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The Plan to Stay Open: Relief for our beleaguered health-care system or a move to further privatization?

Ontario’s Plan to Stay Open, a five-point strategy aimed at “health-care system stability and recovery,” has been the subject of much debate since its final release in August.

When fully in place, the province says it will add up to 6,000 health-care workers and free up more than 2,500 hospital beds. But critics highlight a number of concerns, ranging from misplaced priorities to fears around the further privatization of Ontario’s health-care system.

The plan’s five points are:

Preserving Hospital Capacity: As a nod to the ongoing impact of the COVID-19 pandemic on our health-care system, the province will continue to supply free rapid antigen testing. Antiviral treatments like Paxlovid will also be free for high-risk individuals.

Providing the Right Care in the Right Place: This aims to provide faster access to care and reduce emergency department visits, particularly where homecare would be more appropriate. The province proposes to adjust the number of COVID-19 isolation beds to provide for more long-term care (LTC) beds to reduce waitlists. Additionally, it calls for expanding adult day programs and support for caregivers and providing funding for 20 additional hospice beds.

Another aspect of this is Bill 7, or the “More Beds, Better Care Act” that allows patients in public hospitals who have been designated as “requiring an alternate level of care” to be temporarily transferred to nursing homes not of their choosing. Clinicians and hospitals will no longer require the consent of patients to determine their eligibility for a long-term care facility, select a home and authorize their admission.

Further reducing surgical waitlists: With the aims of “increasing surgical capacity” and managing waitlists, the province will invest an additional $300 million in 2022 and 2023 to increase surgeries in pediatric hospitals and existing private clinics covered by the Ontario Health Insurance Plan (OHIP).

Easing Pressure on Our Emergency Departments: The province proposes to extend of the summer locum program to provide emergency rooms in northern and rural hospitals with additional support, create a program that will provide more peer-to-peer support in rural emergency departments, and increase emphasis on access to family health organization model of primary care.

Further Expanding Ontario’s Health Workforce: This includes a program to bring in more internationally educated personal support workers; temporary suspensions of exam, application and registration fees for internationally trained and retired nurses; and funding to increase the number of nurse practitioners in LTC homes.

There are still many aspects of the plan that have yet to be fully fleshed out. Yet, organizations and individuals alike are divided by the details that have been released to date. The plan has received endorsements from the Ontario Medical Association and the Ontario Hospital Association, and scathing criticism from others like the Ontario Nurses’ Association.

We asked a panel of experts whether the Plan to Stay Open is an effective way to improve health-care services or poses a further risk of privatization to Ontario’s provincial health-care system?

Doris Grinspun, PhD

CEO of the Registered Nurses’ Association of Ontario

Nothing is black and white. There are aspects of the plan that are excellent. For example, the expansion of 625 nurse practitioners (NPs) for nursing homes with the goal to have NPs in each home within five years. Also, the expanded scope for registered nurses (RNs) and others, funding for internationally educated nurses and for retired nurses to come back as mentors and funding to increase the number of RNs and NP in Ontario’s nursing programs. But then there are other aspects that we have to keep an eye on – specifically aspects that can lead to privatization of health-care services. That’s never good, because even if it’s paid by the public wallet, when people set up private clinics, the intent is to make money. The independent health facilities that they are proposing for specialty care need to be looked at very closely. There are similar facilities already, but they are for the most part not-for-profit. As always, the danger – and the opportunity – is in the details.

As always, the danger – and the opportunity – is in the details.

We need to ensure that people have access to health-care services in a timely way and across the province and in all sectors. It’s not just about hospitals. What is often the issue is that when you make a change to one sector, it affects every other aspect of the system. The hospitals are like the canary in the coalmine; if people don’t get what they need in primary care, they then end up in the ER. For example, you cannot operate and then discharge people in a timely way without robust home care. What we need is to strengthen community care, including primary care, home care and long-term care as key sectors. And that’s one of the promises. I’m extremely hopeful and optimistic about the improvements to long-term care but remain very concerned about timely access to primary care and home care. There have been lots of promises made, but time will tell what gets delivered.

I lived and worked in the United States for six years and let me tell you that privatization doesn’t work. The research has proven conclusively that it costs more and delivers less. We need to strengthen our public health system with timely, universal access for everybody. Period.

