Pandemic puts health system to the test: Nurses have answers for shortfalls


On Tuesday RNAO released its major report ECCO 3.0 – Enhancing Community Care for Ontario. It provides the path forward through a comprehensive assessment of the current health system and its fractured response to COVID-19. 

Enhancing Community Care for Ontarians (ECCO) 3.0 was first intended as a call, in the context of Ontario’s health-system transformation, to both government and health-system partners to strengthen community care and anchor the health system in primary care to better meet the needs of all residents. Over the period of its development, ECCO 3.0 has become an urgent response to the need for an integrated health system that can effectively serve Ontarians at all times, even when confronted with a deadly pandemic – COVID-19 – that has ravaged the lives of Ontarians and their communities.

Ontario’s health-system transformation, including the launch of Ontario Health and its now existing 24 Ontario Health Teams (OHT), has been put to the test ahead of schedule. Our response to COVID-19 highlights the work needed ahead to make a marked difference for the people of Ontario, through an integrated system of care. Evidence shows that for the first four months of the COVID-19 pandemic, Ontario’s response was focused mainly on the role of hospitals. All other sectors were an afterthought. This reality must change if we are to fully realize the power of OHTs.

As health officials have pointed out, COVID-19 in Ontario is a tale of two pandemics. One is the management of the spread of the disease in the general population, and its containment though physical distancing, self-isolation and hospitalization, when necessary. Public health officials cautiously shared on April 20, 2020, that community spread had peaked and we were heading down the curve. The second tale of COVID-19 in Ontario is the growing spread in congregate settings – all related to vulnerable populations. RNAO has decried on numerous occasions throughout this pandemic the lack of timely public health action in congregate settings overall, and specifically the devastating effect of COVID-19 on residents of long-term care and retirement homes. On March 22, 2020, we called for the protection of residents with universal masking and pre-outbreak testing. Our call was not heeded until April 8, 2020.

As we write this report, 84 per cent of all lives lost to COVID-19 are residents of Ontario’s long-term care facilities. This is a shocking and tragic reality.

RNAO remains gravely concerned about all other vulnerable populations, including persons experiencing homelessness and living in shelters, persons living in supportive housing, persons housed in correctional facilities, and our Indigenous sisters and brothers. Authorities have been slow to protect these communities, extending histories and reconfirming past neglects.

Ontario Health, the province’s lead health agency, states that its singular focus is to “enable the delivery of better quality health care to every Ontarian while offering the best possible experience at every step along your journey.” RNAO shares this lofty goal, and to achieve it, Ontario must recalibrate its heavy focus on hospital care with much-needed and strengthened community care. This is where ECCO 3.0 is a clarion call for urgent change.

ECCO 1.0 was first released in 2012.6 That first version was discussed with then Minister of Health and Long-Term Care Deb Matthews, and was lauded by then Health Critic for the official opposition, Christine Elliott, and supported by the Leader of the Ontario New Democratic Party, Andrea Horwath. Despite initial praise, there was a lack of movement towards our vision, and RNAO issued ECCO 2.0 in 2014 with an updated human resources transition plan. ECCO 1.0 and 2.0 called on both the government and health-system partners to strengthen community care and anchor the health system in primary care as a means to better meet the health needs of all Ontario residents. Eric Hoskins, Minister of Health in 2014, recognized ECCO 2.0 as a key document that influenced his thinking and his delivery of Putting Patients First, his action plan for better health care, released in 2015.

ECCO 3.0 was first conceived in early 2019, when the Ontario government announced plans to reshape the health system. That announcement renewed RNAO’s hope that reform would focus on enhancing community care in the province as a means of providing services and improving health outcomes for everyone. The idea of OHTs, in particular, had many of the elements included in ECCO.

Now, after almost five months of the COVID-19 pandemic, we urge government – more than ever before and in the strongest possible terms – to incorporate the recommendations of ECCO 3.0 as we all engage in a retrospective analysis of the pandemic. This look into our rearview mirror should help address our health-system performance as well as sector-by-sector successes, failures, experiences and outcomes. We’ve lost too many lives to COVID-19. Let’s make sure those lives were not lost for naught. We owe it to them, to their loved ones, and to so many who sacrificed along the way – starting with our health-care workers – to draw from these lessons that will make for a better health-care system. We need to speed up our health-system transformation – in a revised direction – so we can better respond to people’s needs both in normal times and also during emergencies.

In many respects, RNAO’s call on government and stakeholders remains unchanged in this third version of ECCO. If anything, the current emergency context confirms the need for enhanced community care. Our vision of an accessible, equitable, person-centred, integrated and publicly funded health system will only be realized when we have a fully integrated health system anchored in primary care with enhanced community care capacity. This is a reachable goal with the current health-system reform approach based on OHTs.

In ECCO 3.0, we adapt our model to align with the creation of a single health-system administrator (Ontario Health) and multiple integrated care delivery organizations – OHTs.

The report is divided into three sections. The first sets out the context for the ECCO model, including RNAO’s vision for a healthy Ontario, the current state of our health system, drivers for change, including social and environmental determinants, and ongoing health-system reforms. The second section discusses the ECCO model and its alignment with health-system restructuring. The third section sets out RNAO’s recommendations and actions required to realize health-system reform built around enhanced community care.

The report contains nine system change recommendations and four transition recommendations necessary to move from the current state to the transformed health system. You can read them here.