Commission on the Reform of Ontario's Public Services

Recommendation 5-15: The Local Health Integration Networks must integrate care across
the system by sharing information on patients among health care providers, co-ordinating
decisions and allocating funds to best reflect regional needs.
Recommendation 5-16: Use data and information sharing to better understand and address
the fiscal impacts of chronic and complex conditions and at-risk patients with mental health
and addiction issues (see Recommendations 5-37 to 5-41 for more on managing their care).
Recommendation 5-17: Use information from funding models such as the Health-Based
Allocation Model (HBAM) to examine where services may not be provided equally across
health regions and conduct ongoing evaluations of each Local Health Integration Network’s
progress in managing high-use populations. (See Recommendations 5-50 and 5-73 for
more details on HBAM.)
Recommendation 5-18: Where feasible, services should be shifted to lower-cost caregivers.
Across the spectrum of caregivers, full scope of practice needs to be exercised.
Recommendation 5-19: A broader perspective should be applied to decisions that are made
on the scope of practice of health professionals. Government should play a more active role in
working with the professional colleges to apply a system-wide approach rather than dealing
with individual professions in isolation.
Recommendation 5-20: Maximize opportunities to use nurse practitioners with the aim of
efficiency, while maintaining excellent care.
Recommendation 5-21: Recognize the increased demand for nurses in the capacity of
nursing programs at colleges and universities and their ability to train more nurses.
Recommendation 5-22: Increase the use of personal support workers and integrate them into
teams with nurse practitioners, registered nurses and other staff members where appropriate
to optimize patient care.
Recommendation 5-23: Local Health Integration Networks need to use funding as a lever
to encourage hospitals and other health care providers to use the full scope of practice of
their staff.
Recommendation 5-24: Make changes to the Pharmacy Act to enable an expanded scope
of pharmacy practice. This would involve developing supporting regulations to permit
pharmacists to administer routine injections and inhalations, including immunization.
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