A Multi-Disciplinary Approach to Health Care

The following questions were put to me during the Provincial Election campaign by community health care professionals. My response follows.

Dear MPP candidate:

I am writing to all candidates in my riding to determine whether they support an important solution that will improve access and timeliness of health care in Ontario.

In particular, I would like to know whether you support regulatory, policy and legislative changes that will enable primary health care nurse practitioners across Ontario to fully utilize their knowledge and expertise to improve access to timely health care and reduce fragmentation and duplication of care.

Nurse practitioners provide primary health care to thousands of individuals and families in Ontario and are integral to completing the Second Stage of Medicare. Ten years ago Ontario led the way in implementing the NP role but has since fallen behind other provinces.

Earlier this year, the Primary Health Care Nurse Practitioner Integration Task Team reported to the Minister of Health and Long-Term Care on strategies to address barriers that limit NPs’ ability to provide timely, efficient, comprehensive care. I urge you to commit to implementing these recommendations.

Specifically, I would like to know whether you will commit to several key actions.

Removing barriers that restrict specialists from accepting referrals from nurse practitioners: Many women, for example, who need a referral to an obstetrician or gynaecologist, are required to first see a family physician in order for the specialist to bill the full fee for seeing the patient. The result is less timely care, increased costs for the health system, fragmentation of care and inconvenience for patients.

Removing barriers that limit NPs’ ability to prescribe and order tests and diagnostic procedures: NPs’ authority to prescribe is limited and listed in regulation. When new, more effective and cost-efficient drugs are introduced, it can take up to two years to add these drugs to the NPs’ list. NPs have the knowledge, skills and expertise to prescribe appropriately within the scope of their practice as primary health care providers.

Supporting a variety of strategies to recruit and retain NPs: NP salaries are no longer competitive within nursing in Ontario or across Canada. Government, together with nurse practitioner stakeholders, must support an independent salary review to address this issue. Changes are needed to government funding programs that will facilitate recruitment and retention of NPs through:

a) annual cost-of-living increases;
b) continued and expanded support of the Grow-Your-Own NP program; and
c) financial incentives for positions in rural, remote and under-serviced communities (e.g., moving costs, bonus payments, additional continuing education funding).

Remove barriers that limit effective inter-professional team practice: Current compensation models are structured to provide bonus payments to physician members of inter-professional primary care teams to recognize and reward illness prevention and health promotion activities such as immunizations and mammograms. Physicians are eligible for this compensation regardless of which member of the team - such as NPs or registered nurses - actually provided the care. This is disruptive to effective team development and marginalizes and devalues the contributions of other health care professionals to improving and sustaining the health of patients.

Develop, in collaboration with NP stakeholders, a public education program about NPs and their key role in primary health care: The healthcare system would benefit hugely from an enhanced understanding - by physicians, other health care providers and policy-makers, such as the LHINs - of the role of NPs in increasing access to care, reducing waiting lists, improving management of chronic diseases and implementing preventative health care programs.

Will you commit to these recommendations to support nurse practitioners and more timely access to health care in Ontario?

DearCommunity Member,

Thank you for taking time to contact me regarding this very important issue.

I am very proud of the long term approach that the Green Party of Ontario takes with respect to health care.

My own personal background includes serving on the board of my local community resource centre, the Overbrook-Forbes Community Resource Centre since 2001. I have taken a leave of absence during the election. www.ofcrc.org I served as board President from 2002-2004 and Treasurer, 2004-2007. this organization is in the process of implementing a multi-disciplinary health component which should be open to the public on site by December, 2007.

Below are what I believe are some of the pertinent sections of our platform to your questions. For your reference, the full document can be found here: www.gpo.ca/platform

The GPO’s health plan takes a broad approach to wellness, with an emphasis on healthy communities, healthy lifestyles and a healthy environment, not just health care. Reducing toxins in our environment, addressing the social determinants of health and encouraging healthy lifestyle choices are important components of the Green Party’s health plan.

The Green Party has a plan that will offer more choice, emphasize prevention and be accountable to the public.

