By AMARACHI AMADIKE, Local Journalism Initiative Reporter
Ontario’s healthcare budget is under the microscope once again after The Financial Accountability Office of Ontario (FAO) released its latest report earlier this month.
The independent fiscal watchdog’s March 8 report revealed that Ontario’s healthcare will be short $21.3 billion in spending by 2027-2028.
The reports exposed signs that the province will be unable to meet its healthcare goals unless it significantly increases funding for the current health plans.
Scarborough Southwest MPP Doly Begum believes the shortfall stems from the current shortage of qualified healthcare workers.
“The real healthcare crisis that we’re facing right now is because of the shortage of staff,” said Begum, who is also Deputy Leader of the Ontario NDP. “We need to increase the level of staffing, specifically Personal Support Workers.”
Although Ontario’s government has reported it is implementing a variety of measures to increase the province’s supply of nurses and personal support workers—including measures which address wages—Begum said that the number of incoming nurses is not enough to counteract the amount of workers leaving the field.
“Ontario is being called the best exporters of healthcare workers,” said Begum. “That is not something to be proud of. The fact that a lot of our nurses are leaving the province is a huge problem.”
Begum said that although there are students being recruited into the field, retaining them after graduation is the problem. She said this has created a “revolving door” of nurses entering and leaving the profession because they are “getting burnt out.”
One major cause of Ontario’s inability to retain healthcare workers is compensation. Bill 124 (Protecting a Sustainable Public Sector for Future Generations Act, 2019) limits base salary increases for most provincial employees to one per cent per year for a period of three years.
Out of all provinces in Canada, Ontario has seen the least increase between 2012 and 2022 for nurse wages at less than $5. The static nature of their pay has especially been highlighted in recent years as the economy has experienced a major inflation.
For perspective, in 2012 the Quebec average nurse wage was $30.33 while Ontario sat well above at $34.39. Now Quebec, with an average nurse wage of $39.27, has surpassed Ontario. The average nurse wage is $38.77.
According to the FAO report, new policy measures, along with natural growth, will add 53,700 nurses and PSWs to Ontario’s workforce by 2028. However, this will not be enough to meet Ontario’s commitments to expand care in hospitals, long-term care and home care as there would still be a shortage of 33,000 nurses and PSWs.
The Progressive Conservative government of Premier Doug Ford government said that the latest reports depict the failures of past administrations, and that the future of Ontario’s healthcare system is in good shape.
The government said it has added more hospital beds in four years than the Ontario Liberals did in the 14 years that they were in power (between 2003 and 2018). The Ford goverment also reported that wait times are on the decline across the province for key surgeries.
However, Beaches-East York Liberal MP Nathaniel Erskine-Smith, who is expected to make a bid for the leadership of the Ontario Liberal Party in the near future, condemned the current provincial government’s “deep level of incompetence”.
“The Ford government spends less on healthcare overall than the national average, and nurses are paid well below the national average despite an ongoing labour shortage,” said Erskine-Smith.
It’s unclear whether Ontario government statistics on waitlists are from a more recent time frame than the FAO report which tells a different story.
According to the FAO, “shortages in hospital capacity in turn limit the resources available to hospitals to perform elective surgeries, which has manifested in fewer surgeries performed, longer waitlists and longer wait times, compared to pre-pandemic levels”.
The report shows that average wait times have increased by 48 per cent from 3.7 months in 2019 to 5.5 months in 2022.
Surgery wait times have also increased. Ophthalmic surgery is the most in-demand surgery with the waitlist increasing by 30 per cent between 2019 and 2022 (76,393) while, in that same time period, general surgery saw the highest increase in demand at 51 per cent (27,438).
“Healthcare is the provincial government’s single greatest responsibility, it matters to every community across Ontario, and it is being mismanaged and underfunded,” said Erskine-Smith.
As demand has increased, ophthalmic and general surgery has also experienced a decrease in performed surgeries. All fields except paediatric plastic/reconstruct and paediatric cardiovascular surgery saw a decrease in performed surgeries while demand has soared, said the FAO report.
Begum also highlighted the increase in Hallway Healthcare—a term used to describe a situation when patients await hospital beds in an unconventional or unexpected location.
She told Beach Metro Community News that the number of patients receiving Hallway Healthcare has “increased significantly” over the past couple years, although this could also be a result of the increased demand in medical assistance since the start of COVID-19.
Nonetheless, if the staffing crisis isn’t addressed, the number of Hallway Healthcare recipients will continue to climb, she said.
“On the list of priorities to address the healthcare crisis, you need to address the staffing crisis,” said Begum. “You need to fund and make sure there are enough people who are staying within their professions.”
Ontario’s healthcare system is experiencing a domino effect triggered by staff shortages. The lack of workers has led to a backlog of patients and increased demand which, in turn, has caused a scarcity of available hospital beds.
The province announced plans to add new hospital beds and also introduced measures to free up spaces currently occupied by alternate level of care (ALC) patients.
If this is accomplished, there could be an additional 7,000 hospital beds. But even this has a shortfall of about 500 beds due to the “increasing demand for hospital services from the growing and aging population”.
Ontarians aged 65 and older occupy more than 50 per cent of hospital bed days. But growth in elderly Ontarians has exceeded growth in the number of hospital beds, the FAO report revealed.
Between 2005 and 2019, available beds increased by three per cent—climbing from 31,865 to 32,696 beds. In the same period, the number of seniors increased by 56 per cent—increasing by almost one million (2.5 million). This increase is expected to continue as it was estimated that the number of Ontarians aged 65 and over will increase by 30 per cent between 2019-2020 and 2027-2028.
Coupled with a growth in Ontario’s total population which is expected to increase by 12 per cent, there will be an estimated 21 per cent increase in demand for hospital services.
“Therefore, even if the province achieves its plan to add 4,500 new hospital beds and free up 2,500 existing beds, it will still be 500 beds short of the estimated 7,500 beds needed just to serve the growth in demand for hospital services from 2019-20 to 2027-28,” read the report.
So, what are the Ford government’s options?
“The federal and provincial government have recently agreed to a new Health Accord that will see our federal government increase health transfers to prioritize key issues, including access to primary care,” said Erskine-Smith.
The FAO estimates that changes to health funding arrangements will result in new incremental federal health transfers to the Province of Ontario totaling $10.9 billion from 2023-24 to 2027-28.
Alternatively, the province could dip into the record-high $44 billion contingency fund currently at its disposal.
“So it’s not that the province doesn’t have the money,” said Begum. “It’s just that they’re spending less, which will fuel the crisis even further. If you look at the way the government has taken action, this is what’s leading to the privatization of our healthcare system.”
Amarachi Amadike is a Local Journalism Initiative Reporter for Beach Metro Community News. His reporting is funded by the Government of Canada through its Local Journalism Initiative.
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