Of all the telltale signs of mismanagement in Ontario’s health sector by the Provincial Governments of Dalton McGuinty and Kathleen Wynne, perhaps the most glaring is the current, sorry state of Ontario’s hospital and emergency rooms.
“Gridlock” and “Overcapacity” are terms being used on a regular basis to describe the ongoing overcrowding of hospitals and emergency departments in Ontario. Overcrowding no longer occurs just in a flu season. Hospitals in eastern Ontario are over 100% capacity for most of the year. This lack of capacity has resulted in compromised ability to provide access to care for our most vulnerable citizens at their time of need.
The root of the problem is at the top. Instead of improving access to hospital care to serve our growing population and aging seniors, the Ontario Liberal government chooses to push care to the community and mercilessly underfund those very community health services.
Budget restrictions of the last decade, along with the lack of accessible hospital beds and relative shortage of affordable long term care options, have combined to result in gridlocked hospitals and emergency departments. Today, patients are at risk and it is commonplace to have cancellations of needed elective procedures, longer waits for specialist care, and a myriad of strain and negative health effects on patients and their families.
Liberals’ Frozen Budgets Create Chaos
The last five years of austerity funding for Ontario hospitals have been particularly harsh. From 2012-2015, funding for hospital operational costs were frozen. In 2016, hospitals received a 1% increase. Hospital budgets have fallen in real dollars when inflation is considered despite a growing and aging population that requires more services not fewer. It is estimated that hospitals require a 2% increase just to meet inflation, another 2% increase to address aging and population growth, and roughly 1% increase to address higher demand. (I will not broach the subject of the rising hydro and energy costs hospitals must budget for over and above other rising costs.)
The recent Ontario budget included $518 million allocated for hospital operating costs (roughly a 3% increase while the Ontario Hospital Association was asking for more than 5%). The Liberals have called this announcement a “booster shot” but it fails to come anywhere close to addressing the effects of the lack of funding over the past decade. The “boost” would be more aptly referenced in terms of the Wynne Liberals’ re-election efforts.
To address hospital and emergency department overcrowding and their negative effects on patient care, the government must budget responsibly rather than using a stranglehold on patient services in attempts to make up for the billions of tax dollars it has misspent on the eHealth spending scandal, the ORNGE fiasco, a bulging health management bureaucracy, and the one billion dollars a month it is spending on debt servicing charges. This money could have gone a long way to solving the overcapacity problems in Ontario hospitals and emergency departments.
There is a Lack of Hospital Beds
Evidence shows that minor medical issues do not contribute significantly to ER overcrowding — it is the lack of beds that causes delays in the emergency department. The lack of bed capacity both in the hospital and in the long-term care community limits the ability of the hospital to deal with admissions and important treatment of our most ill patients. If incoming patients who need admission cannot access a hospital bed, the wait times build in the emergency department delaying care and causing waits that can extend from many hours into days. On average, one patient “warehoused” in the ER denies access to approximately four patients per hour to the emergency department.
A surprising fact about how low the last decade of mismanagement has taken our health care system is that Ontario has among the fewest number of hospital beds of countries in the developed world with 2.3 beds per 1,000 people — ranking close to the bottom behind Turkey.
As part of the 2017 budget, Ontario Liberals are proposing to spend an additional $9 Billion to support the construction of new hospital projects across the province. Older hospitals are being replaced, but building new hospitals with fewer hospital beds is not a solution to improving access to care especially when care in the community continues to lag.
Ontario’s growing population and increasing numbers of seniors will need more hospital beds despite the push toward care in the community. The ER overcrowding issue is beyond the point of being managed by doing more with less. Governments must restore additional bed capacity.
Alternate Level of Care Patients with No Place to Go
Outside of the hospital, community supports and long term care options also have potential to improve capacity issues within hospitals and emergency departments.
Long term care access is critical to restoring acute care bed capacity within hospitals and to improving waits in emergency departments. Roughly 15% of all hospital beds are occupied by patients who would be better served in a setting outside of hospital.
To avoid hospital gridlock, patients who cannot return home because of cognitive or physical limitations, so-called “Alternate Level of Care” patients, must have timely and respectful transition to more appropriate care. Early in 2017 there were over 3,000 ALC patients waiting in acute care hospital beds. It is estimated that about a third of ALC patients are waiting for a long-term care home. Even for home care in Eastern Ontario alone, there are approximately 3,000 people on a waiting list.
Addressing the home care and long-term care needs of seniors including ALC patients is critical to improving capacity of Ontario’s hospitals both rural and urban. For more thoughts on this, please read my previous health priorities article A Way Forward with Accessible Long term Care in Ontario.
Here is something more to think about when considering the need to fund community health services versus hospitals. Over these past years, investments in primary care transformation to community managed services have not resulted in reduced numbers of patients visiting the ER.
Statistics show that visits to Ontario hospital emergency departments rose more than 5% between 2012 and 2016. Patient visits are up and the patients are sicker. So, I suggest what the Liberals have failed to properly address is that our aging population means not only more chronic disease but also more acute events such as falls and infection.
If Ontario’s health care system were a patient, it would be whisked immediately to the ER After a decade of mismanagement under McGuinty and Wynne, the Liberal legacy is: cuts to nurses and front line care personnel, ERs empty because hospitals cannot afford to run them, elective surgeries cancelled because of lack of ER beds, sick and elderly having to endure warehousing on gurneys in hospital hallways. These commonplace signs in Ontario’s hospitals are unacceptable. Our provincial government and health minister must do better at managing the health sector – starting with Ontario’s hospitals and emergency rooms.
READ MORE: Dr. Merrilee Fullerton on health care in Ontario