To achieve these objectives, the Green Party of Ontario will:

Provide Ontarians in the lowest 75th percentile of income an additional health care allowance of $1,000 per person, phased in over five years at $200 per year, for purchase of prescription drugs and/or care from any practitioner mandated by the Regulated Health Professionals Act (RHPA) at an eventual cost of $9.75 billion by 2012. These professions include: physicians and surgeons, nurses, chiropractors, physiotherapists, naturopaths, audiologists, chiropodists, dental hygienists, dental technologists, denturists, dieticians, massage therapists, medical laboratory, midwives, occupational therapists, opticians, optometrists, respiratory therapists and dental surgeons.

Immediately increase the budget of the Ministry of Health Promotion, currently at 1%, to 2% of the Ministry of Health and Long-Term Care’s budget. Since most illnesses result from lifestyle choices, the GPO believes that health promotion is fiscally prudent and will lead to improved wellness. These funds would be used to place nurses in the school system to promote healthy lifestyles and to assist in identifying youth at risk of long-term health problems.

Increase the funding and effectiveness of primary and preventive health care by:
Creating a joint commission of stakeholders to explore best practices for implementation of preventive and primary health care by family doctors, with an emphasis on improved outcomes. This may include rewarding doctors who successfully assist their patients resolve risk factors such as obesity, smoking or uncontrolled high blood pressure.
Increasing support and incentives for multidisciplinary clinics and practices that team doctors with nurses, dieticians, psychologists, counsellors, physiotherapists etc. This is particularly important for taking a holistic approach to mental health, addiction and lifestyle counselling.

I am strongly supportive of proposals that promote a multi-disciplinary approach to health care. I view your proposals very favourably.

Thank you for taking the time to contact me.

Regards,
Leonard Poole

Questions from L'Image of Sandy Hill

Questions for the Candidate

1. Funding for Schools

What is the position of your party on extending provincial funding for religious schools?

The Green Party believes in a single publicly funded education system that treats all students fairly and equally. The UN Human Rights Committee has twice censured Ontario for violating the equality of its own citizens by funding Roman Catholic schools but not schools of other religions. The GPO does not support the John Tory solution of funding all faith-based schools. We believe that we should move to one school system with English and French streams.

What is your position for funding other types of private schools (ie. non-religious) like some which operate here in Sandy Hill?

As stated above, the Green Party believes in a single publicly funded education system. We do not support public funding of schools outside of the public system.

What is your party’s position on class size (maximum number of students in a classroom)?

The Green Party recognizes the success of the current government in reducing most class sizes to 20 from Kindergarten to Grade 3. We believe we must extend this effort through to Grade 12.

2. Transportation

What would your party do to provide an alternate route for the heavy truck traffic which currently passes through downtown Ottawa?

I recognize that the need to remove truck transport from downtown Ottawa is great. We must use it as an opportunity to make wise long-term investments in our infrastructure. Our first goal should be to reduce demand for automobile infrastructure by ensuring that a seamless inter-provincial mass transit system is included in any proposal. Second, recognizing that rail is a far more efficient use of energy, the province must begin to plan now for greater reliance on it as opposed to trucks for the transportation of goods. Third, any new infrastructure should be tolled to appropriate cost to users. Finally, we must ensure that we do not repeat the mistake of the King Edward Bridge and allow truck traffic to split apart another community.

3. Homelessness

How does your party plan to address the growing problem of homelessness in the downtown cores of our cities?

I believe that a society is judged by the way it responds to the needs of its most vulnerable. With respect to homelessness, particularly when combined with mental illness and/or drug addiction, our legacy is shameful. Our societal response is patchwork at best, with various agencies scrambling to do what they can for those in need. All too often we resort to “blaming the victim” for their plight. This is inexcusable in the 21^st Century. It is essential that the province develops and implements a comprehensive long-range plan that would ensure that acceptable housing is available to every citizen. We also must ensure that every individual who needs help with drug addictions is provided the treatment needed on a timely basis. Our failure in this area continues to compound problems that destroy neighbourhoods.

The Green Party proposes to address poverty through improvements in the minimum wage, indexing Ontario Works and Ontario Disability Support Program payments to the rate of inflation, and adjust shelter allowances to reflect average local rents as defined by CMHC.
We also propose to divert future budget surpluses to create a $5 billion Long-Term Affordable Housing Investment Dedicated Fund. Annual interest from this Fund would be used to continuously build supported housing, seniors accommodation, affordable housing, rent-to-own housing, coops, co-housing, sweat equity housing, eco-villages.

