Commission on the Reform of Ontario's Public Services

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Chapter 4: Making Transformation Work: Process and Structures Budget Planning...................................................................................................................................................... 136 Chapter 5: Health Background............................................................................................................................................................. 145 The Cost: Now and Ahead ...................................................................................................................................... 147 Is the Health Care System Sustainable? ................................................................................................................ 149 Hard Truths, Measures and Comparisons .............................................................................................................. 152 What Is the Opportunity? ........................................................................................................................................ 167 Recommendations to Turn Problems into Realized Opportunities.......................................................................... 174 Fiscal Issues ........................................................................................................................................................... 176 Integrating the Silos into a Health Care System...................................................................................................... 176 LHINs 2.0 ................................................................................................................................................................ 178 Governance and Structures .................................................................................................................................... 184 Evidence-based Policy............................................................................................................................................ 185 Hospitals ................................................................................................................................................................. 187 Physicians............................................................................................................................................................... 188 Community Care, Home Care and Long-Term Care............................................................................................... 192 Health Promotion and Prevention ........................................................................................................................... 193 Medical Schools/Training ........................................................................................................................................ 195 Pharmaceuticals ..................................................................................................................................................... 195 Cost Efficiencies ..................................................................................................................................................... 199 Scope of Public Sector............................................................................................................................................ 200 Reform Process ...................................................................................................................................................... 200 Conclusion .............................................................................................................................................................. 202 Chapter 6: Elementary and Secondary Education Historical Context and Recent Trends .................................................................................................................... 203 The Current Challenge............................................................................................................................................ 205 <strong>Commission</strong>’s Principles and Goals........................................................................................................................ 207 Investments for the Future in First Nations Education ............................................................................................ 209 Affordability of the Full-Day Kindergarten Program................................................................................................. 213 ii
Table of Contents Class Sizes .............................................................................................................................................................215 Non-Teaching Staff .................................................................................................................................................218 Limits to Funded Secondary School Credits ...........................................................................................................219 Encouraging Efficient Student Transportation.........................................................................................................220 A Comprehensive Resource Plan to Live Within One Per Cent Per Year in Education ..........................................222 Promoting Evidence-Based Solutions in Special Education....................................................................................225 Reform of Provincial Schools ..................................................................................................................................227 Appropriate Incentives for Teachers .......................................................................................................................228 Delivering Services More Efficiently ........................................................................................................................230 Containing Costs of Retirement Benefits ................................................................................................................234 Promoting an Efficient Labour Market for Teachers................................................................................................236 Chapter 7: Post-Secondary Education Challenges Ahead...................................................................................................................................................240 Need for Clear Objectives .......................................................................................................................................241 Status Quo Is Unsustainable...................................................................................................................................242 Thrust of Our Recommendations ............................................................................................................................244 Conclusion ..............................................................................................................................................................258 Chapter 8: Social Programs The Challenge.........................................................................................................................................................261 Transforming Ontario’s Benefit Programs ...............................................................................................................261 Child Welfare...........................................................................................................................................................270 Ontario Child Benefit ...............................................................................................................................................270 Other Social Programs............................................................................................................................................271 Contributions of the Non-Profit Sector.....................................................................................................................273 Social Impact Bonds ...............................................................................................................................................274 iii
Page 1: 2012 COMMISSION O N T H E REFORM O
Page 4 and 5: For electronic copies of this docum
Page 8 and 9: Chapter 9: Employment and Training
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Page 12 and 13: This context lifts the task ahead w
Page 14 and 15: Action must begin very soon. The de
Page 16 and 17: xii Dominic Giroux, Commiss
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Page 20 and 21: First, we assessed the 2011 Budget
Page 22 and 23: How did we get to this point? For m
Page 24 and 25: 6 TABLE 1. Three Views of the Outlo
Page 26 and 27: This permits post-secondary educati
Page 28 and 29: How does our scenario for the perio
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Benefit programs are delivered thro
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Child Welfare: In this case, as wit
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With so many services provided by s
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Over the past decade, the Ontario g
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Urban transportation is a particula
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Environment and Natural Resources R
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� Aging infrastructure is deterio
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Labour Relations and Compensation T
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Leaders in the OPS and BPS should b
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In a number of areas, efficiencies
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Revenue Integrity Across a range of
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Contraband tobacco is another issue
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Risks Posed by the Federal Governme
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� Long-term health costs outstrip
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Immigration settlement and integrat
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Chapter 1: The Need for Strong Fisc
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The Budget Scenario Chapter 1: The
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80 60 40 20 0 Rest of Canada Ontari
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Revenue Implications Chapter 1: The
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TABLE 1.1 Three Views of the Outloo
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Conclusion Chapter 1: The Need for
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Chapter 2: The Fiscal Challenge in
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The Challenge Chapter 2: The Fiscal
