The following details a submission by OPSEU/SEFPO to the Minister of Health on strengthening public hospitals to support Ontarians throughout the COVID-19 pandemic and beyond.
OPSEU/SEFPO’s Hospital Professionals Division
The Ontario Public Service Employees Union (OPSEU)/Le Syndicat des employés de la fonction publique de l’Ontario (SEFPO) represents 25,000 hospital professionals in more than 250 classifications of occupations, in over 80 hospitals across this province. Some of these classifications include medical laboratory technologists and technicians, radiation technologists, respiratory therapists, laboratory assistants, phlebotomists, perfusionists, pharmacists and pharmacy technicians to name a few.
Our members provide paramedical services such as lab tests, ultrasounds, CT and MRI scans. Without accurate and timely medical testing, doctors wouldn’t be able to perform their duties and patients wouldn’t get the care they need.
Furthermore, they also provide therapeutic and rehabilitative services in areas such as social work, physiotherapy, occupational therapy and nutrition. They play a key role in ensuring that patients successfully transition out of hospital and don’t need to be re-admitted.
Introduction
Ontario’s health care system is significantly underfunded, and we have seen this problem intensified in the province’s hospitals during the COVID-19 pandemic.
Decades of underinvestment and cuts to health care have placed our hospitals at a disadvantage, causing them to operate on deficits even before the pandemic began in March 2020. Mass deficits, unanticipated service costs, supply chain issues regarding Personal Protective Equipment (PPE), and recruitment and retention of staff are the new realities hospitals are having to tackle while trying to care for patients.
Ontarians deserve a health care system that provides their families the best possible care, especially when facing tremendous uncertainties due to COVID-19.
As we move into the second wave of the pandemic, hospitals need to be properly funded, staffed, and equipped to respond to the demand on our health care system. Ontario’s hospitals are under more pressure than ever before and more investment is needed in order to make sure that they have all the resources needed to support Ontarians throughout the COVID-19 pandemic and beyond.
Under-funding for Ontario’s hospitals
Pre-pandemic funding situation
Ontario is the most populous province in Canada, yet it still remains the second-least funded province with respect to healthcare per capita.[1] In late 2019, The Financial Accountability Office of Ontario, estimated that in order to maintain the status quo, government spending would have to rise to 4.6 per cent on average between 2018/19 to 2022/23. This estimate includes the core health care cost drivers of population growth, population aging and health sector inflation. It does not include the amount of funding necessary to make up for the years of underfunding that occurred between 2011/12 and 2016/17 when annual health care spending averaged just 2.2 per cent.[2]
The situation for Ontario’s hospitals, where the OPSEU/SEFPO’s hospital professionals work in a multitude of classifications, is equally dire. According to the Canadian Institute for Health Information (CIHI), over the last two decades the Ontario government has reduced the proportion of overall health spending on hospitals from 41.5 per cent in 2000 to 34.1 per cent as of 2019.[3] The restraint imposed on the health sector was even more severe in hospitals, which faced four consecutive years of zero increases to their base funding. Overall, per-capita hospital funding in the seven years between 2012 and 2019 was just 5.4 per cent – far from adequate to address collective agreement obligations, costs of supplies, medication, and equipment.[4]
The effect of COVID-19 on hospital operating costs
In addition to the insufficient funding described above, hospitals are now facing a further, two-pronged blow to their financial stability – unanticipated pandemic-related costs and a steep reduction in non-Ministry revenues. These pressures have eaten away at budgets that were already insufficient going into the pandemic.
The Ontario Hospital Association (OHA) analyzed the financial impact of these budgetary strains over a two-month period. Fiscal losses to hospitals over April and May 2020 totaled $548 million, $320 million of which represents lost revenue due to the pandemic.[5] The OHA also identified an additional cost that is, and will be, a concern for the duration of the pandemic – staffing. The COVID-19 pandemic places extraordinary demands on hospital staff. Our hospitals must now factor staffing shortages and overtime costs related to increased sick time into their planning, as well as, family and child-care responsibilities resulting from closures and lockdowns.
It is a great concern that the additional pressures on our health care system will force employers to make difficult decisions, including cutting back on outpatient services that the public rely on and laying off critical staff that are needed to care for patients.
To add to the laundry list of increased pressures that our hospitals are facing during the COVID-19 pandemic, hospital capacities, which were already in a severe state prior to the pandemic, have now worsened. The hospital bed shortage has been a pressing issue in Ontario for decades. With the onset of the flu season, our hospitals will struggle to meet the capacity demand, increasing wait times for patients. While the government’s recent investment of $116.5 million to create more beds at 32 hospitals in Ontario is a step in the right direction, the specific focus on hospitals in ‘hot spots’ means that this deals solely with surge capacity and not long-term safe occupancy levels throughout all of Ontario’s 140 hospitals.
Further, manufacturers are struggling to keep up with demand for the instrumentation and the reagents needed to process COVID-19 samples.[6] As shortages become more severe and the demand for these items becomes higher, costs of these crucial supplies and equipment also rise.
