Rapid Recap: Ontario Budget 2024

 

Tuesday, March 26, 2024 – Ontario Minister of Finance Peter Bethlenfalvy released the Ontario 2024 Budget “Building a Better Ontario” this afternoon. The budget includes overall spending of $214.5 billion, including $85 billion in health spending, a modest increase from $84.5 billion in 2023-24. The deficit continues to grow to $9.8 billion this year, with Ontario projecting a balanced budget just in time for the next general election in 2026.

Minister Bethlenfalvy committed to “staying the course” with this budget, focusing on many of the same health sector issues as the 2023 Budget including health human resources (HHR), home and community care, and capital investments for both hospitals and long-term care. The 2024 fiscal blueprint lays out how the PC government will “rebuild Ontario’s economy without raising taxes and fees or putting more burden on businesses and municipalities.

The budget also includes $1 billion for the Municipal Housing Infrastructure Program to support core infrastructure projects that help enable housing for growing and developing communities, for costs such as roads and water infrastructure. The Ontario government will also introduce proposed legislation through its spring 2024 Budget Bill that would, if passed, extend the existing gasoline and fuel tax rate cuts until December 31, 2024. The budget has allocated an initial $3 billion for the Building Ontario Fund, previously called the Infrastructure Bank, that will support large-scale infrastructure projects across the province, including for hospitals and long-term care capital builds. The budget is going to expand the Ontario Guaranteed Annual Income System (GAINS) program and index the GAINS benefit to inflation.

See the end of this memo for the full list of health care commitments.

Santis Insights

For weeks, Minister Bethlenfavly has signaled that the budget would demonstrate the government’s commitment to continue on the same trajectory. True to his word, this budget maintains the momentum of the 2023 Budget, staying consistent with its themes, but with more restrained spending than in previous budgets due to ongoing economic uncertainty. Despite the increases in health spending, the government is likely to be criticized for not investing even more and for largely focusing its spending on wage increases necessitated by Bill 124. Opposition parties will likely call for additional spending to prioritize public health care, reducing the use of private staffing agencies, and creating a fully-funded, multi-year staffing plan for all health care professionals.

Notably, the budget includes an additional $2 billion over three years to stabilize the home and community care workforce and to support the expansion of home care services. This investment will help improve compensation for health professionals working in home and community care and narrow the compensation gap between these individuals and those working in other areas of our health care system. Many in the latter group have received retroactive wage increases due to the repeal of Bill 124.

The government is also doubling down on its strategy to expand interprofessional primary care teams. The investment announced in last year’s budget was substantially increased during the 2023-24 fiscal year, and this new budget goes even further in aiming to grow non-physician primary care.

Given the size of these new investments (as well as recent announcements related to physician negotiations) and the relatively modest growth in the Ministry of Health’s overall budget, there is the possibility that this new budget spending could be offset by reductions elsewhere. At minimum, there will likely be pressure on lower priority budget items to slow their growth in the coming years and make room for these investments.

There was no mention of the new Community Surgical and Diagnostic Centres in today’s budget which is notable considering we are anticipating a first call for the new independent health facility applications later this year.

The Financial Accountability Office of Ontario has said pay increases to compensate public sector workers for Bill 124 could end up costing the government more than $13 billion. The province has used the contingency fund to offset some of the increased compensation costs, with $3.3 billion left in the fund at the time of the third-quarter finances report. The Ontario government repealed Bill 124 after the Court of Appeal for Ontario ruled the legislation as unconstitutional and, to date, has agreed to compensate broader public sector workers more than $6 billion in retroactive pay, with many organizations still in arbitration.

Health Funding Announcements

Health Human Resources

• Adding an additional 700 education seats for Medical Radiation and Imaging Technologists, Medical Laboratory Technologists, Medical Lab Technicians and Medical Radiation Extenders. Investing over $485 million to support HHR initiatives, including the ongoing expansion of nursing and medical school seats and the Ontario Learn and Stay Grant where students in targeted nursing, paramedic and medical laboratory technologist programs study and work in underserved communities.
• Working with colleges to explore and pilot compressed programs for pharmacy technicians and medical radiation technologists so more qualified professionals can enter the workforce sooner.
• Supporting the development of a new medical school at York University with a $9 million investment. The school will be located at the Cortellucci Vaughan Hospital site near Major Mackenzie Drive and Highway 400.
• Investing an additional $100 million for the Skills Development Fund Training Stream to address challenges in hiring, training and retaining workers.
• Investing $743 million over three years to address imminent HHR needs:
  • $128 million over the next three years to support enrollment increases of 2,000 registered nurses and 1,000 registered practical nurses at publicly assisted colleges and universities.
  • Making the Extern Program permanent. This program will offer up to 5,590 health care students training opportunities to work in hospitals
  • Making the Supervised Practice Experience Partnership Program permanent. This program will support up to 1,500 internationally educated nurses annually to become accredited nurses in Ontario.
  • Merging the Clinical Scholar Program. This program amalgamates the Late Career Nurse Initiative and the Clinical Preceptor Program that support experienced nurses to mentor and coach new graduates and internationally educated nurses, as well as nurses seeking to upskill.
  • Upskilling of nursing students to be able to work in priority areas within a hospital, such as critical care
  • A Stabilizing Emergency Department Staffing strategy to provide critical investments to bolster and stabilize the emergency department nursing workforce.