4. University Education

Sandy Hill is home to many university students. How does your party propose to help these students meet the increasing expense of their education?

The Green Party believes that high tuition is counterproductive to developing both a competitive economy and a qualified, engaged workforce. To address this issue, the Green Party of Ontario will provide $500 million per year by 2011 to cap university tuition at $3000 average per year and college tuition at $700. The Green Party understands that in the 21st century Ontario needs well-educated citizens who are able to achieve their full potential.

5. Public Transit

What support will your party offer to Ottawa as it tries to improve its public transportation system and meet the challenges of future growth?

The Green Party of Ontario is committed to cleaner, cheaper, more efficient and safer forms of transportation. Ontario’s current transportation system is inefficient, expensive, polluting, dangerous and unsustainable. The Green Party envisions a transportation system that does not reduce our quality of life. Our Plan for sustainability would Divert 75% of all money budgeted for new highway construction until 2012 to public transit such as GO Transit, Toronto Transit Commission and Ottawa’s OCTranspo. This will fund the service improvements, expansion and infrastructure renewal required to create a world-class transportation system, relieve gridlock and eliminate the need for new highways.

Will your party support Ottawa’s public transportation system? If so, how?

As noted above, we would shift our transportation investments from highway construction to a far greater emphasis on public transportation.

6. Medical Care

We are fortunate to have the Sandy Hill Community Health Centre in this neighbourhood but the current wait time for Sandy Hill residents to register with this facility is two years. What strategies does your party propose to increase access to primary care for our community in the next 4 years?

The GPO’s health plan takes a broad approach to wellness, with an emphasis on healthy communities, healthy lifestyles and a healthy environment, not just health care. Reducing toxins in our environment, addressing the social determinants of health and encouraging healthy lifestyle choices are important components of the Green Party’s health plan.

Health care reform is urgently needed if we are to have a health care system that is sustainable and viable in the future. The Green Party plan will offer more choice, emphasize prevention and be accountable to the public. The Green Party of Ontario will provide Ontarians in the lowest 75th percentile of income an additional health care allowance of $1,000 per person, phased in over five years at $200 per year, for purchase of prescription drugs and/or care from any practitioner mandated by the Regulated Health Professionals Act (RHPA).

We will immediately increase the budget of the Ministry of Health Promotion from its current 1% level to 2% of the Ministry of Health and Long-Term Care’s budget. Since many illnesses result from lifestyle choices, the GPO believes that health promotion is fiscally prudent and will lead to improved wellness. These funds would be used to place nurses in the school system to promote healthy lifestyles and to assist in identifying youth at risk of long-term health problems.

We will increase the funding and effectiveness of primary and preventive health care by:

1) Creating a joint commission of stakeholders to explore best practices for implementation of preventive and primary health care by family doctors, with an emphasis on improved outcomes. This may include rewarding doctors who successfully assist their patients resolve risk factors such as obesity, smoking or uncontrolled high blood pressure.

2) Increasing support and incentives for multidisciplinary clinics and practices that team

doctors with nurses, dieticians, psychologists, counsellors, physiotherapists etc. This is particularly important for taking a holistic approach to mental health, addiction and lifestyle counselling.

Responding to Questions from the City Centre Coalition

1. Cities are seriously underfunded for the responsibilities they have been mandated. We favour uploading financial responsibility from cities to the Province for services previously downloaded. What will you do to resolve this longstanding issue?

The province must immediately assume responsibility for the full cost of social services. They should not be imposed on the municipal tax base. Municipal taxes currently have no relationship either to the cost of the service provided or to the ability of an individual to pay. Because of this inherent unfairness, taxpayers understandably put intense pressure on their councilors to eliminate tax increases. This leads to short term thinking on the part of city councils across the province. I am very interested in proposals developed by the Ottawa based Federation of Community Associations (FCA). As an MPP I would work hard for a full review of the provincially imposed municipal tax system.

