. Set the carbon cap at a level that will deliver greenhouse gas (GHG) reductions on the targeted schedule or earlier.

Recommendation 19. Make free or subsidized GHG emission permits highly targeted and temporary.

Recommendation 20. Direct carbon pricing revenues to programs that reduce GHG emissions and mitigate the impact higher carbon prices will have on vulnerable populations. Manage those revenues transparently with strong public oversight.

Recommendation 21. Work with federal and municipal partners to ensure dedicated and sustainable revenue sources to pay for ongoing operation and substantial expansion of transit and active transportation in Ontario.

Improving fiscal capacity

Recommendation 22. Ensure the fiscal capacity to deliver all essential health, health-care, social and environmental services by building a more progressive tax system. Do not cut taxes.

Recommendation 23. Increase revenue sources that encourage environmental and social responsibility. Begin by phasing in environmental levies and continue implementing a cap-and-trade program for carbon emissions.

Recommendation 24. Reject sales of publicly owned crown corporations and assets to fund government programs. Halt the further sale of Hydro One shares.

Recommendation 25. Seize this low-interest, low-deficit opportunity to catch up on investments in human, environmental and physical capital.

Recommendation 26. Ensure transparency and accountability in fiscal measures to deliver services people want and deserve, and to ensure this is done in an efficient manner.

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