Invest in Comprehensive Primary Health Care a strong foundation for an integrated health system
Alliance for Healthier Communities Pre-Budget Recommendations, Ontario Budget 2024
Primary health care is in crisis. Alliance members are doing everything they can to keep doors open, to keep providing services to those who face the most barriers to health. The challenging primary health care system has threatened our members capacity to deliver the comprehensive primary health care that everyone living in Ontario needs. We believe in investing in and adequately funding Comprehensive Primary Health Care as the foundation of an integrated health system.
The Alliance for Healthier Communities (Alliance) represents a vibrant network of 111 community-governed primary health care organizations serving communities across Ontario. Together, we have a common vision towards equitable health and wellbeing for everyone living in Ontario. We strive for this by advancing comprehensive primary health care and advocating for changes in Ontario’s health and social systems to address inequities.
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A well-resourced, fully-staffed primary health care system can keep people in community and out of emergency departments |
Alliance members include community health centres, nurse practitioner-led clinics, community family health teams and Indigenous primary health care organizations. These organizations serve populations marginalized and underserved by other parts of the health system; those who face the greatest barriers to health and the poorest health outcomes; including Indigenous peoples, Black populations and other racialized groups, Francophones, people who identify as 2SLGBTQ+, people living in rural, remote and northern communities, people with disabilities and mental health challenges, as well as recent immigrants and refugees.
The people and communities in Ontario who face the greatest barriers to health care rely on our members to provide primary health care, mental health, community services and supports. We can’t let them down now.
Ontario needs to make Investments in comprehensive primary health care that support an integrated health care system to provide connected and convenient care for people in Ontario. A well-resourced, fully-staffed primary health care system can keep people in community and out of emergency rooms and hospitals while ensuring efficient use of healthcare funding towards equitable health outcomes.
Invest in Comprehensive Primary Health Care a strong foundation for an integrated health system
For the Ontario Budget 2024, we propose the Ontario Government focus on funding investments in three (3) key areas to keep community health strong and keep people in community and out of emergency rooms and long-term care. These investments will ensure efficient use of healthcare funding for equitable health outcomes for everyone in Ontario.
Summary
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Invest in Health Human Resources for inter-professional primary health care teams |
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Budget Request |
$165 million over five years Ontario needs to invest approximately $165 million or a 12.3% increase over 5 years to reach the 2023 recommended salaries for Alliance members to ensure a well-resourced, fully-staffed primary health care system that can support people and communities and ensure the whole health system is not overwhelmed. |
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Invest in community primary health care organizations through base funding increases to sustain health for communities in Ontario. |
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Budget Request |
$33.7 million Ontario needs to invest in a base budget increase of 5% or $33.7 million for community-governed comprehensive primary health care organizations so they can maintain and improve service levels, keep their lights on and meet the needs of their clients and the communities they serve who face the greatest barriers to care and poorest health outcomes. They have not had a base budget increase to meet operational pressures in 15 years.
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Invest in equitable, culturally safe inter-professional team-based care. |
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Budget Request |
$97 million Ontario needs to invest $60 million in expansion of inter-professional team based care at Alliance member centres who serve those facing most barriers to health such as people living in rural, remote and northern communities, Indigenous, Black, Francophone and 2SLGBTQ+ people and communities
Ontario also needs to invest $37 million over three years in Indigenous-led primary health care services to support a Provincial Indigenous Integrated Health Hub. |
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TOTAL INVESTMENT: $ 295.7 million |
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Primary health care staff have been paid at or under 2017 salary rates and are leaving the sector as the cost of living rises. |
INVEST IN HEALTH HUMAN RESOURCES FOR INTER-PROFESSIONAL PRIMARY HEALTH CARE TEAMS
Community-governed comprehensive primary health care organizations inter-professional teams need to be properly staffed and resourced to deliver primary health care for those who need it the most. Community-based primary health care organizations need to be able to meet the mounting pressures of the Health Human Resource (HHR) crisis. We call on the Government to invest $165 million in Health Human Resources for inter-professional primary health care teams.
