Temporary emergency room closures and increased wait times have become increasingly common in Ontario as the province’s health care system struggles with staff shortages.
Prime Minister Doug Ford has acknowledged that more can be done to ease pressures on the health care system, but his throne speech this week did not offer solutions to the problem.
The Canadian Press asked experts and advocates what they suggest to relieve Ontario’s overburdened health care system. Here are five solutions they proposed:
1. Repeal bill 124
Eliminating the law known as Bill 124, which caps wage increases on public sector contracts at one percent annually for three years, is high on the list of the Registered Nurses Association of Ontario.
Doris Grinspun, the association’s chief executive, said the law should be repealed to ensure nurses are adequately compensated for their work, which would encourage them to stay in the profession. He pointed to the rising cost of living in 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 spur more public sector health workers to jump into private agencies, where they could earn more.
“(Act 124) makes nurses and other public sector health 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 the increase you are,” he said.
“While money is not the only thing, we have seen a migration of nurses, particularly from publicly funded and unionized hospital positions, to private agency work.”
The prime minister has noted that the provisions of Bill 124 expire and will not apply to future contract negotiations, but has not said he would repeal the law.
2. Train, register more workers
Experts say more people need to be registered and trained to work in health care to ease the workloads of those currently in the sector.
Last week, Ontario’s health minister ordered the regulatory colleges for nurses and doctors to develop plans to more quickly register internationally trained professionals.
But the RNAO’s Grinspun said he is waiting to see what those plans entail and how quickly they speed up the process, noting that the number of nurses “waiting on the sidelines” to register is around 26,000. “The backlog must be addressed immediately,” he said.
Abi Sriharan, an assistant professor at the University of Toronto’s Institute for Health Policy, Management and Evaluation, said Canada should have a standardized accreditation system. That would allow any doctor or nurse who wants to work in Ontario to make the transition easily 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 college and university nursing programmes. Grinspun said that would help accommodate a 35 percent increase in applicants to the program that produces registered nurses and a 70 percent increase in applicants to the nurse practitioner program.
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3. Create autonomous centers to catch up with the surgical backlog
Ontario should build freestanding, publicly funded health centers that can perform less complex surgeries and outpatient procedures, said Dr. Rose Zacharias, president of the Ontario Medical Association and an emergency department physician.
That would free up beds and other resources at hospitals, which Zacharias said would translate into shorter patient wait times and allow the province to catch up with its backlog of surgeries and procedures.
Over the course of the pandemic, he said 22 million patient services were delayed, 10 million of which were surgeries and cancer screening procedures. That’s contributing to the “strain” being felt in emergency departments, he said.
“We need these facilities and we recommend that a number of these facilities be built across the province to manage the backlog,” Zacharias said.
4. Improve the working conditions of the staff
Burnout among healthcare workers and the conditions that contribute to it need to be addressed, experts say.
The RNAO’s Grinspun said nurses were facing “brutal” workloads and that more staff was key to solving the problem. Mental health support, mentoring and good leadership will in turn help with retention, she added, as nurses struggle with nearly three years of pandemic burnout.
“Having the support is helpful at all times, even more so during this time,” she said.
Sriharan, an expert in health systems leadership at the University of Toronto, said mental health resources for burned-out workers will only be “band-aids” 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 each organization and make the appropriate changes, she said.
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5. Implement a system to follow up, prevent staff shortages
Experts say a national system is also needed to track staffing levels at different health institutions to ensure there is a balanced distribution of the workforce and avoid service disruptions.
“In certain areas, we have a lot of people and then many more areas, we don’t have the optimal capacity, therefore we don’t have enough primary care doctors, we don’t have nurses who can function at the level. that we need service,” said Sriharan of the University of Toronto’s Institute for Health Policy, Management and Evaluation.
Zacharias, of the Ontario Medical Association, said a tracking system is also needed to monitor staffing shortages within health teams.
“We have been operating on intuitions and anecdotes and we need the clear data.”