Policy and Political Action

Policy & Political Action

Patients First - Proposal to Strengthen Patient-Centred Health Care in Ontario (MOHLTC)

The Registered Nurses' Association of Ontario (RNAO) is delighted to provide feedback to Ontario's Minister of Health and Long-Term Care Dr. Eric Hoskins' Patient’s First Discussion Paper. We begin with a brief summary in the form of a table to facilitate a high-level overview of RNAO's responses to the various proposals in the Minister's paper. This brief executive summary is followed by the full submission, which provides a more detailed analysis of each component of the paper, along with identified enablers for success.

RNAO urges Minister Hoskins to be bold and visionary, so that restructuring leads to real change that improves Ontarians' health experiences, their outcomes, and their health systems’ cost effectiveness.

Patient’s First Proposal

RNAO’s Recommendations

Proposal #1

1) Enable LHINs to plan, integrate, fund, monitor and be ultimately accountable for local health system performance while refraining from service delivery and management.

Provide care that is more integrated and responsive to local needs. Make LHINs responsible and accountable for all health service planning and performance. (p.13)

Identify smaller regions as part of each LHIN to be the focal point for local planning and service management and delivery. (p.13)

2) Proceed with sub-LHIN regions to facilitate horizontal primary care integration and ensure they serve to improve services for patients and not create barriers, unnecessary new bureaucracy, or new governance layers.

Proposal #2

3) Empower LHINs to oversee the planning, performance and contract management and funding of all primary care entities.

Bring the planning and monitoring of primary care closer to the communities where services are delivered. LHINs, in partnership with local clinical leaders, would take responsibility for primary care planning and performance management. (p.15)

Set out clearly the principles for successful clinical change, including engagement of local clinical leaders. (p.15)

4) Ensure that clinical leadership roles are inclusive and incorporate a range of regulated health professionals

… enable the approach to Patient-Centred Medical Homes as recommended by the Ontario College of Family Physicians and others. (p. 16)

5) Avoid the "Medical Home" model. Instead, make interprofessional primary care the foundation of Ontario’s health system and the key priority for LHIN and Ministry planning efforts. Grow and expand the capacity of the primary care sector.

Proposal #3

6) Move forward with substantive health system transformation that includes true realignment of all necessary CCAC functions and services within existing areas of the health system.

7) Reallocate any savings from the elimination of CCACs into service provision with a focus on increasing hours of direct home health-care and support service delivery and mental health and addictions care.

8) Do not transition CCAC executive positions to the LHINs.

Strengthen accountability and integration of home and community care. Transfer direct responsibility for service management and delivery from the CCACs to the LHINs. (p. 18)

CCAC employees providing support to clients would be transitioned to, and employed by, LHINs. (p. 18)

9) Transition mental health nurses in schools into public health units and the mental health sector. Transition NPs to appropriate primary care and home health-care/support service providers.

Home care co-ordinators would be focused on LHIN sub-regions, and may be deployed into community settings (such as family health teams, community health centres or hospitals). (p. 18)

10) Locate the 3,500 CCAC care co-ordinators within primary care organizations through a secondment and develop provincial standards for care co-ordination and system navigation based on RNAO’s implementation advice.

Proposal #4

11) Formalize relationships between public health units and the LHINs and identify a primary LHIN for those units that span multiple LHIN boundaries.

Integrate local population and public health planning with other health services. Formalize linkages between LHINs and public health units. (p. 20)


Ontario’s health system belongs to its people. As the chief steward, the Minister of Health and Long-Term Care has an important leadership role to play in ensuring that the system effectively meets the needs of the population as patients and citizens. We commend the Minister for advancing proposals that have been informed by our ideas and are stimulating great discussion across the province. The time has come for bold change. RNAO reiterates its gratitude for the opportunity to respond to the consultation underway and we urge the Minister to carefully review our feedback. We hope to see it reflected in the next steps of this important work.

A final message to our Minister: be bold and visionary. The type of health system restructuring being proposed is likely to come once in a generation. Thus, move forward with health system and human resource restructuring that will lead to real change that delivers faster and better access, improves the health experience and outcomes for all Ontarians, and results in a higher performing and more cost-effective health system. Ontarians deserve nothing less.

See the full submission with references below.

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