Five Things to Look for in Tomorrow’s “Health Budget”

By Dan Carbin, Principal at Santis Health

Tomorrow, Ontario Finance Minister Charles Sousa will table the government’s penultimate budget before the next provincial election in June 2018. While the 2018 budget is widely expected to include a host of new spending commitments and dovetail with the Liberal Party’s re-election sales pitch, the 2017 budget is shaping up to be more defensively minded and focused squarely on neutralizing health care as a potential electoral liability in 2018.

In recent months, the government has come under increasing scrutiny for its handling of the health file. Hospitals have been warning with increasing resonance that years of sub-inflationary investment is leading to ER backlogs, stretchers in hallways and over-crowded wards. Doctors are engaged in a divisive and prolonged dispute with the government over fees. CCACs in some areas of the province have been forced to dramatically increase home care wait lists in response to surging demand and constrained budgets. Patients are complaining to the media about cancelled elective surgeries and long wait lists for long-term care placement.

It is an oft-repeated axiom in Canadian provincial politics that parties don’t win re-election due to their handling of the health file. Parties certainly get voted out, however, if the public believes that they have mismanaged the health care system. With the 2017 Budget, the Liberals will be looking to address that risk head-on. Sources suggest that the Budget is squarely focused on investment in new health care programs and services to improve access to care. The ultimate goal is to take health care off the table as an area of political risk in 2018, and bolster the Liberal Party’s credibility as a “defender of public services”.

While full details of the budget plan will become clear on Thursday afternoon, stakeholders have been actively speculating for weeks about what to expect. Sources suggest that the system can expect movement in the following areas:

1. Health spending will inch up, perhaps signalling an end to the era of strict cost containment.

Over the past five years, as the government focused on returning the province to a balanced budget, health care spending growth was squeezed to just over 2% annually. As the government’s own Fiscal Accountability Office (FAO) has reported, such a level is insufficient to simply maintain access to care in the face of an aging population and growing demand for care. In fact, the FAO projects that spending would have to increase by an average of 5.2% annually for current standards to be maintained.

While no one expects the government to table a budget with over 5% health spending growth, there are suggestions that spending will finally inch back up over 3%. While this is incredibly modest in the historical context – the FAO points out that spending averaged 7.2% per year between 2005-06 and 2009-10 – it does, perhaps, signal the end to five years of singular focus on cost containment.

2. Hospitals will receive a base budget increase and targeted funding to address capacity problems.

Hospitals have been warning, loudly, for months that without targeted new investments they will be forced to close beds, cut back on elective procedures and reduce service levels. Already, the province has the fewest number of hospital beds per capita in the country. Premier Wynne has already signaled to the media that more funding is on the way for hospitals in the budget. The acute sector is anticipating both an increase in overall hospital base budgets and targeted investments to relieve over-crowding (particularly in the GTA) and ALC pressures in a number of communities.

3. There will be new investments in primary care.

In 2014, the Liberal Party platform included a commitment to ensure that every Ontarian has access to a family care provider. There is still more work to be done in this area. There are strong suggestions that Budget 2017 will include a host of measures to expand the capacity of inter-professional primary care teams like Family Health Teams (FHTs), Community Health Centres (CHCs) and Nurse Practitioner led clinics.

4. The Budget will reveal next step in the government’s strategy to shift care to the community.

The Health Accord that Ontario recently signed with the federal government commits an additional $2.3B over 10 years for investments in home care. While this is a drop in the bucket in terms of the overall health spend (around 0.5% boost in overall funding over that period), it is significant for the home and community sector. Just yesterday the government announced that it would be expanding support for caregivers an investing $20 million more per year in respite services. Budget 2017 is expected to provide more clarity on the government’s overall home and community investment strategy. The plan may also reveal details regarding the next step in the government’s plan to recruit and retain Personal Support Workers (PSWs).

5. The Budget may expand access to the Ontario public drug plan.

Ontario Health Minister Hoskins has advocated loudly and consistently for a national pharmacare program, but has done little to date to expand universal access at the provincial level. The Ontario NDP recently announced their plan to introduce a provincial pharmacare program if elected in 2018. This move appears to have caught Hoskins and the Liberal government off guard. While the 2017 budget is not expected to contain a universal pharmacare program to match the NDP pledge, there are rumblings that the government could make targeted investments to expand access in areas like cancer drugs for children. Some sources suggest that the government is also considering further cuts in generic drug pricing to support the listing of new medications of the provincial formulary. There are also rumours that the Budget will pave the way for an expanded role for pharmacists.

Of course, speculation and conjecture abounds prior to any budget. The real picture will become much clearer after 4 p.m. tomorrow when Ontario Finance Minister Charles Sousa formally tables the budget.

OPINION: Missed Opportunities to Encourage National Collaboration in Health Care

By Keltie Gale, Consultant at Santis Health

Despite Canada’s “universal” health care system, the care a patient receives can vary drastically between provinces. In order to achieve the equality of care that Canadians expect and deserve, provincial health systems need greater cooperation and collaboration and the federal government needs to incentivize these behaviours.

