Social Policy in Ontario

In 2019, Ontario saw the introduction of a new integrated approach to health care delivery with the government’s enactment of the Connecting Care Act, 2019 (the “CCA”). One of the most significant aspects of the CCA was to empower a single provincial agency, Ontario Health, with the management of health service needs across Ontario (subject to government oversight).[1]

In the past few months, steps have been taken towards expanding and further prescribing the role of Ontario Health. Steps have also been taken towards implementing Ontario Health’s mandate. These steps include new regulations under the CCA and a number of transfer orders issued by the Minister of Health (the “Minister”). This bulletin provides a summary of the recent developments.

The Objects of Ontario Health Now Include Shared Services and Research

Effective December 2, 2019, Ontario Health was given two additional objects pursuant to new Ontario Regulation 376/19 under the CCA (the “Additional Objects Reg”).

Ontario Health’s first eight objects as prescribed by the CCA are to:

• implement government health system strategies;
• manage health service needs across Ontario;[2]
• undertake activities related to tissue donation and transplantation;
• support the patient ombudsman in their functions;
• support or provide supply chain management services to health service providers and related organizations;
• provide health care advice, recommendations and information;
• promote integration; and
• respect diversity.

The first of the new objects prescribed by the Additional Objects Reg is to provide shared services to local health integration networks (“LHINs”), approved home care and community service agencies[3] and long-term care home placement co-ordinators.[4] Those shared services include:

• human resources, labour relations and collective bargaining;
• managing provincial patient care technology platforms;
• finance and administration;[5]
• communications and public relations; and
• supporting policy development and implementation and quality improvement.

These shared services are currently performed by Health Shared Services Ontario (“HSSOntario”). HSSOntario is one of five provincial agencies that is now part of Ontario Health. See “Transfer Orders” below.

The second new object of Ontario Health introduced by the Additional Objects Reg is to conduct or fund research programs (to be specified in the accountability agreement entered between the Minister and Ontario Health).

Transfer Orders

Under the CCA, the Minister may order the transfer of all or some of the assets, liabilities, rights, obligations and employees of existing provincial agencies to Ontario Health, a health service provider or an Ontario Health Team (a “Transfer Order”). The CCA deems a Transfer Order not to (1) constitute a change of control; or (2) constitute a breach of any Act, regulation or by-law; constitute an event of default or force majeure; give rise to any right to terminate an agreement, licence, permit or other right; or give rise to any estoppel. These provisions allow Transfer Orders to proceed without the consents that would normally be required at law or under contract.

The Provincial Agencies

On November 13, 2019, the Minister issued Transfer Orders effective December 2, 2019 to five agencies: Cancer Care Ontario, Health Quality Ontario, eHealth Ontario, HSSOntario and HealthForceOntario Marketing and Recruitment Agency (the “Transferred Agencies”).  Notification letters setting out the intention to issue these Transfer Orders were sent to the Transferred Agencies on August 15, 2019.

The Ministry has indicated that there will be no immediate changes to the activities of the Transferred Agencies and current contracts and obligations will remain in place as the transfers take place.[6]

The CCA also contemplates the transfer of the Trillium Gift of Life Network. That transfer will take place at a later date. All Transfer Orders are available on Ontario Health’s website at https://www.ontariohealth.ca/corporate-documents.

LHINs

The CCA also empowers the Minister to transfer the 14 existing LHINs to Ontario Health.  Effective December 2, 2019, the LHINs were clustered into five regional areas. This step did not constitute a merger of the LHINs, and 14 LHINs continue to exist. However, the number of chief executive officers among the LHINs was reduced to five, with such five individuals serving in transitional roles for the eventual transition of the LHIN responsibilities to Ontario Health or Ontario Health Teams.[7]

Additionally, on November 28, 2019, the Minister issued Transfer Orders to the LHINs, transferring non-Home and Community Care Vice Presidents and Directors of the LHINs into Ontario Health effective December 2, 2019 . The Ministry reiterated that there would be no changes to LHIN services but underscored that the move was part of the eventual transition of certain LHIN functions to Ontario Health. The Ministry has also confirmed that the LHINs would continue their work with respect to home and community care and long-term care but noted that, eventually, home and community care supports will be integrated into Ontario Health Teams.[8]

Ontario Telemedicine Network Deemed a Prescribed Organization

Effective January 1, 2020, Ontario Regulation 390/19 came into effect under the CCA and prescribed Ontario Telemedicine Network (“OTN”) as an agency that may be transferred into Ontario Health. The Ministry has indicated that a decision about whether OTN will transfer to Ontario Health had yet to be made. The Ministry also explained that the new regulation is part of the transition to a digital-first approach to health care.[9]

Ontario Health Leadership

On December 20, 2019, the Board of Directors of Ontario Health announced that Matthew Anderson, President and Chief Executive of Lakeridge Health, will become President and Chief Executive Officer of Ontario Health effective February 1, 2020.[10] Susan Fitzpatrick has served as Interim Chief Executive Officer since April, 2019.

Descriptions of the roles of the Chief Executive Officer, Chair and Board of Directors of Ontario Health are set out in the CCA and expanded on in a memorandum of understanding between the Minister and the Chair entered in November, 2019 and available on Ontario Health’s website. The first annual business plan for Ontario Health is expected to be delivered to the Minister in draft by February 28, 2020 in respect of the period from April 1, 2020 to March 31, 2023.

We will continue to monitor the progress of Ontario Health, Ontario Health Teams, and other integration initiatives, and cover updates in future bulletins.
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[1] Ontario Health is referred to as the “Agency” in the CCA and other legislation. Ontario Health Teams are referred to as “integrated care delivery systems”.

[2] This object includes ensuring the quality and sustainability of the Ontario health system through a number of areas including operational management and co-ordination; performance measurement and evaluation, quality improvement; patient relations; digital health; and health care practitioner recruitment. The full list is included in section 6(b) of the CCA.

[3] Approved under the Home Care and Community Services Act, 1994.

[4] Designated under the Long-Term Care Homes Act, 2007.

[5] Including accounts payable and inventory management

[6] With the exception of the HealthForceOntario Marketing and Recruitment Agency Physician Assistant Career Start Program, which will be operated by the Minister of Health.  See the Ministry’s November 13, 2019 news release: https://news.ontario.ca/mohltc/en/2019/11/ontario-taking-next-steps-to-integrate-health-care-system.html (the “November 13th News Release”) and the Connected Care Update from December 2, 2019: http://www.health.gov.on.ca/en/news/connectedcare/2019/CC_20191202.aspx (the “December 2nd Update”).

[7] See the November 13th News Release.

[8] See the November 13th News Release and the December 2nd Update.

[9] See the December 2nd Update.

[10] See Ontario Health’s December 20, 2019 news release: https://www.ontariohealth.ca/sites/ontariohealth/files/2019-12/News-Release-Ontario-Health-CEO-Appointment.pdf
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