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Ontario health-care system not prepared for this decade's increased demand: watchdog

The province is on track to be short on health-care capacity, funding and staffing in the coming years, the Financial Accountability Office found
Ontario Financial Accountability Officer Peter Weltman answers questions in Toronto on Monday Dec. 10, 2018

The Ontario government is not ready to meet the health-care demands of the growing and aging population over the next few years, according to a hard-hitting report from the province’s fiscal watchdog. 

The Financial Accountability Office (FAO) found the government’s plans fall short in three key ways: it isn’t building sufficient capacity in the hospital, long-term-care and home-care systems; its budgeted funding falls short; and it will not have enough health-care workers to meet the commitments to expansion it has made.

“Given that the province’s capacity expansion commitments in hospitals, home care and long-term care will not meet growth in demand for these services from Ontario’s growing and aging population, the province has not allocated sufficient funding to the health sector to support its programs and commitments, and the province has not taken sufficient measures to supply the nurses and PSWs needed to deliver on its expansion commitments, challenges are expected to persist across Ontario’s health care system.” — Ontario Health Sector: Spending Plan Review

However, Financial accountability officer Peter Weltman noted that the Doug Ford government has been working to solve the health-care pressures it inherited from the previous Liberal government, which invested in home capacity but added little to hospital and long-term care capcity as the population of high-needs seniors grew.

“It's not like they're doing nothing,” he said of the Ford government. “If the government was doing nothing, we'd have a huge problem right now, but they aren't doing nothing. They're doing a lot, but they have a lot to do.”

When it comes to hospital beds, the FAO found the province is likely to have built capacity for 4,500 additional beds by 2027-28 but that falls short of the 7,500 it would need to keep pace with the growing and aging population by that time. 

On home and long-term care, the province is on track to build its promised 30,000 net new long-term care beds by 2028 and has promised to spend an additional $1.0 billion over three years to increase the supply of home care services — but again, the population's needs are growing faster.

"For long-term care, the number of beds per 1,000 Ontarians aged 75 and over will decline slightly from 71 in 2019-20 to 70 in 2027-28," the FAO wrote. 

"For home care, the number of nursing and personal care hours per Ontarian aged 65 and over will be about the same in 2024-25 as it was in 2019-20."

Weltman noted that the health-care sectors are interdependent in that weakness in one sector leads to problems in the others. The combined stresses on the system led to the “hallway health care” problem the Ford government came into power in 2018 promising to solve. 

It hasn't managed to yet. The report found 1,300 patients “received care in hallways or other unconventional spaces on any given day, which is the highest number since the province started collecting this data in 2017.”

Asked about that finding Wednesday, Ford cited the stresses of the pandemic and said he believes his government is now making progress toward that goal of ending hallway health care.

The FAO also notes that the government hasn't budgeted enough in its own fiscal projections to fund the expansion of health care it has committed to. Financial Minister Peter Bethlenfalvy will table his 2023 budget, with updated projections, on March. 23.

Bethlenfalvy didn’t give specifics Wednesday, but said he is planning to give the health-care system the money it needs. “We're making sure that the funding is there because that's our top priority, not only the physical health-care infrastructure, but the human health-care resources that (are) necessary.”

When it comes to staffing that capacity, the FAO noted the province's efforts to increase the health-care workforce, which include expanding education capacity and making it easier for nurses trained in other countries or provinces to practice in Ontario.

But the need is far greater, the FAO found.

"Overall, to return to pre-pandemic vacancy rates and meet government program expansion commitments in hospitals, home care and long-term care, the FAO projects that Ontario needs 34,800 additional nurses and 51,900 additional personal support workers by 2027. This represents an approximately 26 per cent increase in nurses and a 45 per cent increase in personal support workers employed in these sectors," the FAO wrote.

The report projects a shortfall of 33,000 nurses and PSWs in 2027-28 — and even then there are risks that could worsen the situation. In particular, the watchdog noted that the well-publicized complaints from nursing organizations that low job satisfaction from burnout and low wage growth are leading to high attrition, which would worsen the FAO outlook on staffing.

The report also notes that the government has launched an appeal of a court decision that found its legislation that restrained public sector compensation, including in the health-care sector, is unconstitutional. If it is unsuccessful, increased wages will likely cost the province an additional $3.6 billion until 2027-28, the FAO found.

The Ford government's critics cite that legislation, Bill 124, as one of the primary causes of the staffing crisis in health care.

Weltman highlighted staffing shortage as a key takeaway from his report.

"Failure to address the projected shortfall in nurses and PSWs will result in the province being unable to meet its expansion commitments in hospitals, home care and long-term care," the FAO wrote. "The shortfall will also have additional impacts on health sector service levels, including in hospital emergency departments, the wait-list and wait times for surgeries, and average hours of direct care provided to long-term care residents."

Asked Tuesday if she believes Ontario has done enough to address the province's health-care worker shortage, Health Minister Sylvia Jones replied that the government has “done a lot to address staffing crisis.”

The government has expanded education spots and accelerated the licensing of internationally trained nurses, she said. “And the numbers show that we've had a historic number of licences, both in the nursing side and at the college level.”

On Wednesday morning, Jones' spokesperson released a further statement saying the report "confirms what we’ve been saying for months: the status quo in health-care is no longer acceptable."

"We’ve added more hospital beds in four years than the Liberals did in fourteen," the statement says.

That is backed up by the report, which shows capacity challenges in the hospital and long-term care sectors increased steadily through the years the Liberals were in power.

"Today’s report also confirms why all provinces and territories have spent years advocating for the federal government to pay its fair share of health-care funding," said Jones' spokesperson. "Ontario is proud to have been the first province to accept the federal government’s down payment and looks forward to finalizing bilateral discussions so we can invest even more in priority areas like hiring more nurses and connecting more people to family doctors."


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