The Drummond Commission on public service reform released it's long-awaited findings earlier today. In an effort to bring the provincial deficit under control, the report suggests the following:

Here is a summary of the kind of changes we seek: a shift towards health promotion rather than after-the-problem treatment; a system centred on patients rather than hospitals; more attention to chronic care; co-ordination across a broad continuum of care rather than independent silos that allow too many people to fall between the cracks; and new ways of dealing with the small
minority of patients who require intensive care.

Health care is the Ontario government’s single biggest spending program. In 2010–11, the province spent $44.8 billion on health — 40.3 per cent of its total spending on programs. The cost of health care is driven by inflation, population growth, aging, new technology and the increasing use of new procedures. Rising costs have been a subject of intense public attention and discussion for at least two decades. The trajectory of ever-more-costly health care will moderate only modestly if left to operate as it does now.

In 2010–11, operation of hospitals accounted for about 35 per cent of provincial health care spending, and doctors and practitioners, about 27 per cent; almost eight per cent each went to prescription drugs and long-term care, and another six per cent to community care. The remaining 17 per cent financed everything else.

In our Status Quo Scenario, the one that relies heavily on existing drivers to project the overall cost of government programs, Ontario’s health care budget rises to $62.5 billion by 2017–18, for an average annual increase of 4.9 per cent from 2010–11. In our Preferred Scenario, we have set out a much more modest path for health care spending: an increase of 2.5 per cent per year.

Polls reveal large gaps between how we run health care in Canada and what Canadians say they want. Most Canadians, for example, want medicare to cover home care, long-term care, mental health care and drug benefits. Ontarians are wedded to the single, public payer model of health care and will not tolerate any deterioration in access and quality of care. There also seems to be less concern that all services be delivered under public administration, as long as the bill can be paid with an OHIP card. Ontarians want their health care system not only sustained, but also improved.

First Nations Education: On-reserve First Nations education urgently needs improvement. Although this is a federal responsibility, the province is affected because most Aboriginal students are educated in provincially funded schools. Most on-reserve secondary students are educated off-reserve and the underfunding of on-reserve elementary schools often means that students arrive at the secondary level with acute remedial needs.

Federal funding per student falls well short of parity with provincial education spending. The province should put strong pressure on the federal government to adequately fund on-reserve education at least at parity with per-student provincial funding.

Failing an agreement with the federal government, the Commission recommends that the province provide the required funding. Agreements would include the facilitation of forming education entities among participating First Nations with powers similar to provincially funded district school boards, and negotiation of multi-year targets for the proportion of supervisory officers, principals and teachers who will be deemed qualified by the Ontario College of Teachers.

Social programs help the province’s most vulnerable citizens. From 2000 to 2010, social spending grew by an average of 6.0 per cent per year, mainly because of increases in the two main programs of social assistance — Ontario Disability Support Program (ODSP) and Ontario Works (OW). To return the budget to balance by 2017–18, we recommend limiting social programs to growth of 0.5 per cent per year. Bold policy prescriptions, new partnerships and a continuing commitment to transformation will be needed to meet this challenge.

Child Welfare: In this case, as with social assistance, we deferred to the ongoing work of another commission, the Commission to Promote Sustainable Child Welfare, now two years into its three-year mandate. Its reports to date are consistent with our themes, but dealing with our 0.5 per cent growth cap per year will nonetheless be difficult. The government should continue to implement reforms proposed by the Commission to Promote Sustainable Child Welfare.

Ring of Fire: This development of major mineral deposits in northern Ontario offers the prospect of substantial socio-economic opportunities for all northern residents, particularly Aboriginal Peoples. The government should collaborate with Aboriginals, industry and the federal government to maximize these opportunities.

Risks Posed by the Municipal Sector: There are potential risks for the province in the event of default by a municipality. The province should work with municipalities to ensure that commitments are met. Known risks include potential overruns in municipal infrastructure and the Pan Am Games. Although municipalities are responsible for maintaining their infrastructure, there are continual calls on senior governments to finance new projects. What is needed is a comprehensive plan that points the province, municipalities and the federal government in the same direction. This is an opportune time to take stock of the current approach to municipal infrastructure.

Toronto and the Golden Horseshoe region will host the 2015 Pan Am Games. The province is contributing $500 million and is responsible for any spending beyond the approved $1.4 billion budget. As the deficit guarantor, the province must be vigilant in ensuring that the parties involved do not allow any overrun in expenditures.

Children’s Mental Health Services: The legislature’s Select Committee on Mental Health and Addictions has noted that services are delivered across several ministries and offered in many care settings. The government has taken steps to reduce this fragmentation. It should further integrate child and youth mental health services.

We recommend cancellation of the FDK program with appropriate phase-out provisions. If the government decides to continue implementation, it should do two things. First, it should delay full implementation from 2014–15 to 2017–18 and reduce FDK program costs by adopting a more affordable staffing model of one teacher for about 20 students, rather than a teacher and an early childhood educator for 26 students. Second, before confirming full implementation of FDK, it should get assurances from school boards, teacher federations and support staff unions that negotiated annual wage increases by 2017–18 will be no higher than current trends in the broader public sector (BPS), and that class-size increases and reductions in non-teaching staff contemplated by the Commission by 2017–18 will be achieved.

Class Sizes: One of Ontario’s fundamental strategies to improve student achievement has been to reduce class sizes in primary schools (junior kindergarten to Grade 3). Some 90 per cent of classes now have 20 students or fewer, and none has more than 23. The government has committed significant resources to class-size reductions at the primary and other levels. While the
government has emphasized that smaller classes promote better education outcomes, empirical evidence presents a more complicated picture. Ontario’s recent improvements on provincial assessments and quality indicators have coincided with reduced class sizes, but there is no evidence of causality.

 Even if smaller classes had some impact on outcomes, the evidence suggests that investments in smaller classes do not offer the most efficient means for improving results. Given this lack of convincing empirical support, the Commission believes that scarce resources should not be applied to reducing class sizes. We recommend increasing the class-size cap for primary schools from 20 to 23, and increasing the class-size averages in junior/intermediate schools from 24.5 to 26 and in secondary schools from 22 to 24. The Commission supports continued emphasis on programs that have proven critical to increasing
graduation rates. Class sizes should be increased in a manner that does not jeopardize programs that have helped increase graduation rates and benefited Ontario students.

To view the report:
Drummond Report Ontario