What today’s health crisis means for tomorrow
Posted: February 5, 2022
(February 3, 2022)
By: Trevor Hutchinson, The Lindsay Advocate
The Ontario health care system is behind most other developed nations and most Canadian provinces in many areas.
“If given the chance to start over, I don’t know that I would go into nursing now,” says Bonnie Kennedy, a Kawartha Lakes resident who retired from nursing after more than 40 years in the profession.
“I worked during the (former Conservative Premier) Harris cutbacks. I remember beds and entire floors at hospitals being closed due to funding cuts. But the situation seems so much worse now.”
Kennedy is not alone in her worry about our health care system. The COVID pandemic has made use more aware than ever about hospital and health care capacity. But according to many experts, COVID has merely exposed and exacerbated long-existing problems in our province’s health care system.
“We have had capacity issues for decades. Before COVID, every winter we had surge capacity issues in acute care and down the chain through chain sub-acute and reactive units every year during flu season,” Dr Adam Kassam, president of the Ontario Medical Association (OMA), told the Advocate. The OMA represents more than 43,000 doctors, medical students and retired doctors in the province.
Natalie Mehra, executive director of the Ontario Health Coalition (OHC) agrees, noting that, “health care was in a total crisis before COVID. We had hospitals running at 120 to 150 per cent capacity. We had patients in lounges and hallways waiting for beds.”
The OHC’s goal is to be a guardian of public health care and it works to advocate for health care in a non-partisan manner.
As Sharleen Stewart, president of SIEU Healthcare, one of the largest unions in the Ontario health care sector notes, “problems of health care system capacity existed for decades. Some of us have been ringing alarm bells for years about these issues.”
The data definitely support the idea that some alarms are indeed ringing. The Ontario health care system is behind most other developed nations and most Canadian provinces in many areas. In 2020, Canada had one of the lowest per capita hospital bed ratios among the worlds richest nations, at 2.5 beds per 1,000 people, well below the World Health Organization’s recommendation of five hospital beds per 1,000. Canada also has the highest hospital occupancy rate in the developed world, which signals a system under too much pressure. Ontario lags almost every province for this statistic and spends less than all of them. Ontario also has one of the lowest rates of physicians per capita in the developed world. The capacity of our intensive care units does not compare well to the world either: We have just over half of the capacity of the United States and a measly 23 per cent of German ICU capacity.
In a calculation done by Dr. Danyall Raza provided by the OHC, Ontario would need an additional 12,850 hospital beds to just match the Canadian average per capita. In 2019, the Ontario Hospital Association estimated that it would require a $4-billion-dollar investment just to get Ontario up to Canadian capacity averages.
So, by almost any standard, we have a system whose capacity was stretched and squeezed to the limit by a succession of governments of every political stripe. And this situation existed well before the pandemic hit.
But as we have been reminded many times throughout the pandemic, capacity is about more than hospitals and the furniture that may be in them. Our health care it involves home care, long-term care and community-based care, and most importantly the people who provide these services.
“It is not just a brick-and-mortar capacity issue; it is also a human resources capacity issue,” says the OMA’s Kassam.
Home care and long-term care (LTC) were already short of workers before the pandemic, says Mehra of the Ontario Health Coalition. “Multiple missed home visits were common in home care for example. Things have gotten much worse during the multiple waves of COVID.
“Despite all the challenges there was resilience in the system prior to COVID. LTC is in a staffing collapse now. I’ve seen reports of half the necessary staffing levels in LTC,” she says, adding that on the day she spoke to the Advocate, she heard from two families whose relatives in long-term care hadn’t had a bath in three weeks. “There is no way to state the emergency that we are in,” she adds.
While Ontario and Canada have had better outcomes and fewer deaths than many other countries due to our high vaccination uptake and public health measures, COVID has been devastating to our province and country. As of press time , there have been more than 10,500 deaths in Ontario, of which 3,200 were long-term care residents. In fact, Canada’s rate of COVID deaths in long-term care facilities is almost double that of other developed nations.
Add COVID hospitalizations and the unknown but troubling prospect of long COVID into this mix, and our systems will continue to be put under increasing strain. Not to mention the effect that the pandemic has had on our regular health care needs.
Some prominent conservative voices, noting the crisis in the sector, have begun advocating for more privatization in the health care system.
“Over the past 20 months we have had to do restrictive health care. Directive 2, which Ontario has been under a few times during the pandemic, instructs physicians to delay certain procedures. This has led to a backlog of 20 million health care events — everything from diagnostic tests to appointments” to non-emergency surgeries, says Kassam.
With such a backlog of non-COVID health procedures (which will lead to worse health outcomes and a further pressure on the system) the race is now on to find solutions to our historical, current and future healthcare problems.
Some prominent conservative voices, noting the crisis in the sector, have begun advocating for more privatization in the health care system. The health coalition’s Mehta disagrees. “The province needs to stop their privatization efforts that siphon billions out of public health care.”
Privatization is a complicated subject here. Since the advent of medicare, the public purse has historically paid for 70 per cent of total health care expenses, with the remainder coming from insurance companies and individuals. But not all health care workers are government employees. The vast majority of doctors, for example, are not employed by the government but are more like small business owners. So, our health system has always had a mix of publicly and privately provided services.
What worries some people like Stewart and the front-line health care workers she represents in SEIU, is the increasing trend in Ontario of services that have been traditionally provided by public bodies being assigned to private corporations.
