‘You can not run a hospital sector as if it were a car’: Here’s why Ontario’s hospitals were not ready for Omicron

OTTAWA — Wayne Redekop has seen hospital treatment in his city become thinner for more than 20 years.

The five-year-old mayor of Fort Erie remembers the day in the mid-1990s when the local hospital’s obstetrics department shut down and moved to Niagara Falls, 30 miles away.

He more clearly recalls the anger in 2009, when the entire hospital closed after more than 75 years.

And just this week, amid a massive rise in COVID-19 infections driven by the Omicron variant, the regional health unit closed Fort Erie’s emergency care center – a temporary blow due to staff shortages that will force the city’s about 33,000 residents to drive 20 minutes west to Port Colborne for emergencies, Redekop said.

For him, it’s all part of the same unfortunate story: that a generation of cost-cutting has made health care in Ontario stretched thin and vulnerable. And then came COVID-19.

“The pandemic has put full focus on the shortcomings of our hospital and healthcare system and the lack of resilience,” Redekop said.

“Resilience requires money,” he added. “We have not, and we have not had it for a while.”

For experts, it’s no surprise that Ontario is straining under the Omicron wave. Despite the widespread use of vaccines and predictions that Omicron is less likely to result in serious illness, indoor eating is banned again. Gyms are closed and schools are closed. Once again the provincial government fears that hospitals will be overrun, with their limited beds and staff shortages, as infections of this particularly transmissible variant of coronavirus rise to record highs.

The potential shortcomings of Ontario’s hospital system have long been known. The province’s hospitals operated at almost full capacity (96 percent on average) even before the pandemic, in 2018-19, when nearly a quarter of the province’s hospitals actually struggled with over 100 percent capacity, according to Ontario’s fiscal responsibility watchdog.

In December 2019, the same month COVID-19 emerged as an ominous new respiratory virus in China, the Ontario Hospital Association announced a report it said the province was tied to Mexico for the lowest number of hospital beds per capita. inhabitant of all countries, which is tracked by the Organization for Economic Co-operation and Development (OECD). “The current situation,” the report concluded, “can not realistically be maintained.”

And that was again before the pandemic.

“You’ve taken a system that really tipped on the edge and you’ve pushed it over,” said Dr. Katherine Smart, president of the Canadian Medical Association, who has long called for increased health funding from provinces and the federal government.

The result has been the need to cancel operations that are not considered life-saving and relocate staff to intensive care units, a strategy that resulted in about 560,000 fewer operations during the first 16 months of the pandemic compared to the 12 months of the pandemic. 2019, according to a data published last month by the Canadian Institute for Health Information.

Over the past 30 years in Ontario, annual health care spending has increased and sometimes decreased, but the government’s overall stance has been cost-cutting, said Anthony Dale, president and CEO of the Ontario Hospital Association.

Health care spending fills a large portion of the provincial budget – and did so even before the billions of dollars Queen’s Park and Ottawa have spent countering the pandemic. In 2019, for example, health care represented 41 percent of total program spending in Ontario, and the province’s 141 hospitals accounted for the bulk of it with 36 percent.

With this huge record on the balance sheet, successive governments of all kinds in Queen’s Park have tried to keep spending in check as the population grew larger and older, Dale explained.

Former Prime Minister Kathleen Wynne admitted the same thing in a recent interview with Maclean’s magazine.

“All the time I was prime minister, we worked hard to balance the budget. We kept health spending down,” she said. “If I had to do it again, given what I know about COVID, I probably would not do it.”

Part of the problem is that the provinces have been under pressure to raise a larger share of health spending, as the federal contribution to the joint project on public health care has fallen over the years, Smart said. In the 1970s, Ottawa shared the costs 50-50 with the provinces. In 2019, the federal share was around 23.5 percent, according to one report from the Folketing Library.

Meanwhile, Dale said, the overall political goal in recent years has been to find ways to strengthen forms of care that prevent people from landing in expensive hospital beds. But he said that this so-called “revolution” in health care never came to fruition.

Instead, hospitals have been under pressure to become more “efficient,” something Dale said they have actually achieved. His association’s report from the threshold of the pandemic said that Ontario, with the lowest hospital costs per capita. per capita in Canada, also had the shortest average stays for acute patients. It’s the hospital’s standardized mortality rate – a way of measuring care standards – was also in line with the national average, the report said.

This happened even though the report said the total number of hospital beds in the province fell in the 1990s and remained relatively flat between 1999 and 2019, a 20-year period in which Ontario’s population grew 27 percent and the number of people over 65 increased. with 75 per cent.

Despite this “efficiency,” the hospitals in Ontario ran at almost full capacity all the time. There was not much slack in the system for an emergency like the pandemic.

“You can not run a hospital sector, as if it were a car, with the gas tank empty all the time,” he said. “Sooner or later you will see the gas light flash and you will run into problems on the side of the road.”

Although it comes with disadvantages in the event of a crisis like the pandemic, there are obvious reasons why the hospital system in Ontario ran so close to its limit before the pandemic, says Bob Bell, a former deputy health minister for Ontario who ran the University of Toronto Health Network for nine years. .

“I’ll give you $ 100 million as hospital director to run your hospital, okay? What do you think I expect you to do with it as a government agent for the system? Do you think I expect you to have a bunch of nurses who do not doing something? ” he said. “What I want you to do is employ everyone who is in your hospital fully and provide care to the patients.

“It’s not really good, but that’s why Ontario is running at $ 1,000 less per capita than Alberta.”

For CMA’s Smart, the pandemic has shown the foolishness of operating so close to the system’s limits. She argues that governments across the country need to pump billions more into health care spending – including Ottawa, which is jointly awarding pressures to increase its share of total Canadian health care spending to 35 percent, a difference that would cost around $ 28 billion a year.

Bell argued that it is best to spend additional money on expanding out-of-hospital capacity in the area of ​​”transitional treatment” where specialists can take care of patients who need attention but do not need to be in the hospital. As of 2019, according to the Ontario Hospital Association, such patients occupied a record 17 percent of the hospital beds in the province.

Others, such as University Health Networks Dr. Andrew Boozary, wants to see more money along with reforms to integrate parts of the health and social systems operating in silos, as well as improvements such as the uniform use of electronic medical records.

But increased funding cannot come from nowhere; it requires trade-offs, such as reduced spending in other areas, increased public borrowing or the politically difficult decision to raise taxes, said Phil Triadafilopoulos, a political scientist at the University of Toronto.

And when the system seems to work reasonably well – outside of the pandemic – there is little political incentive to make difficult decisions to prepare for a potential disaster or future challenges such as the health needs of an aging demographic, he said.

Triadafilopoulos compared the situation to Aesop’s fable about the ant and the locust: the ant stored food and prepared for winter, while the locust did not and became hungry.

“Most governments are grasshopper-like,” he said.

However, they have pumped more money into healthcare during the pandemic. Since the crisis began, the Ford government, for example. put $ 5.1 billion extra on hospitals and says it has created 3,100 beds. In Ottawa, the Liberal government has also pledged an additional $ 25 billion over the next five years to hire more nurses and doctors, eliminate pandemic surgeries and improve long-term care and mental health care.

Redekop, the mayor of Fort Erie, says the current crisis should trigger a public debate about increasing overall health care spending in the coming years.

What do you want available to you as a citizen, as a taxpayer? Do you want a health care system that meets your needs and the needs of your family and your neighbors in your community, or not? ” he said.

“If you want it, you have to pay for it.”

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