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Auditor General's report on Community Health Centres
On December 6, 2017, the Auditor General released her audit of Community Health Centres (CHCs) in Ontario. The report also contains several mentions of other models of team-based primary health care including Nurse Practitioner-Led Clinics (NPLCs), Family Health Teams (FHTs) and Aboriginal Health Access Centres (AHACs).
There is much to support in this report, and there are also areas for improvement. The Auditor General demonstrates a thorough understanding of our Model of Health and Wellbeing (p. 184) and states that:
- "CHCs stand out from other models of primary care...because they deliver medical services under the same roof as health promotion and community programs" (p. 180).
- "By serving vulnerable people, CHCs can contribute to reducing the strain on the health care system and other provincial government programs" (p. 185).
- "The goal of CHCs is to keep people in the communities where they live in good health" (p. 184).
The report acknowledges AOHC members’ leadership in serving medically and socially complex clients, identifies our role in reducing social isolation, meeting the needs of refugees and uninsured populations, and describes us appropriately vis-a-vis other primary care models (p. 220).
In her press conference, Auditor General Bonnie Lysyk was asked what stood out to her from her review of five different health care sectors. She responded that it was the CHCs and the comprehensive services they provide under one roof: "They are pretty neat. It was most surprising to understand that type of operation exists in Ontario."
This response is also reflected in the client experiences profiled on p. 218, such as the client who had been without primary health care for over 20 years before accessing the health and social services at a CHC: "Kevin could not have imagined success without his perseverance and that of the staff at the Centre. He described that he had never come across such an organization that work so hard on behalf of its clients and really goes above and beyond the call of duty."
Key findings include:
- The Ministry of Health and Long-Term Care (MOHLTC) and Local Health Integration Networks (LHINs) do not sufficiently mandate, track or use CHC data. As a result, the Ministry and the LHINs do not have sufficient information to know whether CHCs are cost-effectively serving their intended populations.
- Without a core basket of services or defined staffing model, there is inequity in our sector regarding what people can access within each CHC.
- About half of CHCs are serving less than 80% of their patient capacity, while 16% are seeing or exceeding their patient capacity. Annual base funding is not tied to the number of clients served, and LHINs are not adjusting base funding for CHCs who exceed or serve less than their targeted number of clients.
- The Ministry and LHINs are not adequately planning for the growth in populations that CHCs are currently mandated to serve.
Key recommendations include:
- An analysis of whether CHCs are meeting the needs of communities "would inform how many CHCs should be funded and where they should be located across Ontario to best meet the needs of Ontarians" (p. 191-192).
- CHCs need a plan. Patients First does "not specify how CHCs fit strategically within the primary care system, in order to help the Ministry and the LHINs determine whether CHCs are developing along the right path according to plan and population needs. The plan also lacks performance metrics to measure achievement of and progress toward the stated goals of the plan" (p. 194).
- CHCs should collect and review wait-list information and ensure 24/7 on-call services (p. 200)
The report also includes responses from the Ministry of Health and Long-Term Care, the LHINs, and Health Quality Ontario. In a press release, Minister of Health and Long-Term Care Eric Hoskins said, "Our government agrees with the Auditor General that Community Health Centres across Ontario provide important health care access to over half a million Ontarians, many of whom are vulnerable populations including new Canadians, homeless populations and seniors."
There's still a lot of work to be done to improve quality, and to grow and more widely demonstrate our impacts for the people and communities facing barriers to good health in Ontario. We look forward to working with CHC leaders and our government and community partners in advancing health equity through comprehensive primary health care.
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