2. We, along with other organizations, have filed a bump-up request regarding the proposed widening of the Queensway through various central sections of Ottawa. Our request is that the Environmental Assessment on the proposed project be done at the proper level of thoroughness in order to assure adequate protection of neighbourhoods through which the highway passes. Do you support our request?

I strongly support your request. The Green Party of Ontario is committed to cleaner,
cheaper, more efficient and safer forms of transportation. Ontario’s current transportation system is inefficient, expensive, polluting, dangerous and unsustainable. TheGreen Party envisions a transportation system that does not reduce our quality of life. Our Plan for sustainability would Divert 75% of all money budgeted for new highway construction until 2012 to public transit such as GO Transit, Toronto Transit Commission and Ottawa’s OCTranspo. This will fund the service improvements, expansion and infrastructure renewal required to create a world-class transportation system, relieve gridlock and eliminate the need for new highways.

3. We have asked the Minister of the Environment not to approve the inadequate Environmental Assessment done on a proposed project to build a highway through the Alta Vista Corridor – a project that would cause irreparable harm to communities bordering the corridor and to those downstream that would have the traffic dumped on them. Do you support our request?

I strongly support your request. Transportation systems must be designed to integrate well with the surrounding communities and bring us together not split us apart.

4. Very little provincial attention is paid toward promoting cycling and
   educating all road users about cycling safety. While the Ministry of
   Health Promotion pays much attention to helmet safety, such programs
   reach only people who already cycle. Do you support provincial funding
   for expanded cycling facilities and for programming to encourage
   bicycle use and awareness?

Yes I do. I am an active cyclist and enjoy cycle touring. It is a sustainable practice that enhances one’s health.

Why I Decided to Run as a Green Party Candidate

Since the beginning of the campaign, it has been my intention to bring the issue of long-term sustainability to the forefront of the debate. As the new century has unfolded it has become clear to increasing numbers of us that we are at a very critical time in the evolution of humanity on our precious planet. We see the strains of the earth reaching and surpassing its ecological limits all around us. Whether it is our collapsed cod fishery, pine beetle infestation, disappearing polar ice sheets, rising carbon emissions or reduction in biodiversity, the evidence of our impact is overwhelming.

We know that if every person on the planet consumed resources at the rate that the average Ontarian does, we would need at least four planets to support them. This is unsustainable and must be corrected if we are to continue to exist as a species.

I challenge my political opponents to recognize that the long-term consequences of our policy decisions must be accounted for. In the 1950’s the prevailing view was that energy resources were limitless, and that there was no down side to harnessing the power of carbon. My, how times have changed. We are now being confronted with the consequences of such short-term thinking. We now know that if we design our cities for cars, and invest more in highways to move those cars instead of transit to move people, what we get is, no surprise, more cars, congestion, sprawl, fouled air and climate change.

In spite of this, our present political leaders suggest that we need only change a few light bulbs, and perhaps drive a different car. Otherwise, we can continue to expand and consume as before.

The Green Party of Ontario sees things very differently. We believe that we are approaching a tipping point over which we must not fall. We believe that we must begin now to discuss, develop and implement ways of living on this planet that truly is sustainable.

We recognize that any growth must be balanced with the imperative of finite resources. We believe that social, economic and environmental policy should:

1. create a green and sustainable living for the people of Ontario

2. contribute to the planet’s greater good

3. establish the foundation for a green and sustainable future.

Our platform seeks to do so not by spending more money, but by shifting priorities to achieve sustainable results.

It is my sincerest desire that my colleagues of all political stripes will accept the challenge to debate how their proposals move us to sustainability. The decisions we make today will have an impact for generations to come. Politicians must be challenged to explain not only what they will do for us today and for the next four years. They must also explain how their proposals will benefit our children and grand children.

We must remember that ultimately, we do not own this precious planet. We borrow it from future generations.

Faith Based School Funding - A Choice for Ontario

John Tory, with his early summer announcement that he would extend funding to faith based schools across Ontario, has changed the face of this election. He has clearly drawn a line in the sand on this issue, proclaiming that it is a matter of principle, and the right thing to do.