Amit Arya

Palliative care leader at Kensington Gardens long-term care home in Toronto

In my opinion, the Plan to Stay Open fails to adequately address many of the issues facing Ontario’s health-care system. The No. 1 concern across our health-care system is a dire shortage of health workers.

To be fair, the current government did not create the health-worker shortage. It is trying to hire health workers, for example, by reducing the barriers for entry of internationally educated nurses. But the problem is that it is only focusing on recruitment and not doing enough to address retention. The overwhelming majority of nurses feel that they are not being fairly compensated. If the government were serious about retaining health workers, especially nurses, it would have repealed Bill 124 and provided all health workers, including nurses, a fair wage increase commensurate with the very high cost of living and inflation. Also, ensuring equal pay for equal work would go a long way in reducing wage disparities between nurses employed by hospitals and nurses employed by private, for-profit agencies.

The plan also speaks about changing the status quo and increasing innovation. Many people speculate that this may mean an increase in private, for-profit delivery of care to help address surgical and diagnostic imaging backlogs. If we look at the evidence, we know that outsourcing health-care delivery to private, for-profit corporations results in worse health outcomes and a higher cost to the public. So, it is important for the Ontario government to instead invest in solutions within our public system. For example, a centralized referral system where a patient is referred to the next available surgeon could reduce wait times by more than 50 per cent.

If the government were serious about retaining health workers, especially nurses, it would have repealed Bill 124.

Furthermore, the Plan to Stay Open spoke about creating space in hospitals. Subsequent to the announcement, the government proceeded to pass Bill 7. Unfortunately, this bill will put frail elders and people with disabilities at significant risk by sending them to long-term care facilities far away from their families and communities – all without their consent. What many people may not know is that many of these patients have a limited prognosis, and some will live less than three months. So, while it is absolutely true that hospitals are significantly short on space and under pressure to discharge patients, a far better solution would be to invest in home care as home is where almost all older adults and people with disabilities want to be.

The final concern is that we have inadequate measures to address the ongoing COVID-19 pandemic. We simply cannot expect to pummel our exhausted health-care system with yet another wave of COVID-19 and expect nothing bad to happen. Of course, this is not a call for lockdowns or capacity restrictions. But as a starting point, the government needs to be honest with the public about the risks of COVID-19 for individuals and for society at large. This can involve a media strategy to destigmatize important public health protections such as masking and vaccines. A plan to educate everyone about airborne transmission of COVID that can be mitigated through improving ventilation. Understanding the risks of long COVID is also very important. Finally, normalizing the ability for everyone to stay home when they are sick by implementing 10 paid sick days for all workers would go a long way to controlling unnecessary spread of COVID-19, and needless death and disability.

We simply cannot expect to pummel our exhausted health-care system with yet another wave of COVID-19 and expect nothing bad to happen.

Jim Wright

Pediatric orthopedic surgeon and OMA Executive Vice President, Economics, Policy & Research

With regard to addressing the health and human resources issue, I very much welcome the expansion of medical schools and the investment in nursing and other health-care professionals. But let’s take, for example, the opening of medical schools. That doesn’t help us for a minimum of probably eight years. There are foreign-trained physicians who practiced in their country of origin who are now landed immigrants, have completed the basic qualifying exam and are very keen to start practicing. We believe there’s a real opportunity, with the appropriate safeguards, to get a fairly immediate infusion of physicians. The minister has directed the College of Nurses along similar lines, and that was a very positive move we would like to see amplified.

We believe there’s a real opportunity to get a fairly immediate infusion of physicians.

I also want to emphasize that hospitals are struggling to meet needs. In terms of the ALS (alternative length of stay) patients, anything that can be done to strengthen home care or long-term care to allow those patients to be moved out of an acute care setting is positive. In addition, the reduction of surgical wait times is completely aligned with our aim of what we call “integrated ambulatory centres” that work in partnership with the regions and hospitals for less complicated outpatient surgeries and procedures to ease the burden on hospitals and reduce wait times.

The only other thing that we brought up that was not in the five-point plan is palliative care. This is a highly vulnerable part of the population. We believe that if we could expand palliative care and expand the number of hospice beds, that would be better not only for patients but also happens to be more cost effective. We think that providing more home-care support for hospice patients would allow them to live their final days at home. That’s something we would really like to see some attention on because we do know that a significant proportion of those that would benefit from this are not accessing it.