Our hospitals are severely underfunded and require significant additional support to ensure that Ontarians are getting the best care possible.
Staffing shortages in hospitals
Ontario’s hospitals have been facing staffing shortages in numerous areas of healthcare, including our labs, ultrasound services, nuclear medicine, diagnostic imaging, and physiotherapy to name a few. Recruitment and retention of these positions has been a problem that continues to go unaddressed, and will continue to affect access to care for Ontarians if action is not taken to resolve this issue.
For example, one of the most important weapons in the fight against the virus is an adequate supply of Medical Laboratory Technologists and Technicians to process and analyze patient samples. OPSEU/SEFPO and the Canadian Society of Medical Laboratory Science (CSMLS) have been sounding the alarm for decades about the coming shortage of these crucial hospital professionals. OPSEU/SEFPO hospital professionals lobbied their provincial representatives about these exact concerns as recently as 2019. Christine Nielsen, CEO of the CSMLS, has stated that Ontario is short as many as 300 lab professionals and 50 per cent of the current workforce is eligible to retire in the next five years.[7]
A precarious supply of laboratory professionals is a problem that can only get worse. Our lab professionals are under an immense pressure, performing their usual tasks in addition to working to meet the government’s testing quotas. As testing quotas increase, more workers burn out and consider retirement or a change in profession, subsequently intensifying recruitment and retention issues.
Recommendations
As we head into the second and potentially third and fourth waves of this pandemic, how hospitals respond to these added pressures needs to be different; we need to ensure that they are well-prepared.
Now is the time to focus on health system planning and stable long-term investments to ensure that our province’s population needs are met.
OPSEU/SEFPO recommends the following actions to strengthen Ontario’s health care system and support our hospitals in caring for the public:
- Increase global funding for hospitals by 5.5 per cent per year
Global funding for hospitals remains significantly lower than it needs to be in order to barely maintain current service levels. We continue to recommend increased investments by at least 5.5 per cent per year, which is the health care inflation rate.
In recent years, Ontario’s provincial government has leaned more heavily on private labs and has increased capacity in the private sector over the years. Instead of taking this route, we highly recommend focusing those resources on our public hospitals. Privatized services cost more and are less effective. Evidence of this can be seen when looking at privatized laboratory and diagnostic testing, which costs 40 per cent more than public testing.[8]
- Establish a committee to outline a human resources strategy that addresses shortage of hospital professionals
We recommend that the Ontario government work with OPSEU/SEFPO and the OHA to identify looming shortages in the fields that service our hospitals and outline a human resources strategy to address the labour supply. Such a strategy should include the expansion of existing training programs and the opening of new programs, including incentivized college and university programs. A vital component of a human resources strategy for hospital professionals is making the professions more attractive, both to young people just starting their careers and existing hospital professionals looking for a career change.
- Build more hospitals to address capacity demands
Ontario needs an increased investment in our health infrastructure to be able to sufficiently address the long wait times in our hospital emergency rooms and hallway healthcare. Ontario has an aging population which means that access to care for seniors will be increasingly important in the upcoming decades, and the COVID-19 pandemic has shown us that our healthcare system needs to be prepared for any number of scenarios. OPSEU/SEFPO recommends that the government build more hospitals to address our looming and upcoming capacity demands, to ensure that Ontarians have the access to care that they need.
Conclusion
Ontarians take pride in having a strong public health care system that’s affordable, accessible, and fair. Our hospitals have been suffering as a result of underfunding and budget cuts for decades. The COVID-19 pandemic has placed a significant additional strain on our hospitals as it pertains to operational costs, capacity, staffing, and instrumentation.
Our hospital’s professionals have also been under immense pressure during this pandemic, with no end in sight. The shortage of hospital professionals, including lab technicians and technologists, in the province is an issue that needs to be acted on immediately to ensure that Ontario can meet the demand for testing and address the labour shortage in the years to come.
Long-term planning and increased investment in our public hospitals is key to ensuring that Ontario’s health care system is strong enough to care for Ontarians throughout the pandemic and beyond.
1 OHA, “Ontario Hospitals – Leaders in Efficiency,” December 2019.
[2] Sheila Block, “Talk vs. action: Doug Ford’s inadequate response to the second wave of COVID-19”
[3] CIHI, Health Expenditures in the Provinces and Territories, Provincial and Territorial Chartbook, 2019 (2019 numbers are forecast)
[4] OHA, “Ontario Hospitals – Leaders in Efficiency,” December 2019.
[5] OHA, Understanding the Impact of COVID-19 on Ontario Hospital Finances, September 2020.
[6] National Post, “Ontario’s COVID testing slowed by shortage of key chemical”, October 9, 2020.
[7] https://globalnews.ca/news/7396535/ontario-lab-worker-training-covid19-test-backlog/
[8] (The Ontario Health Coalition , 2017)