On the point of it being a principled position, there can be no argument. Dalton McGuinty may believe otherwise, but, the status quo, whereby Ontario funds one religious group to the exclusion of others, is indefensible. Does this mean, though, that we must fund all faith based schools? The Green Party believes that full consideration must be given to the alternative of moving toward a unified public system.

Our current system has its roots in pre-confederation Ontario when a Methodist Minister, Egerton Ryerson, was laying the foundation. There was no consideration at that time of any faith other than Christianity. The only issue was your denomination within that faith. The schism of the day was between Protestant and Catholic.

This is the 21st Century, however, and times clearly have changed. Unfortunately our method of funding education has not.

John Tory, as noted above, would have us solve this by extending funding to all faith based institutions that follow Ministry of Education guidelines and its curriculum. I believe this to be a short sighted path that moves us away from long term sustainability for our education system. Not only financially costly, the ultimate effect is that it moves us toward focusing on what separates us rather than what bring us together.

There are many financial and environmental arguments that can be made against such a proposal. John Tory has already thrown out the figure of investing an extra half a billion dollars to bring this about. This is from someone who professes to be a firm believer in economic efficiency. Environmentally, the profusion of various separate schools would lead to ever more demand for transportation as children go from one side of a city to another to get to their unique school.

However, these immediate costs pale in comparison to the long term social consequences. Ontario’s immigration patterns have changed in the past thirty years. People of a multitude of faiths and ethnic backgrounds have been welcomed. We have had difficulties, but we, and our children, have ultimately learned so much from each other. We are now recognized around the world as an example of how diversity can be celebrated, while simultaneously developing vibrant cohesive communities.

One of my most memorable experiences in this regard was from three summers ago. I had the opportunity to volunteer as a teacher’s assistant in a summer ESL class for teenagers. About twenty students in each class, from at least a dozen different backgrounds. New friendships were being formed amongst the students. I noted in particular two young students who were virtually inseparable in their friendship. One Muslim, the other Jewish, both newly arrived in Canada. And then there was the shy Christian from Jordan helped with his homework by the equally shy Vietnamese Buddhist. It was a memorable summer for all of us. How could this have happened if each newcomer had been directed toward a faith-based education?

In our schools today our children have the opportunity to discover what brings them together while simultaneously appreciating their diversity. I do believe that so many of these opportunities would be lost if we chose the path of further fragmentation of our educational system.

I make the argument then, for a unified school system, not on the basis of the economic and environmental arguments, (although such arguments are valid), but because it simply is the right thing to do to ensure that we continue to develop strong, cohesive, respectful communities.

Responding to Questions from the Manor Park Chronicle

Manor Park Chronicle

September, 2007 Edition

Questions for Ottawa-Vanier, October 10, 2007 Provincial Election

Q1: The NCC and the governments of Ontario and Quebec are jointly funding an Environmental Assessment of proposed locations for one or more new interprovincial crossings. There has been considerable public comment on this issue from politicians at all three levels and from the general public.

Do you favour any of the options under study? Do you believe that Kettle Island would be a viable location for a new crossing?

Word Limit: 275

I currently do not favour any of the options under study. There is a fundamental flaw in the Terms of Reference of the Environmental Assessment. They are based on the assumption that we should continue to encourage and expect growth in demand for automobile and trucking transportation infrastructure. As we are all well aware, Canada, like every other nation, needs to develop and implement action plans that respond to the twin threats of climate change and dwindling carbon based energy supplies. Such action plans therefore, need to point us in the direction of reducing, not increasing our dependence on the personal automobile and reliance on truck transport. Any future transportation infrastructure investments need to recognize this reality.

The need to remove truck transport from downtown Ottawa provides us with the opportunity to make wise long-term investments in our infrastructure. Our first goal should be to reduce demand for automobile infrastructure by ensuring that a seamless inter-provincial mass transit system is developed. Second, recognizing that rail is a far more efficient use of energy, we must begin to plan now for greater reliance on it as opposed to trucks for the transportation of goods. Third, any new infrastructure should be tolled to appropriate cost to users.

I am not in favour of the Kettle Island crossing. According to studies already completed by the NCC and the former Region it has been shown to be the most costly, not only financially, but also environmentally and socially. We need a solution that removes truck traffic from our communities. As your MPP I would work for a transportation infrastructure that brings us to together, instead of splitting us apart.