One prime opportunity for collaboration and cooperation is laid out in Dr. Danielle Martin’s recent book Better Now, Six Big Ideas To Improve Health Care for All Canadians. Big Idea Number Six speaks to the need to build systems that support the implementation of large-scale change. She points to the need for systems that will allow successful innovations to spread and scale in order to achieve better consistency across individual healthcare systems and between systems.

Acknowledging the challenges of implementation of new ideas, Dr. Martin points to three key success factors: (1) The system responsible for implementation must have the ability to track their implementation and to respond to the data; (2) they need to be bold enough to overcome entrenched interest; and (3) they need healthcare providers who are engaged in the process and who want to participate.

The Canadian Institute for Health Information (CIHI) annual report on wait times, released in March, is an example of the type of collaboration needed. CIHI can effectively collect and report this nationally standardized data because of provisions in the 2004 health accord that committed the provinces to working towards meeting wait times benchmarks for five priority procedures. In this case, CIHI is the mechanism that allows systems to track progress towards this goal.

Beyond these first five procedures, CIHI anticipates that it will have consistent reporting across the country on chemotherapy wait times for breast, colorectal and lung cancer by 2018, and six provinces have already standardized their reporting for wait times for diagnostic imaging. While these advances may seem minor, they represent growing alignment and any movement towards consistency across provinces should be seen as a success. Standardization of definitions, benchmarks and reporting can serve as the base for greater consistency of care.

Despite these modest signs of progress, the federal government has missed two major opportunities to take the bold steps needed to overcome entrenched interests and encourage greater national collaboration.

First, the recent health accord negotiations. When the negotiations among the health ministers broke down in December, the federal government pursued a different strategy. One by one, federal Minister of Health Jane Philpott and her team negotiated bilateral agreements with each province, save Manitoba with whom discussions are continuing as the province holds out for more money in key areas including healthcare in indigenous communities.

By negotiating and signing bilateral agreements with provinces individually, the Federal government missed an opportunity to rally the provinces around a common goal. Funding was directed to home care and mental health but the stipulations for this funding were negotiated province by province. While it is important to invest in these areas, the federal government could have created systems for better coordination and consistency across the country if these commitments had been made by the provinces collectively.

Second, Budget 2017. There is continued funding for CIHI and the Canadian Foundation for Healthcare Improvement along with investment in Health Canada, the Patented Medicine Prices Review Board (PMPRB), and the Canadian Agency for Drugs and Technologies in Health (CADTH). The government re-announced the specific funding agreed upon in the health accord negotiations for home care and mental health. Increased funding was directed to addressing the opioid crisis through the Canadian Drugs and Substances Strategy and its Opioid Action Plan.

While all of these federal initiatives are worthwhile, perhaps the budget is more notable for what is not there. More investments like that for the opioid crisis could have targeted other government health care priorities and helped build the necessary foundations for greater provincial collaboration.

Whether they live in the east or the west and a rural or urban area, Canadians should expect consistency in the care they receive. Agreements on wait times in 2004 were a start but Canada needs new, collective, broad, bold goals for better patient care and needs the provinces working together to achieve these goals. The federal government should have stepped up and used the health accord negotiations and the budget as platforms for working towards the equality we all expect and deserve in our healthcare systems.


Santis Health Expands Ottawa Presence with New Senior Consultant

Ottawa, ON – April 3, 2017 – Santis Health is pleased to announce that it is expanding its national presence, bringing on Peter Cleary as the firm’s point person on the ground in Ottawa.

Santis has a growing roster of clients who are impacted by federal policy or are based out of Ottawa. With Peter’s leadership experience in the federal government and a larger footprint in Ottawa, Santis will be well-positioned to increase our strategic and tactical support to clients in Canada’s capital and across the country.

Peter brings senior experience in policy, issues management and communications for three different governments, most recently serving as Director of Parliamentary Affairs for the Honourable Jane Philpott, Minister of Health in the Government of Canada. Peter was a senior advisor on some of Canada’s highest-profile health issues including the government’s landmark assisted dying legislation and the health accord with provinces and territories. Peter has also worked as a senior political advisor for the Ontario government, including as Issues Manager for the Honourable Deb Matthews, former Minister of Health. With experience working in health departments for two levels of government, Peter has unique insight on policy development and regulatory processes. He is extremely qualified to assist clients to solve complex problems and achieve their public policy goals.

“We are excited to bring Peter on board to strengthen our firm’s capacity to serve clients in Ottawa,” said Patrick Nelson, Principal at Santis Health. “His reputation, insights and direct experience dealing with some of the nation’s most important health files will be a great asset to Santis and clients across Canada.”

Santis is a strategic advisory consultancy dedicated to providing first-class counsel and support for clients exclusively in the health care sector. Our areas of expertise include management and governance consulting, health system planning, public policy analysis and development, and communications and stakeholder engagement for health care organizations undergoing complex changes that depend on effective stakeholder and government relationships. Our Principals have decades of relevant leadership experience inside the health system, including senior roles in the broader public sector, associations, hospitals, Ministers’ and Premiers’ offices and industry.


For more information, contact Gemma Villanueva, Public Affairs Coordinator, Santis Health.
phone: (647) 776-8010

Link to Peter Cleary’s bio on our website: ‎