May 5th 2007
Good afternoon everyone. Thank you for your kind welcome. And I want to thank your Chair and President, Eleanor Roppel, and your CEO, Robin Hesler, for inviting me here today.
For more than 70 years, the Ontario Association of Medical Radiation Technologists has been supporting the work of Ontario’s
- Radiographers
- Radiation Therapists
- Nuclear Medicine Technologists and
- Magnetic Resonance Technologists.
All of you – and I understand that’s more than 3,500 Association members -- play a crucial role in the provision of health care across this province, providing essential services in the diagnosis and treatment of Ontario’s citizens.
In his video message to you, Minister Smitherman has emphasized the esteem in which he and the government hold you.
I echo his sentiments, and I’m here today to talk about just how important your role is when it comes to:
- health-system sustainability;
- helping to reduce wait times; and
- the model of inter-professional practice.
I also want to take a few moments to discuss the Ministry’s response to the 2006 Auditor General’s report on Hospitals - Management and Use of Diagnostic Imaging Equipment.
SUSTAINABILITY
We all know there have been significant threats to the sustainability of health care in Ontario – and indeed in other jurisdictions -- for quite some time.
These include, for instance, the increased costs of the kind of technology you work with on a daily basis. They also include the increased costs of information management, drugs and other new treatments. And all these costs are coupled with the demographics of a growing and aging population.
This year Ontario’s budget for health care is $37.9 billion, a 29 per cent – or $8.5 billion – increase from the 2003-04 level of $29.4 billion, in just four short years.
Since that time, October of 2003, the government has been working to establish a health-care system that’s patient focused, results driven, integrated and sustainable.
That’s being achieved through better planning, management and co-ordination.
And it’s being achieved with the continued focus on a vision of Ontario’s health-care system as one that:
- helps people stay healthy;
- delivers good care when they need it; and
- ensures that the health system will be there for the generations of the future.
Of all the changes taking place in the health system, the most significant has been the government’s decision to put much of the operational decision-making in the hands of local control through the introduction of the Local Health Integration Networks (LHINs).
As you know, Ontario’s 14 LHINs officially assumed their statutory role on April the first of this year. And they’ll be responsible for roughly half of the health budget.
One cannot over estimate the importance of this change to the future of both the health-care system and the Ministry of Health and Long-Term Care.
What this means for the Ministry is, that by 2008/09, we’ll be less involved when it comes to the actual delivery of health care, and more involved in establishing overall direction on policy, priorities and investments.
Our focus will be on determining where we’re going with the health system, and on what we need to do today to ensure health care that works for people down the road.
In other words, we’ll be focusing on the over-arching challenges of sustainability, chronic disease management, health human resources, quality of care and patient and health care provider safety issues.
Many of the solutions to the problems of the health system today can only be resolved over the longer term.
As you know, it takes seven to ten years to create new doctors.
It takes five to six years to create new nurses.
And, while it can take twenty years for diabetes or other chronic diseases to develop…we need to intervene now to prevent the onset of disease in the future.
So, let’s look at health-system sustainability as it relates to diagnostic imaging and radiation therapy.
As you know, the ministry strongly supports health-care professionals in working to their full scope of practice. And we recognize that career advancement is a valuable retention strategy in any field.
Consequently, while establishing new and expanded roles to meet human resource demands in the health system, we’re also giving the public a greater choice of health-care professionals qualified to provide much-needed services.
The Clinical Specialist Radiation Therapist for MRT-RTs is a case in point, providing radiation therapists with the additional training they need to provide more specialized care. And that’s an innovative way to meet the growing and changing needs in such high-demand areas as emergency care, surgical services and cancer care.
INTER-PROFESSIONAL PRACTICE
As you know, a year ago, the government launched HealthForceOntario, its health human resources strategy to ensure Ontario has the right supply and mix of health-care professionals.
HealthForceOntario has three principal components.
First is establishing new roles to help address the shortage of health-care professionals in key areas. The four new professional roles include:
- Physician Assistant;
- Nurse Endoscopist;
- Surgical First Assist; as well as the
- Clinical Specialist Radiation Therapist role that I just referred to.
Second is the establishment of a one-stop centre for internationally educated health professionals to obtain the information they need to work in Ontario.
And third is equipping Ontario to compete for health professionals, both from the rest of Canada and from beyond our borders. That involves establishing a marketing and recruitment centre and a comprehensive job portal.
So let’s look at the model of inter-professional practice as it applies to the field of medical radiation technology.
We know that many allied health professions, such as medical radiation technologists are experiencing both current and impending shortages of professionals.
That’s why medical radiation technologists were chosen as one of the six professions eligible for the highly successful Allied Health Professional Development Fund.
The Fund provides a vital and necessary support to allied health professions so they can participate in skill and knowledge-development opportunities.
And of course, with increased knowledge and professional skills, medical radiation technologists can contribute even more to the improved quality of patient care.