Adequate funding is needed to ensure that our health care providers and staff are paid equitably to other health sectors across the system and in a way that adequately reflect their scopes of practice. Healthcare workers and staff across the community-based primary health care sector are facing unprecedented burnout and low morale, particularly after nearly three years providing health care and social services to patients/clients during the pandemic, compounded by a time of social unrest and of economic instability.
For years, healthcare providers and administrative staff in community based non-profit primary, community, mental health and addiction, and long-term care have faced lower pay grades than other parts of the healthcare sector, including newly created government healthcare agencies. The current level of funding is inadequate and does not keep up with inflation or cost of living, which makes recruiting and retaining staff a challenge.
Primary health care staff have been paid at or under 2017 salary rates and are leaving the sector as the cost of living rises. If this continues with compensation being years behind other parts of the healthcare sector, we will see increases to hospitalizations and emergency department usage as primary care will be unable to sustain care for Ontario’s most complex patients.
In November 2023, the Alliance for Healthier Communities, along with nine other provincial associations representing primary and community care providers jointly released a new report, Ontario Community Health Compensation Market Salary Review, showing that despite the rising cost of living and a competitive health care job market, community health sector staff experienced an average salary increase of only 1.53% in 2023, with some roles projecting a 0% increase. This pales in comparison to the 11% increase awarded to hospital nurses and the 8% increase for emergency medical services, further exacerbating the wage gap.
As a result, the community health sector is witnessing an exodus of workers to other fields, making it increasingly challenging to recruit and retain essential health workers. Research based on a survey issued to more than 1,300 community health agencies reveals that 94% of respondents identify compensation as the single most significant challenge for recruitment and retention. The community health workforce remains steadfast in their commitment to support the wellbeing of Ontarians, but in light of the rising cost of living, a sustainable approach to addressing the wage gap is critical to ensure the continued delivery of safe and high-quality community health services.
We call on the Government of Ontario to provide funding targeted to compensation so that community-based health care organizations can offer compensation packages that make it possible to attract and retain critical health human resources. We also call on the Government to develop a comprehensive HHR strategy, with a focus on paying healthcare providers the salary that they deserve while keeping up with inflation and cost of living.
INVEST IN COMMUNITY PRIMARY HEALTH CARE ORGANIZATIONS THROUGH BASE BUDGET FUNDING INCREASES TO SUSTAIN HEALTH FOR COMMUNITIES IN ONTARIO
Community health organizations provide care for populations that are 68% more complex, on average, compared to the average Ontarian. Despite this complexity, clients served go to emergency departments less than expected - resulting in over $27 million saved every year.
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Community-governed comprehensive primary health care organizations have not had a base budget funding increase in over 15 years. |
We call on the Government to invest $33.7 million or 5% base budget funding increases to community-governed comprehensive primary health care organizations so they can maintain and improve service levels, keep their lights on and meet the needs of their clients and the communities they serve.
Alliance members serve communities who face the greatest barriers to care and poorest health outcomes and that have been disproportionately affected by chronic diseases, respiratory illnesses, mental health and addictions, among others.
Community-government comprehensive primary health care organizations provide the most innovative services that help end hallway health care by keeping people in Ontario who face the greatest barriers to care and poorest health outcomes out of hospital and in our communities.
Alliance members divert people away from hospitals and emergency rooms while ensuring they get the care they need, when they need it. And we alleviate pressures on the rest of the health system by managing complex clients in the community and close to home.
Community-governed comprehensive primary health care organizations have not had a base budget funding increase in over 15 years. Comprehensive primary health care providers need sustainable resourcing in order to maintain capacity to deliver primary care, mental health, community supports and the innovative services that help end hallway health care.
Costs have continued to rise -- increasing costs of utilities, insurance, property maintenance, and rent top the list of pressures, closely followed by cyber security and overhead/staff support for new initiatives -- plus the mounting pressures of the Health Human Resource (HHR) crisis as mentioned earlier. Now Alliance members are in the unfortunate position of having to make cuts to service delivery in order to pay their bills.