Health Infrastructure

• Providing an additional $965 million, including a 4% increase in total base hospital operations, to ensure hospitals can meet patients’ needs and to increase access to high-quality care.
• Re-announcing the nearly $50 billion over ten years in health infrastructure, including close to $36 billion in capital grants, for more than 50 previously announced hospital projects that would add about 3,000 new beds.
• Spending on hospital infrastructure in the 2024-2025 year went up slightly from $3.34 billion last year to $3.58 billion in 2024.
• Expanding palliative care services in local communities by adding up to 84 new adult beds and 12 pediatric beds, bringing the total to over 750.

Home and Community Care and Seniors Care

• Supporting the home and community care workforce with additional $2 billion over three years to accelerate the expansion of home care services.
• Investing in transforming the home care system, including new models of care and modernizing the Client Health and Related Information System (CHRIS), the digital infrastructure system supporting home care.
• Providing support for the community care workforce to strengthen adult day programs, meal services, transportation and assisted living services.

Long-Term Care

• Investing $155 million in 2024–25 to increase the construction funding subsidy, to support the cost of developing or redeveloping a long‐term care home in order to manage the increasing construction costs on many capital projects.
  • Eligible projects will receive an additional construction funding subsidy of up to $35 per bed, per day, for 25 years.
  • In addition, eligible not‐for‐profit applicants will be able to convert up to $15 per bed, per day, of the supplemental funding into a construction grant payable at the start of construction.

Mental Health and Addictions

• Investing an additional $396 million over three years for mental health and addictions. This includes:
  • $124 million in additional funding for the addictions recovery fund will create 383 new beds.
  • The development of three mobile mental health hubs.
  • The development of three police-partnered mobile crisis response teams.
• Investing $152 million over the next three years for supportive housing. This will support individuals facing unstable housing conditions and dealing with mental health and addictions challenges.
• Investing $9 million over three years for Stonehenge Therapeutic Community and Guelph Community Health Centre to support individuals with complex, high acuity mental health and substance use issues
• Investing $46 million over three years, starting in 2024–25, to support the continued operation of the 59 Behavioural Specialized Unit (BSU) beds added in 2023–24, and to add more than 200 net new BSU beds to expand care for individuals with complex needs. (*This investment also can also be attributed to the Long-Term Care sector.)

Autism

• Investing an additional $120 million in the Ontario Autism Program for 2024–25. This increased funding will support the government’s commitment to enroll 20,000 children and youth in core clinical services.

Life Sciences

• Establishing a Health Technology Accelerator Fund with the investment of $12 million to help health care service providers buy and use promising new technologies to improve patient care. This project is in collaboration with Supply Ontario to accelerate the review and adoption of promising new health innovations and bring them into the system faster for patients to benefit.

Primary Care

• Investing a further $546 million in primary health care over three years to connect 600,000 more people to team-based primary care, in addition to the $110 million invested in February.
• Investing $13.5 million in funding for new and expanded interprofessional primary care teams in the following communities:
  • Peterborough;
  • Kingston;
  • North Dumfrie;
  • Simcoe Muskoka, Barrie and Orillia;
  • Niagara Region; and
  • Sault Ste. Marie and Region.

Emergency Preparedness

• Investing $5 million to ensure communities across the province have the resources and equipment they need to prepare for natural disasters and emergencies.

Indigenous and Northern Communities

• Investing an additional $45 million to the Northern Health Travel Grant Program over three years. This investment will help foster more equitable access to specialized care and diagnostic services for the residents of Northern Ontario.
• Investing $94 million over three years to support projects that enhance the health and well-being of Indigenous and Northern communities:
  • $60 million over three years to maintain mental health and addictions services, including clinical supports, community mental health and well‐being initiatives, and opioid programming.
  • $15 million over three years to support the ongoing delivery of Indigenous public health programs, including vaccination initiatives to improve health outcomes.
  • $11 million over three years to enhance early detection and management of foot complications arising from diabetes for Indigenous communities. Through prevention and earlier detection, this program aims to improve health outcomes for those living with diabetes and cardiovascular disease.
  • $8 million over three years to strengthen prevention initiatives in Indigenous communities, targeting diabetes, smoking and chronic diseases.
• Supporting the implementation of culturally responsive and safe care for women and children with an investment of $50 million over three years for three specific projects:
  • $24 million Indigenous Healthy Babies Healthy Children Program;
  • $15 million for Mobile Maternal Care; and
  • $11 million for safer births in Northern Ontario.

Further Reading

• Read the Ontario 2024 Budget here.
• Read the press release here.
• Read Santis’ Rapid Recap on Ontario’s health care agreement with the federal government here.