Another initiative is the Interprofessional Care Steering Committee which is made up of representatives from the Ministry as well as a range of health-system stakeholders, including regulatory colleges, associations, and educational programs.
This Committee will develop a blueprint for inter-professional care in Ontario. The blueprint will set out the steps that all stakeholders need to take to support, nurture and champion inter-professional care. A draft will be available this summer.
REDUCING WAIT TIMES
Let me turn now to wait times. When it comes to wait times, members of the public – like it or not – use wait times as a measure of the quality of the health care they’re getting.
And why shouldn’t they…after all, the best medical procedure in the world might not be good enough if it’s not delivered in time.
As you know, the government has instituted a plan to improve timely and appropriate access and reduce wait times for five major health services.
Of particular relevance to your field, are MRI/CT scans and procedures.
The other four services being:
- Hip and knee total joint replacements;
- Selected cancer surgery;
- Selected cardiac services and procedures; and
- Cataract surgery.
Since the start of the Wait Time Strategy in 2004, the government has invested for CT scanners and MRI alone more than $176 million, including, in 2005, the addition or replacement of 27 CT machines and 7 MRI machines with new and more-efficient units. This has resulted in more than 950,000 additional MRI and CT exams. And as a result, we have seen wait times drop by 12.5 per cent for MRI and 23.5 per cent for CT scans. That means that the wait time for MRIs has dropped by 15 days; and 19 days for CTs.
This is an important achievement, and one that could not have been accomplished without the diligence and hard work of your members.
In addition, the government appointed a clinical expert panel for MRI/CT whose first report, released in December 2005, established provincial targets for these services along with many other recommendations.
Despite these actions and the significant investments made, we have not seen the same improvements in patient waiting times for CT and MRI as in the other areas funded by the Wait Time Strategy.
An MRI/CT Action Group is currently being formed whose mandate is to implement the recommendations made by the Expert Panel’s second report. And that report, in addition to increases in capacity, suggests a multi-pronged approach aimed at improvements in:
- MRI and CT utilization;
- equipment replacement and siting of new machines; and
- human resource training and development.
I trust that you will watch these developments and where possible, participate with enthusiasm. The goal is better care for our patients.
OTHER ISSUES
AUDITOR GENERAL REPORT: HOSPITALS – MANAGEMENT and USE of DIAGNOSTIC IMAGING EQUIPMENT
Now as to the Auditor General’s report, Hospitals – Management and Use of Diagnostic Imaging Equipment, that highlighted safety and access concerns related to diagnostic radiation.
Last December I spoke to the Standing Committee on Public Accounts following the release of this report. For those of you who have not seen it, I would encourage you to review the report. There are important issues that the Auditor raises that are important for your profession to consider. And while the report deals with MRIs and CTs, the principles can easily be extended to general radiology.
In the presentation to the Standing Committee, I highlighted the multiple entities within the current health care system – each with its own roles and responsibilities under Ontario’s legislation.
This included one of the key issues that the Auditor General’s report reinforced – that it is the responsibility of health care providers to practice within the full scope of their practice.
This is a fundamental expectation of a professional – one that the public demands that all health care providers take seriously.
Among the many issues that the Auditor raised, the one that caught the public’s attention was patient safety. The Auditor criticized radiation dosage levels, particularly those administered to children.
We know that you take your role and responsibilities very seriously and apply the ALARA principle - as low as reasonably possible – to your work.
Determining the most effective radiation exposure levels for individual patients is a clinical decision that rightly belongs in the realm of you and your college.
And while I appreciate that your practice flows from the order of a physician, the performance of procedures falls entirely within your responsibility as independent practitioners. It is a responsibility that I know you take seriously and it is one upon which the public depends.
As a follow up to the Auditor’s report a number of actions have been taken.
.This includes a number of committees that are already in place, including:
- The Ontario Health Technology Advisory Committee
- The Diagnostic Imaging Safety Committee, and
- The MRI and CT Expert Panel.
I want to talk for a minute about the Diagnostic Imaging Safety Committee, which has been developing recommendations for minimizing the impact of radiation exposure for patients and hospital personnel.
And I want to thank your Robin Hesler, for his membership on the committee.
The committee’s work has been progressing well and staff from the Ministry will be contacting your Association shortly to begin work on implementing its recommendations.
Best practice guidelines for children have also been distributed to all hospitals.
As well, we’ve asked hospitals to review their policies and procedures to ensure compliance with recommended manufacturer equipment settings.
We’ve also asked them to review their CT practice to ensure that patient safety isn’t compromised, particularly with respect to radiation levels used for children.
In closing, I want to stress our on-going commitment to working closely with our partners as we seek to improve our health system. That includes health professionals, their colleges and associations, as well as the hospitals and other providers offering medical radiation.
It’s by working together that we can best ensure diagnostic care that’s appropriate and effective for Ontarians.
Thank you for the work that you do every day. You represent an essential part of the care and treatment that is so important for the on-going health of Ontarians. My best wishes for a successful conference.