Temporary emergency department closures and increased wait times are becoming more common in Ontario as the province’s health care system struggles with staffing shortages.
Prime Minister Doug Ford acknowledged that more could be done to ease pressure on the health system, but his throne speech this week failed to offer solutions to the problem.
The Canadian Press asked experts and advocates what they were proposing to provide relief to Ontario’s overburdened health care system. Here are five solutions they suggested:
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1. Repeal of Bill 124
Repeal of the law known as Bill 124 — which caps wage increases for public sector contracts at one per cent a year for three years — is at the top of the list for the Registered Nurses Association of Ontario.
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Doris Grinspoon, chief executive of the association, said the law needed to be overturned to ensure nurses were adequately compensated for their work, which would encourage them to stay in the profession. She pointed to the rising cost of living, calling for higher wages.
Dr. Michael Warner, an intensive care physician at Toronto’s Michael Garron Hospital, warned that keeping the law in place could encourage more public sector health workers to switch to private agencies where they could earn more.
“(Bill 124) makes nurses and other public sector health care workers who are subject to this legislation feel devalued and puts them in a position where they have minimal bargaining leverage because there is a cap on their salary increases “, he said.
“Although money is not the only thing, we are seeing a migration of nurses, particularly from publicly funded hospital positions that are unionized, to work in private agencies.”
The prime minister noted that the provisions of Bill 124 are expiring and will not apply in the next treaty negotiations, but stopped short of saying he would repeal the law.
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2. Train, register more workers
Experts say more people need to be registered and trained to work in healthcare to ease the workload of those currently working in the sector.
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Last week, Ontario’s health minister ordered the regulatory colleges of nurses and physicians to develop plans to more quickly register internationally educated professionals.
But the RNAO’s Grinspoon said he was waiting to see what those plans included and how quickly they would speed up the process, noting that the number of nurses “waiting on the sidelines” to be registered was around 26,000. “The backlog needs to be resolved immediately,” she said.
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Abby Sriharan, an assistant professor at the University of Toronto’s Institute for Health Policy, Management and Evaluation, said Canada needs to have a standardized accreditation system. That would allow any doctor or nurse who wants to work in Ontario to easily make the transition without going through a lengthy and often expensive licensing process, Sriharan said.
The RNAO is also calling on the Government to increase funding for additional places on nursing programs at universities and colleges. Grinspun said that will help accommodate a 35 percent increase in applicants for the program that produces registered nurses and a 70 percent increase in applicants for the nurse practitioner program.
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3. Build stand-alone centers to catch up with backlog of surgeries
Ontario needs to build publicly funded, free-standing health centers that can perform less complex outpatient surgeries and procedures, said Dr. Rose Zacharias, president of the Ontario Medical Association and an emergency room physician.
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This will free up beds and other resources in hospitals, which Zacharias said will lead to shorter wait times for patients and allow the province to catch up on its backlog of operations and procedures.
During the pandemic, she said 22 million patient services were delayed, 10 million of which were surgeries and cancer screening procedures. That adds to the “tension” felt in emergency rooms, she said.
“We need these facilities and we recommend that a series of these facilities be built across the province to address the backlog,” Zacharias said.
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4. Improvement of staff working conditions
Burnout among healthcare workers and the conditions that contribute to it need to be addressed, experts say.
The RNAO’s Grinspoon said nurses were facing “brutal” workloads and having more staff was key to solving the problem. Mental health support, mentoring and good leadership will in turn help retention, she added, as nurses battle nearly three years of pandemic attrition.
“Having support is helpful at any time, even more so during this time,” she said.
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Sriharan, an expert on health systems leadership at the University of Toronto, said mental health resources for burned-out workers will only be “patches” if the environment that caused the problem doesn’t also change.
It’s important to talk to healthcare workers to understand what’s causing burnout in any organization and make appropriate changes, she said.
5. Implement a tracking system, prevent staff shortages
Experts say a national system to track staffing levels across health institutions is also needed to ensure there is a balanced distribution of the workforce and prevent service disruptions.
“In certain areas we have a lot of people and then many more areas, we don’t have optimal capacity, so we don’t have enough primary care doctors, we don’t have nurses who can function at the level that we need to serve,” said Sriharan of the Institute of University of Toronto Health Policy, Management and Evaluation.
Zacharias of the Ontario Medical Association said a tracking system is also needed to monitor staffing shortages in health care teams.
“We’re running on hunches and anecdotes, and we need clear data.”
— with files from The Canadian Press’ Holly McKenzie-Sutter
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