Q2: Zoning decisions made at the municipal level may be challenged at the Ontario Municipal Board (OMB). Since the OMB is a quasi-judicial body, a successful case usually depends on legal counsel and expert witnesses.

What are your views on the role and structure of the OMB?

Word Limit: 200

Ontario is unique within Canada in having this type of oversight of municipal decision-making. Like our antiquated municipal tax system, it has its origins in late 19^th Century patriarchal Ontario. It was developed at a time when the only way to legally deal with many municipal matters was through private bills in the Provincial Legislature. Obviously, times have changed and our municipalities have matured. Unfortunately, the OMB has not; as it continues to intervene in the same manner it did over 100 years ago.

Being quasi-judicial it is by definition undemocratic and arbitrary. Far too often a local community will, through democratic process, choose a particular development path, only to be threatened with appeal to the OMB. Local communities are often at a distinct disadvantage as they seldom can match the resources of a deep-pocketed developer.

As your MPP I would propose a thorough review of the mandate and purpose of the OMB. We must start by looking at best practices in other jurisdictions in Canada. How has the rest of the country been served without such an oversight body? Maybe they know something we don’t.

Q3: Municipalities across Ontario are struggling to meet their commitments within their current taxation capabilities. The basis for calculating property assessment for taxation purposes has also been controversial.

What services should be funded by property taxes?

What is the best method to finance municipalities?

Should there be changes to the structure and responsibilities of MPAC (the Municipal Property Assessment Corporation)?

Word Limit: 350

The municipal tax system in Ontario, like the OMB, is a quaint relic of the 19^th Century that has not kept up with the times. The Green Party of Ontario believes that part of the solution lies in moving toward a system that assesses land value, but not the value of buildings and improvements made to such buildings, to determine municipal tax rates. This would vastly simplify the responsibilities of MPAC, as the relative value of building improvements would not be considered in their calculations.

Our plan would encourage development more along the lines of a municipality’s official plan. Land value is proportional not only to its quantity, but also to the scale and type of development permitted. Our proposal would create a disincentive to land speculation, as the property would be taxed according to its full potential for use, as reflected in its assessment and class.

This removes the disincentive of higher taxes on home improvement. A property owner is more likely to invest in best building practices, and erect a carbon neutral facility with the threat of higher taxes removed. This enhances not only the value of the building, but the community at large with cleaner air.

Another part of the solution lies in apportioning taxes according to the cost of specific services provided. Dense communities are generally less costly to serve than sprawling communities. We need a method to recognize this fact when tax bills are calculated.

Changes also are needed to the Provincial Development Charges Act. It is much too restrictive in its definition of what costs municipalities can recoup from Greenfield development. This needs to be changed to ensure that the full cost of urban sprawl is assessed to those who create it.

The cost of services that involve income redistribution and equity-related goals should not be borne by the municipal taxpayer. Therefore the provincial government should take back responsibility for 100% of the funding of all provincially mandated social service programs. The Liberals have had four years to fix the problem created by the Harris Conservatives, yet they have failed to act.

Q4: The provision of a secure electricity supply, while minimizing environmental impacts, is an important issue in Ontario. Ontario has a growing population, yet an aging electricity generation and transmission infrastructure.

What do you propose should be done on both the electricity supply and demand sides?

Word Limit: 175

As Ontario and the world confronts dwindling non-renewable energy reserves we must refocus our strategy on developing local renewable resources.

Unfortunately the province seems determined to make a critical investment error as it considers betting the farm on a $45-billion investment in nuclear energy. It takes at least 12 years to bring a nuclear plant on stream. Historically they have been drastically over-budget and never as reliable as predicted.

Instead, we must invest now in local communities. We need to remove electric element space and water heating from hundreds of thousands of Ontario homes. We must provide real-time feedback to consumers on consumption. We need to aggressively push the installation of solar hot water and geo-thermal earth energy systems.

We need changes to our building and electrical codes and the Planning Act that will mandate the highest energy efficiency of all future construction and development. It is much cheaper, more secure, and more environmentally friendly to conserve a megawatt than produce one. Our future energy security depends on a strong localized energy infrastructure.