Doug Ford told ministers to significantly reform health and education in 2018 mandate letters

After a sweeping and emphatic victory in the 2018 provincial election, effectively wiping the Ontario Liberals off the political map, Premier Doug Ford had a clear message for his ministers of health and education: it was time for dramatic change.

The ministers of the province’s largest ministries were both given sweeping mandates to roll out significant — and potentially controversial — changes.

The tasks and reforms handed to Christine Elliott in health and Lisa Thompson in education were contained within the mandate letters Ford wrote in 2018. The letters, which were closely guarded secret by the government for years, can now be exclusively revealed by Global News in an ongoing series, ‘Mandated.’

In the Progressive Conservative party’s 2018 election platform, A Plan for the People, Ford took aim at Ontario’s education system, campaigning along on the idea of a woke, culture war.

“More and more of our schools have been turned into social laboratories and our kids into test subjects,” the platform read.

Ford pledged to get “back to basics” by changing the math curriculum, fixing testing scores and coming up with a new sex education plan. Those promises were among the dramatic changes included in the mandate letter sent to Ford’s first education minister.

“Repeal discovery math and work with education experts to replace this failed ideological experiment with a math curriculum that teaches the building blocks needed for a successful future,” Ford told his new education minister.

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Instead, the minister was directed to concentrate on a key metric — standardized math test scores — and to reverse the decline.

“Ensure mathematics is a focus throughout the education system,” the education minister was told. “Ultimately, your goal should be to dramatically improve Ontario’s math scores.”

Five years later, test scores under the Progressive Conservatives continue to falter.

In October 2022, the latest data showed that after more than a term in government, the majority of of Grade 6 students were failing their standardized math test, which the Ford government blamed on pandemic-related learning loss.

Ford, in 2018, also ordered his education minister to repeal the “current inappropriate sex education curriculum” and replace it with a new “age appropriate” version after consultation.

The overhaul outlined in the mandate letter was a nod to the social conservative wing of the Ontario PC party, which helped propel Doug Ford into the leadership in March 2018.

Ultimately, when the new sex education system was announced, experts widely said it was the same as the version introduced by the former Liberal government.

While the mandate letter also instructed the education minister to “increase supports for students in the classroom,” the document doesn’t offer specific instruction on what types of supports the ministry was intended to invest in. It just mentioned a larger $3.8 billion mental health services budget.

Between 2018 and 2022, the overall education budget increased by 8.7 per cent from $29.8 billion to $32.4 billion, leading to criticisms that the Ford government has been underfunding the province’s school system because the increases have not kept up with the pace of inflation.

Missing from the mandate letter are any bargaining objectives with Ontario’s various education unions, although all ministers were told to “adhere to the program-spending guidelines” established by the treasury board and to expect a “disruptive” response as a result.

Before the Ford government decided to split up the responsibility for Health and Long-Term Care into two separate portfolios, the combined ministry was given the task of creating an “efficient” and “cutting edge” health-care system that still put patients at the centre of the decision making.

In July 2018, Premier Doug Ford’s instructions to his then-Minister of Health, Christine Elliott, were clear: reform and restructure the system to keep in line with spending restraints.

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“The administration of health in Ontario has undergone several large changes in recent years … report back with additional reforms to help invest precious health-care dollars in front line care instead of back room administration,” the mandate latter read.

“Review the structure of health-care oversight from the Ministry of Health and Long-Term Care and its agencies to create a health-care system that is patient and family centred,” read another bullet point from the minister’s mandate letter.

The result was a sweeping consolidation of the health-care system with the creation of Ontario Health in 2019, and the dissolution of five health agencies including Cancer Care Ontario, Health Quality Ontario and eHealth.

The government also announced the clustering of local health integration networks and attempted to downsize the number of public health units. The government’s plans, however, were disrupted by the COVID-19 global pandemic, shortly after the creation of Ontario Health.

Weaved throughout the mandate letter to the health minister is a repeated theme of finding savings and efficiencies, where possible, and reinvesting the money into the front lines.

OHIP+, a late-stage policy by the former Liberal government that made prescription medication free for anyone 25 and under, became an early target for the Ford government.

“Repurpose OHIP+ into a government as second payer system,” the mandate letter stated. “Consider how the structure of the province’s various prescription drug programs could be enhanced to save precious healthcare dollars, reduce red tape, and enhance patient experiences.”

When it came to negotiations with Ontario doctors, the minister was directed to resolve the labour dispute with the Ontario Medical Association while also looking for savings.

“Ensure the province is getting adequate value-for-money while also treating doctors with respect, such as on conscience rights issues,” the mandate stated without elaborating on which issues the minister was to focus on.

Even the instructions on ending hallway medicine, a significant problem plaguing Ontario’s hospitals and one Ford promised to fix, focused on delivering a health-care system that is “efficient, patient focused, cutting edge, and world class.”

Despite the focus on savings and efficiencies, pandemic-related spending forced the government to dramatically scale up spending on Ontario’s health-care system between 2019 and 2022. The health-care budget was increased from $63.5 billion to $75.2 billion, an increase of 18 per cent over the course of the government’s first mandate.

