Alex Munter is CEO of CHEO, the national capital region’s pediatric health-care and research centre.
At a recent meeting with hospital administrators, an Ontario government official delivered the good news that funding requested for surge beds had been approved.
“That’s great! Could you send people, too?” joked one of the hospital representatives on the call.
It wasn’t really a joke, though.
Across Canada, news coverage is full of reports of emergency departments, mental health programs, home care, school health programs and other services reducing hours, temporarily suspending operations or limiting access.
Communities suffer, people wait longer for care. Many will get sicker, some will die.
And here’s the thing. Organizations often have the funding to deliver care. They just can’t find the trained, skilled staff to keep the doors open.
We have an opportunity as Prime Minister Justin Trudeau shapes his new cabinet. Shoring up the staffing of Canada’s health-care system should be the number one item in the mandate letter he drafts for the health minister. Everything else, including pandemic response, flows from that.
Health-care staffing is an overnight crisis years in the making. Before the pandemic, the Canadian Nurses Association projected Canada would have a shortage of 60,000 nurses by 2022. That’s now a few months away. CHEO routinely wins best employer awards, is in a major urban centre and has always been able to attract staff. A decade ago, recruitment challenges were limited to the most highly-specialized roles, such as developmental pediatricians or neurosurgeons. Now, it’s across the board in all disciplines and at all pay ranges. And we’re still doing better than most.
COVID-19 has illustrated the resilience of Canada’s much-valued health-care system, and also its fragility, which boils down to how many people we have, how trained they are and how we treat them. Canadian health-care patients are at risk of a vicious cycle. When there aren’t enough people, staff are asked to do overtime, shifts are extended, the work gets tougher. Burnout increases, sick leave goes up, older staff retire and others opt for new careers. That makes the working conditions of those left behind even more challenging. In other words, it’s not an employer’s labour market.
As Australian doctor Eric Levi recently tweeted, “It’s the ‘Intensive Care Unit’ not the ‘Lots of Ventilators Unit.’”
And yet, in times of budget restraint, governments have traditionally targeted health care wages and jobs, since those are the primary drivers of expense. That’s not going to work any more.
So what do we do about this?
First of all, money does matter. We need to put the system on a solid financial footing. Start-and-stop funding, temporary programs and running a reactive, bare-bones system isn’t good for patients and certainly won’t help with this problem.
Just two months prior to the pandemic, the Ontario Hospital Association sounded the alarm that the province’s hospitals were “under significant strain, largely due to multiple years of funding restraint, demographic growth and a shortage of capacity in other sectors.” It revealed Ontario had fewer acute care hospital beds per capita than any other jurisdiction in the developed world.
But money isn’t enough. Governments that think they can announce funding for service expansions and it will magically materialize are in for a surprise.
When it comes to our health human resources, we need to figure out what we need because, amazingly, at the macro level we don’t really know. Ontario’s health-care system last developed a comprehensive capacity plan in 1998. Canada is the only developed country in the world without a national health human resources strategy.
And we need to move forward on immediate, emergency measures as we figure out the long game.
We need accelerated training programs through postsecondary institutions and programs to allow rapid upskilling within health-care organizations. Health care employers require secure funding to allow the creation of more permanent, full-time positions, as well as late-career incentives to delay retirement of senior staff. We must also turn talk to action on putting foreign-trained professionals to work.
There are lots of great ideas and there’s high motivation across the health care sector to make those happen. But we can’t do it alone.
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