We need sustainable and adequate funding in order to maintain our capacity to deliver primary health care, mental health services, health promotion and community programs and services to keep people healthy and well in their communities and out of hospital.
INVESTING IN EQUITABLE, CULTURALLY SAFE INTER-PROFESSIONAL
TEAM BASED CARE
Alliance members provide comprehensive team-based primary care through the model of health and well-being or the model of wholistic health and well being. Whether in community health centres, nurse practitioner-led clinics, family health teams or Indigenous primary health care organizations, clinicians work together in teams to meet the needs of the community and tackle population health through a health-equity and community focus.
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Alliance members provide culturally safe primary care services, health promotion and community development services. |
Primary care clinicians, such as those working in Alliance members’ teams, continue to play an integral and multi-faceted role in Ontario’s health care system, taking on new roles, innovating and responding to urgent and new needs, while also continuing to provide primary care services like prevention, acute and chronic care — all without additional resources. We call on the Government to invest $97 million in equitable, culturally safe inter-professional team based care.
On average, patients with access to team-based care have improved health outcomes, fewer emergency visits, better discharge experiences, and cost savings ranging from $10-90 per patient, per month. Team-based care supports the Your Health: A Plan for Connected and Convenient Care, but also ensures people are provided the best care outside of hospitals ensuring the supports are available to people who need them most.
Invest $37 million over three years in Indigenous-led primary health care services to support a Provincial Indigenous Integrated Health Hub.
Alliance supports adopting an Indigenous Health in Indigenous Hands approach to primary health care, and supports the requests from the Indigenous Primary Health Care Council for sustainable and adequate funding in order to maintain our capacity to deliver primary health care, Traditional and culture-based services, mental health services, health promotion and community programs and services to keep people healthy and well in their communities and out of hospital.
Alliance supports IPHCC and its’ network of members call for the provincial government to support a Provincial Indigenous Integrated Health Hub.
We need immediate action from the provincial government to ensure action-oriented plans are developed by and for Indigenous communities that place the priorities of community at the centre.
Invest $60 million in expansion of inter-professional team-based care at Alliance member centres who serve those facing most barriers to access such as Indigenous, Black, Francophone and 2SLGBTQ+ communities and communities in rural, remote and northern communities.
The Ontario Government has announced funding of $30 million for inter-professional teams across the province. We thank the Government for this investment and recommend additional investments. The response to the Expression of Interest for new and expanded inter-professional teams demonstrates the need in Ontario for future investments in team-based care. Further investments in team-based primary care will help to reduce costs and strain on Ontario’s acute care system. Community-governed comprehensive primary health care organizations help alleviate pressures on the rest of the health system by managing clients in the community and close to home with services rooted in the determinants of health, anti-oppression and cultural safety.
Alliance members provide culturally safe primary care services, health promotion and community development services that help address the social, economic and ecological determinants of health. Over 60% of population health outcomes are determined by social and environmental factors (such as income, education, working conditions, housing and the environment.) Investing in inter-professional, team-based comprehensive primary health care means addressing health inequities that impact hospital system use.
CONCLUSION
Evidence provided by the Institute for Clinical Evaluative Sciences (ICES) found that, even though the majority of Alliance members serve people with more socially and medically complex needs, they do a significantly better job than other primary care models at keeping these people out of hospital emergency rooms and helping to end hallway medicine.
Alliance members serve populations who face the most barriers to health: Indigenous peoples, Francophones, Black populations, people with disabilities and mental health challenges, other racialized groups, recent immigrants and refugees, people who are 2SLGBTQ+ and people living in Northern, rural and remote areas.
Increasing funding to address the HHR crisis, a 5% increase base budget funding for community-governed comprehensive primary healthcare organizations and funding equitable, culturally safe inter-professional team-based care will enable the sector to respond to the barriers to health for priority populations, population health and improve health care for everyone living in Ontario.
Contact:
Marie-Lauren Gregoire Drummond
Director of Communications and Stakeholder Relations
Alliance for Healthier Communities