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Chapter 3: Our Mandate and Approach
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Chapter 4: Making Transformation Wo
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Chapter 5: Health Chapter 5: Health
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Chapter 5: Health Indeed, quality a
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The Cost: Now and Ahead Chapter 5:
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Is the Health Care System Sustainab
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Chapter 5: Health In Ontario, a few
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Chapter 5: Health Case Study #1: A
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Chapter 5: Health Canada’s health
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Canada falls short on many measures
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There are inefficiencies in the hea
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Chapter 5: Health A broader perspec
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Chapter 5: Health However, this is
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Mental health and addiction issues
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Chapter 5: Health Today, however, t
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Service Delivery Chapter 5: Health
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Chapter 5: Health Medical schools p
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Chapter 5: Health There is much to
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Recommendation 5-2: Evaluate all pr
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Chapter 5: Health Several key princ
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Chapter 5: Health There are more th
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Optimize Human Resources Capacity C
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Chapter 5: Health The LHINs should
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Chapter 5: Health Recommendation 5-
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Chapter 5: Health Despite variation
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Chapter 5: Health The ministry shou
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Chapter 5: Health � An “assess
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Chapter 5: Health The Commi
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Cost Efficiencies Chapter 5: Health
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Chapter 5: Health The stakeholders
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Chapter 6: Elementary and Secondary
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Affordability of the Full-Day Kinde
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Class Sizes Chapter 6: Elementary a
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Reform of Provincial Schools Chapte
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Chapter 7: Post-Secondary Education
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Need for Clear Objectives Chapter 7
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Chapter 8: Social Programs Chapter
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The Challenge Chapter 8: Social Pro
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Chapter 8: Social Programs Recommen
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Chapter 8: Social Programs In the a
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Initial Assessment Chapter 8: Socia
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Chapter 8: Social Programs To quali
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Chapter 8: Social Programs While th
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Youth Justice Chapter 8: Social Pro
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General Approach � Transaction fo
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Chapter 9: Employment and Training
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Employment and Training Services Pr
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Chapter 10: Immigration The Economi
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TABLE 10.1 Permanent Residents Admi
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Chapter 10: Immigration Recommendat
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Other Integration Issues Chapter 10
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TABLE 10.4 Integration Program Fund
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Chapter 10: Immigration A new COIA
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Chapter 11: Business Support Chapte
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� Investment in post-secondary ed
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TABLE 11.1 Total Business Tax Relie
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Types of Business Support Chapter 1
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Chapter 11: Business Support The pr
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Chapter 11: Business Support An Ill
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Chapter 11: Business Support The pr
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Chapter 11: Business Support To fun
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Chapter 11: Business Support Tax ex
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Chapter 11: Business Support For ex
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Appendix 11.1 List of Business Supp
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Chapter 12: Infrastructure, Real Es
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Transportation Chapter 12: Infrastr
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Chapter 13: Environment and Natural
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Reform the approvals process Chapte
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Ring of Fire Chapter 13: Environmen
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Chapter 14: Justice Sector 2010-11
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Recent Expenditures Chapter 14: Jus
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Chapter 14: Justice Sector Public E
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Chapter 14: Justice Sector Continuo
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Chapter 14: Justice Sector Building
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Efficiencies Clustering OPS Adjudic
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Chapter 14: Justice Sector Analysis
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Chapter 14: Justice Sector Recommen
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Chapter 15: Labour Relations and Co
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A Balanced, Effective and Transpare
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Chapter 16: Operating and Back-Offi
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ServiceOntario Transformation Chapt
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I&IT Transformation Chapter 16: Ope
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Back-Office Consolidation Chapter 1
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Chapter 17: Government Business Ent
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Chapter 18: Revenue Integrity Chapt
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Chapter 18: Revenue Integrity Stati
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Uncollected Fines Chapter 18: Reven
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Chapter 18: Revenue Integrity The M
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Tax Revenue Chapter 18: Revenue Int
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CHART 18.2 Assessment and Tax Growt
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Chapter 18: Revenue Integrity The c
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Chapter 18: Revenue Integrity The t
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Chapter 18: Revenue Integrity Appen
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Chapter 19: Liability Management In
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Chapter 19: Liability Management To
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Chapter 19: Liability Management Th
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Chapter 19: Liability Management Bo
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TABLE 19.2 Historical and Projected
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Chapter 19: Liability Management Re
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Chapter 19: Liability Management Re
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Social Housing Chapter 19: Liabilit
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Chapter 19: Liability Management Fo
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Chapter 20: Intergovernmental Relat
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CHART 20.1 Ontario’s Share of Fed
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CHART 20.3 Ontario’s Fiscal Gap 1
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Potential Federal Impacts on Ontari
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Long-Term Health Costs Likely Outpa
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TABLE 20.2 Selected Examples of Tra
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CHART 20.7 2011-12 Equalization Ent
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Canada Social Transfer Chapter 20:
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Chart 20.10 Employment Outcomes for
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Green Energy Chapter 20: Intergover
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Environmental Protection and Regula
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CHART 20.11 2009 Municipal Revenues
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Infrastructure, Real Estate and Ele
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Appendix 1: Commission</str
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Appendix: Commission</stron
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Recommendation 8-9: Advocate for fe
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Chapter 11: Business Support Append
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Chapter 18: Revenue Integrity Appen
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Appendix 2: List of Acronyms ABCs a
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FIT feed-in tariff FSCO Financial S
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MTCU Ministry of Training, Colleges
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REA Renewable Energy Approval RFP r
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Commission on the Reform of Ontario's Public Services

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