Shortly after 2022 re-election, however, the Ford government announced the introduction of more private, for-profit healthcare facilities in the province’s OHIP-funded system, after the government claimed the “status quo” could not continue.

The government faced accusations that the PC party deliberately underfunded health care to create the context for the publicly funded, private delivery model.

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Here is the mandate letter given to the Minister of Education in 2018:

•       Renew math education in Ontario. Repeal discovery math and work with education experts to replace this failed ideological experiment with a math curriculum that teaches the building blocks needed for a successful future. Ensure mathematics is a focus throughout the education system, including financial literacy in secondary schools. Ultimately, your goal should be to dramatically improve Ontario’s math scores.
•       As part of this revamp of the math curriculum, fix the standardized testing system administered by the Education Quality Assessment Office. Evaluate new ways to use the data collected, how to locally target math resources, and discover which teaching methods work best by consulting with teachers and students based on the results of this testing.
•       Repeal Ontario’s current inappropriate sex education curriculum and replace it with the previous curriculum until you properly consult with parents and families across the province about a new age appropriate curriculum.
•       Work with the Minister of Training, Colleges and Universities to ensure a seamless transition from secondary school to post-secondary life, including a renewed emphasis on the skilled trades. Ensure that secondary students are well informed of all post-secondary options, including the skilled trades, while ensuring more opportunities for students to be introduced to the skilled trades before graduation.
•       Increase supports for students in the classroom, specifically by working with the Minister of Health and Long-Term Care to implement our promise of investing $3.8 billion into mental health services.
•       Fix the Pupil Accommodation Review Guideline so that any school slated for closure must be reviewed with a consideration of economic impact to the local municipality. Impose a moratorium on school closures until this is finished.
•       Work with the Minister of Finance to repurpose the Child Care Expense Deduction and implement our refundable child care tax credit proposal. As part of a new approach to child care, re-evaluate the changes by the previous government through Bill 10 that limited the role of independent child care facilities, and pursue reforms that enhance parental choice while promoting high standards of care.
• Continue to increase access to child care spaces, including building new child care spaces where needed and ensuring every new school that is built has child care spaces in it from the beginning. Consult closely with the Minister of Children, Community and Social Services when evaluating future reforms to child care in Ontario.

Here is the mandate letter given to the Minister of Health and Long-Term care in 2018:

•       Fulfill our promises to build 15,000 long-term care beds in five years and 30,000 long-term care beds in 10 years. Ensure that our long-term care sector has a proper path forward to handle the growing elderly population and reduce wait lists across the province. Look at innovative ways to expand access to long-term care, including these new builds.
•       Fulfill our promise to invest $3.8 billion in mental health, addictions and supportive housing. Work with your fellow Cabinet colleagues to properly invest the money in initiatives such as supports for students, investments in post-secondary institutions, proper housing for those with mental health issues, and resources for our police and frontline emergency workers.
•       Implement our promise for free dental services for seniors with lower-incomes. Consider the interaction between this program and existing dental assistance programs for low-income Ontarians when implementing.
•       Ensure continued investment and establish a system for proper long-term capacity planning in Ontario’s health care system. Specifically, focus on dealing with capacity issues and end hallway medicine in our hospitals.
•       Work with the Premier’s Council on Improving Health Care and Ending Hallway Medicine and its chair, Dr. Rueben Devlin, to deliver a health-care system that is efficient, patient focused, cutting edge, and world class.
•       Review the scope of practice throughout the health-care system to ensure that our healthcare professionals are being used to the best of their abilities. This should not just include reviewing regulatory restrictions on the levels of care each type of healthcare professional can provide, but what type of setting or institution this care should be provided in.  Include proper consultation with doctors as part of this work.
•       Work with the Ontario Medical Association to resolve their ongoing labour dispute. Ensure the province is getting adequate value-for-money while also treating doctors with respect, such as on conscience rights issues.
•  The administration of health in Ontario has undergone several large changes in recent years, including the consolidation of the Community Care Access Centres into the Local Health Integration Networks and the introduction of health data management systems including e-health. Review both fundamental changes to Ontario’s health care system to ensure the original purpose and intent of these changes has been fulfilled. Report back with additional reforms to help invest precious healthcare dollars in front line care instead of back room administration.
•       Review the structure of health care oversight from the Ministry of Health and Long-Term Care and its agencies to create a health care system that is patient and family centred.
•       Repurpose OHIP+ into a government as second payer system. Concurrently, evaluate how to expand access to rare disease prescription drugs and fix the Exceptional Access Program. Consider how the structure of the province’s various prescription drug programs could be enhanced to save precious healthcare dollars, reduce red tape, and enhance patient experiences.
•       Ensure Ontario’s home care system remains world class. End the failed experiments of the past administration into government run complex care units for home care and the recently created personal support worker agency. Work with the sector to reduce red tape and improve patient outcomes.

This story is the fourth story in the new Global News series ‘Mandated.’ Over several days, a series of stories will reveal the contents of the Ford government’s first set of mandate letters, handed to ministers after the party formed government in 2018. The letters have been kept secret since Doug Ford’s first election — a battle that has gone all the way to the Supreme Court of Canada.

Photo illustration by Janet Cordahi