Andrew Longhurst

Health policy researcher and PhD candidate at Simon Fraser University

Taken as a whole, the plan itself poses a lot of issues and risks in terms of maintaining health-system capacity and being able to provide effective and timely care to Ontarians.

There are some really problematic policy directions like proposing to ramp up the use of private for-profit surgical centres. This is an area where I’ve done a lot of work. We just released a report on the situation in B.C. and a lot of these initiatives couldn’t come at a worse time. Namely, we’re relying on a health-care workforce that is burned out, that is leaving in droves and looking for other opportunities where there may be a reduced workload. Private nursing agencies and other private for-profit clinics may have reduced workloads and more regular 9-5 type hours. The issue here is we are going to be drawing on the same health-care workforce and trying to split them into two different sectors. We have a lot of empirical evidence to show that this is going to exacerbate the staffing shortages that we already face in our public hospitals.

What is particularly jarring in the plan itself and in the pieces of it have been rolled out is the big disconnect between the Ontario government’s approach and many of the issues that it sees as the solution.  For example, contained in it is nothing that is focused on reducing the disease burden of COVID-19 to help preserve health-system capacity.

There’s a big disconnect between the government’s approach and the issues that it sees as the solution.

SARS-CoV-2 and long COVID, which needs to be communicated as a vascular and neurotropic disease, burden our health system. There seems to be an inverse relationship: the more we learn about this virus, the disease, and the lingering and its long-term effects, the less we do to manage it. That’s a real problem. We know how to prevent and slow the transmission of SARS-CoV-2. We need to communicate to the public that it’s an airborne virus. Those interventions include the use of masks and indoor in congregate settings. We need to involve the use of testing in a systematic and widespread manner. We also need to adopt adequate paid sick leave, which is not available in Ontario, as well as in much of the country.

As we go into fall and winter, we’re going indoors and other respiratory viruses are circulating more frequently. We’re going to see compounding stress and strain at a time when we can’t afford it. We need to manage the ongoing pandemic in a smarter way. If we’re serious about providing timely access to care, which is the stated goal of this plan, the government would be taking these steps seriously rather than abdicating its public health responsibilities. We need to protect our health-care system, and in the government’s plan there seems to be a complete disregard for the evidence around how we do that.

 

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2 Comments
  • Rob Murray says:

    Part of a better solution can be found on an episode of White Coat Black Art. It would decrease the log jam in the ALC units with neighbourhood home care teams making autonomous decisions with less travel and less bureaucracy.

    ENHANCED, Intensified Neighbourhood Home Care:
    As pressures mount on home care in Canada, experts look abroad for solutions, Ore J, White Coat Black Art, CBC Radio 2022-09-17: https://www.cbc.ca/radio/whitecoat/home-care-problems-solutions-wcba-1.6581490

  • Ross Kirkconnell says:

    For many years, local health systems have come together to develop plans for “seasonal surge,” with the knowledge the capacity of our health care system, at any point in time, is precarious. Let’s reflect on how that happens…

    We were all awestruck on the devastation caused by Hurricane Ian on the Gulf coast of Florida. But years and years of removal of natural dunes and wetlands, overbuilding on wetland areas with the corresponding dredging and channelization left cities like Fort Myers extremely vulnerable: the picture-perfect communities teetered on the edge of disaster, hoping the roulette wheel never landed on their number. Oops…

    That’s for health care in Ontario. Reduced enrollment in medical schools in the ’90s, insufficient investment in nursing and PSW training programs in the early 2000’s were an inverse correlation with the aging population, the obesity epidemic and the aging of the health care workforce comprised of boomers. I so remember reading Victor Marshall’s Aging in Canada (1980), clearly telling us what was coming and the need for investment in health care and the other supports for an aging population. Instead, we continued to dredge.

    So COVID, like Hurricane Ian, has come and left devastation in its wake. There isn’t enough infrastructure to fix this quickly: we can’t bring in the National Guard. The clean-up after this storm will take quite some time and requires action by all. The months ahead will be difficult but hopefully governments, system leaders and the general population will have learned about the importance of sustainable investment.

Authors

Maddi Dellplain

Digital Editor and Staff Writer

Maddi Dellplain is a B.C.-based journalist specializing in health reporting. Maddi works across multiple mediums with an emphasis on long-form features and audio-based storytelling. Her work has appeared in The Tyee, Megaphone Magazine, and more.

maddi@healthydebate.ca
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