“I have never seen such a dependence on, and the increase of, the use of agency nurses, especially for regulated staff. And new agencies are popping up all the time,” she says.
As Stewart explains, the average wage of a Registered Practical Nurse is about $30 per hour. An agency, which might employ an RPN at slightly higher wage (but without benefits, pension or job security) will charge a hospital or a LTC facility $90 an hour for that service. Stewart notes that this extra cost could be invested in hiring more people and boosting system capacity but is instead going to the profit margins of private companies.
“Corporations . . . are not in business to provide care. They are in the business to provide return to their shareholders,” she observes.
Clearly the Ford government cannot be blamed for the funding decisions by all the major parties at the provincial and national levels over the years that led to the current crisis of hospital capacity.. However, several critics of the government cite actions of the Ford government that suggest a privatization agenda.
In March 2019 the Ontario government introduced Bill 74, which created a super-agency for health, with plans to eliminate the 15-year-old local health integration networks. While COVID slowed down some of the bill’s implementation timelines, leaked documents have revealed the government’s intention to privatize eHealth (a way to bring more patient data into the electronic age), laboratories, air ambulances, long-term care inspections and other services.
Critics also point to Ford’s appointment of several pro-privatization people to his inner circle including Shelly Jamieson, a former president of private long-term care operator Extendicare, as one of the appointed board members of the new body. The super agency, in the opinion of several researchers, strips away any local control over health care and allows the government to force privatization or even close hospitals without any public input or right of appeal.
Premier Doug Ford.
Just two weeks before the pandemic, the Ford government introduced Bill 175, which allowed for privatization of the last remaining Ontario home care that was still publicly run. (Even before the bill, Ontario had the highest rate of privately supplied home care in the country.) And while Ford has called nurses heroes throughout the pandemic, his Bill 114, introduced in 2019, caps nurses’ wage increases at one per cent for three years. This legislation is cited as one reason why some nurses are either leaving the profession or considering employment at agencies. Yet police and fire fighters were exempt from this bill.
Mehra also criticizes what she calls “an array of cuts from the Ford government — real dollar cuts intended to privatize health care.”
Ford and his ministers’ appearances for photo opportunities early in 2022 at private health facilities to announce COVID measures have only stoked the concerns of those advocating for public health care. Ultimately, these advocates fear a two-tier system, where the wealthy access private care and those without wealth are forced to wait for underfunded public care.
Stewart , is bluntly suggests the government is purposefully underfunding health care to encourage privatization. “We have questioned whether there is some intention in the way the government has responded to COVID and other crises,” she says.
Stewart also notes the many well-documented connections between Progressive Conservative party insiders and private long-term care operators. Despite the fact that for-profit homes had worse outcomes than not-for-profit and municipally owned LTC homes, many private companies have received extensions and new licences.
“This government has so many connections to the private health care and LTC worlds. It doesn’t take a rocket scientist to understand what is going on here,” she says.
The OMA is more muted in its comments about privatization, declaring in a written statement, “Privatization of health care is a complicated issue that can’t be answered yes or no, as there are arguments on both sides of the issue. We need to define what we are discussing. We have a single-payer system for medically-necessary care, but some services are private, such as physiotherapy. Ultimately, this is a decision for Canadians to decide.”
What almost every advocate does agree on is that to increase capacity, address the pandemic backlog and future-proof our system, more provincial and federal government support is needed for health care. In other words, it is going to take money. A lot of money.
“You can’t get to a better place without investments,” says OMA president Kassam. “After massive decreases in funding in the 1990s and flat spending levels throughout the 21st century, a big investment is needed now.”
The Canada Health Transfer is the largest chunk of funding the federal government provides to the provinces and territories. . This federal money is used to ensure they maintain federal health standards and helps ensure general uniformity of health care services across the country. The transfer used to pay for about 50 per cent of a province’s health care costs, but through successive Conservative and Liberal governments, it has dwindled to about 23 per cent.
The OMA is advocating for the federal transfer rate to be increased to 35 per cent, which would require billions in additional funding. “Health care is a team sport. We need the federal and provincial governments to step up,” Kassam says.
Deciding how we would pay for such an investment will require an intense debate. Mehra points to existing loopholes in Ontario that allow certain companies such as accounting and legal firms to not pay the employer health tax. She estimates that were such loopholes to be closed, the results could provide billions in additional provincial funding. Proponents of public health care also point out that reducing privatization can increase money to invest in the public system. Others point to an increase in Ontario’s low tax rates, compared to the past, for corporations and the country’s most wealthy.
What worries advocates like Mehra is that Ontario seems to be going in the opposite direction of the needed funding increase. She points out that the province’s Financial Accountability Office noted in its analysis of the most recent provincial budget that the government would have to cut almost $18 billion dollars of public services to reach its long-term budget targets.
Kassam, on the other hand, sees all the current challenges in Ontario health care as a chance to make some big changes. “We have an opportunity to look at our health care system, to look forward. This is an opportunity for transformation.”
Stewart concurs, saying, “We need more investment, but we need to think systemically. We need a system-wide lens.”
There are few more complicated issues to solve provincially and in the coming months and years, Ontarians will be asked to make some huge decisions regarding what the future of the health care system will be and how it will be funded. And it will be up to us, the citizens, to express our decisions at the ballot box.
As Stewart notes, the election campaign is coming. “We all have reason to worry. So, we have to ask questions of the people knocking on our door this June.”