Ontario’s health care system is facing staffing, capacity and funding shortages over the next six years, according to a new report, leading to concerns about whether growing demand will outpace and overwhelm hospitals in the province.
An analysis of the Ford government’s health care promises, conducted by Ontario’s Financial Accountability Officer (FAO), found the province will fall $21.3 billion short of the funding needed for hospitals, home care and long-term care by 2028 unless the government changes courses.
The report also found that, despite the province’s efforts to train and hire thousands of nurses and personal support workers, Ontario will still need 33,000 additional health care staff over the next six years to keep pace with the demand.
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The FAO found the province had failed to allocate enough money to the health-care sector to match demand for care which is projected to continue to grow.
Those factors will mean Ontario will have less hospital capacity, less long-term care capacity and similar homecare capacity in 2028 than it did roughly a decade earlier, the report said.
The Ford government said the report showed the failings of past administrations and argued the health-care system was in good shape for the future.
“Our plan is working,” the Ministry of Health said in a statement. “We’ve added more hospital beds in four years than the Liberals did in fourteen. In 2022, Ontario broke records by registering more new nurses than ever before. Emergency department wait times are coming down and we’ve started to shorten wait times for key surgeries. Nearly 100,000 people have connected to convenient care at the pharmacy for a common ailment.”
Spending on health care
While the Ford government has boasted that it won’t spare a penny when it comes to health care, the FAO’s report suggests the pool of funding isn’t as deep as the provincial claims.
By the year 2028, the FAO projects Ontario will need to spend $93.8 billion a year on health care. Using the government’s own projections, however, the report concluded that the province is planning to spend $87.8 billion in 2028 — leaving the system with a massive $21-billion funding gap.
The FAO pointed out that unallocated contingency funds held by the Ford government could be put toward health care.
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Critics have raised concerns around underspending on programs and growing rainy day funds kept by the province. The Financial Accountability Officer himself, Peter Weltman, raised questions about the unallocated money earlier this year.
“When the legislative assembly approves a spending plan, it has a certain amount of visibility into where that money’s going to go,” Weltman said.
“But if a whole bunch of money is sitting in an unallocated fund, the assembly has absolutely no idea where that money’s going to go, and they won’t find out about it until they read one of our expenditure monitor reports.”
The government is projected to spend the largest portion of its health budget on hospitals, followed by payments for OHIP and then long-term care over the next six years.
Staffing in health care
In the legislature on Tuesday, Premier Doug Ford highlighted the 12,000 nurses registered with the Ontario’s College of Nurses in 2022 and said additional nursing staff are currently being trained.
“We have 30,000 nurses in our colleges and universities being trained to get into the field. That’s what we’re doing,” Ford told MPPs at Queen’s Park.
But the FAO estimates that to make good on its various health-care sector promises — and to fill vast vacancies — tens of thousands of new staff are needed.
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In order to staff the 1,400 new hospital beds the FAO estimates Ontario will add by 2028, for example, the report says around 10,000 new hospital workers will be needed.
That could be a tall order given the state of recruitment outlined by the FAO.
The report found that, since the start of the COVID-19 pandemic, the number of health-care sector job vacancies in Ontario has doubled.
At the end of 2019, there were 14,800 vacancies for health-care jobs, the report said. Near the end of 2022, Ontario had 34,800 unoccupied positions. Of those vacancies, more than 14,000 were for nursing jobs.
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The need to recruit new staff for bigger hospitals will compound that problem.
The FAO report estimates 23,000 extra nurses and 44,100 new personal support workers will be needed in hospitals, long-term care and home care by 2027-28 to meet the Ford government’s commitments.
The combined vacancies and new jobs amount to a 26-per cent increase in Ontario nurses and a 45-per cent increase in personal support workers.
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“Adding to the challenge, Ontario currently has the lowest wages for nurses in Canada,” the FAO said.
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As previously reported by Global News, internal documents show the Ford government is concerned about its ability to recruit and retain both nurses and personal support workers.
An internal presentation, obtained through freedom of information, references a “lack of new nurses to replace those retiring and (the fact that) demand for nursing services has increased,” as one issue, going on to reference a “systemic shortage of nurses. ”
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Another line in the released document says 25 per cent of personal support workers (PSW) in Ontario can leave the workforce in a single year.
“We must reduce attrition to avoid chronic shortages,” the provincial government briefing warns about PSWs. For nurses, it warns that increased supply and avoided an increase in attrition “are required to head off chronic shortages.”
The report found Ontario’s aging population is putting a strain on the system. It is a strain the FAO said the province is failing to keep up with.
Between 2005 and 2019, under the previous administration, the number of hospital beds in Ontario grew by 2.6 per cent, the FAO was founded. At the same time, the number of Ontarians over the age of 65 years old jumped by 56 per cent.
People 65-plus occupy more than 50 per cent of hospital bed days in Ontario.
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Ontario hopes to dramatically ramp up its capacity.
Through a combination of measures, the report estimates Ontario plans to add 4,500 new beds by 2028, compared to 2020. The province also hopes to free up 2,500 beds currently occupied by patients who it plans to move to long-term care.
The FAO, however, believes the province has not set aside enough money to make that ambitious plan a reality.
“To ensure the 4,500 additional hospital beds can be operated, the Province must increase funding to the health sector beginning in 2023-24,” the report said.
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Even if the province succeeded in its ambitious plan to add 7,000 new beds by 2028 through various measures, it would not be enough to keep up with an aging population, the report said.
A combination of population growth and aging could increase demand for hospitals by 21 per cent by 2027-28, the FAO said, above the capacity increase the province hopes to deliver.
“This suggests that without additional measures, Ontario will have less available hospital capacity relative to need in 2027-28 than in 2019-20,” the FAO wrote.