The Kingston area requires a 22 per cent increase in hospital beds and staff in order to meet demand over the next four years, according to a new report on the province’s hospital crisis.
The report, entitled “The Hospital Crisis: No Capacity, No Plan, No End” and released on Wednesday, Aug. 23, 2023, by the Canadian Union of Public Employees (CUPE) and the Ontario Council of Hospital Unions (OCHU, the hospital division of CUPE), warns that the crisis in the province’s hospital sector will only worsen over the next four years unless Ontario makes significant investments to improve staffing levels and capacity. Citing the latest available data, the report estimates that the province must improve both staffing levels and bed capacity by 22 per cent to meaningfully address patient needs over the next four years. In Kingston, that equates to 1,388 additional staff and 172 more beds.
However, based on the current trajectory and plans put forth by Ontario Premier Doug Ford’s government, staffing and capacity across Ontario will grow by less than three per cent over the same duration.
Michael Hurley, president of OCHU/CUPE, together with Doug Allan, research representative at CUPE, held a press conference Wednesday, Aug. 23, 2023, at Kingston City Hall to coincide with the release of the report. “The government must address the untenable situation in our public hospitals,” said Hurley, whose unions represent 40,000 hospital workers across the province.
“We are in a deep crisis with no signs of improvement as we continue to fail patients and workers alike,” he continued. “You’ve got services being reduced because of staff shortages; you’ve got patients being treated on stretchers because of lack of capacity; you’ve got people waiting for services for long periods or being turned away from services; you’ve got people being discharged prematurely. It’s unacceptable.”
OCHU/CUPE cites recent Statistics Canada data showing hospital staffing levels have only increased by 0.4 per cent annually since 2020, despite patient needs necessitating a corresponding increase of 5.2 per cent annually.
Consequently, staff have been saddled with heavy workloads which, combined with wage suppression, have led to high turnover, as evidenced by the fact that staff vacancy rates in the first quarter of 2023 have increased by about 300 per cent since 2015.
“The ongoing retention and recruitment challenges will only worsen if the government fails to address working conditions and compensation,” Hurley explained. “Staff-to-patient ratios are extremely poor and getting worse. There are so many patients as demand for hospital care continues to grow, and the workloads continue to intensify. The conditions are so unsatisfactory that staff feel like they are failing patients, and they just can’t do it anymore.”
Staff are leaving for better-paying jobs with reasonable hours in the private sector, he pointed out, giving the example of a new private surgery clinic in Ottawa: “They draw qualified people away from the Ottawa hospital, which has thousands of unfilled jobs… and of course [the private clinic] only take[s] the easiest to perform surgeries — by which I mean no one with a pre-existing condition like diabetes or congestive heart failure or anything else, which would be, you know, dangerous or time-consuming. Those are left to the Ottawa hospital.” That means, in effect, the unhealthiest patients who are most in need of surgery are left to wait.
Worse yet, Allan said, “Ontario hospitals are dramatically understaffed compared to the rest of Canada. Canada itself is an outlier in terms of the international developed economies, with a record few number of beds, but Ontario within Canada is much worse.”
Allan went on to explain that Ontario has 38 per cent less inpatient staffing in hospitals compared to the Canadian average. And further, if Ontario’s staffing reached the same level as the rest of the country, it would have 33,778 more full-time staff including inpatient workers and support staff.
Allan pointed out the unprecedented situation in Kingston, where the Urgent Care Centre at Hotel Dieu Hospital has recently reduced hours, “This is the first time I have heard of an [emergency room] facility actually reducing its hours in a large urban centre,” he said incredulously.
The OCHU/CUPE report makes several recommendations to address staffing issues, including the provision of more full-time work, improvement in real wages, and banning the use of agency staff.
Improving staffing levels would also help address capacity issues in Ontario’s hospitals. Since 2022, there have been more than 145 emergency room closures due to staffing shortages, with no sign of abatement in 2023, according to the report.
However, the problem goes beyond staffing shortages, as Ontario’s hospital capacity has sharply declined over the past three decades. Based on the most recent Canadian Institute for Health Information data, Canada as a whole has 7.7 per cent more hospital beds per capita than Ontario. The result is very high hospital bed occupancy, cancelled surgeries, and increased usage of unconventional spaces, with a 22 per cent increase in “hallway health care” since Ford became premier in 2018.
According to CUPE, the government’s plan to grow capacity by 3,000 beds over the next 10 years falls well short of what is needed. That would achieve only a 0.79 per cent annual increase, even as the government itself projects an annual 1.5 per cent population growth rate over the next decade.
The report states, “Given the state of preparedness by the current government, we recognise this cannot all be done at once, so we assume just under a 3% improvement in capacity per year. With the allocation to offset the growing and aging population, we need a total 5.18% increase per year, and a compounded increase of 22.39% over four years. This means we need to add 1,891 beds in the year and 8,170 added beds over four years, far more than planned.”
Compounding the problem is the fact that health care needs are sensitive to age, Hurley said, pointing out that the population of people aged 65 and over — the ones who tend to use hospitals the most — is growing at twice the rate of the rest of Ontario’s population.
While the most recent provincial budget has greatly expanded funding for long-term care and home care (both predominantly for-profit), projections by the independent Financial Accountability Office of Ontario (FAO) indicate no significant improvement in these subsectors that would help take pressure off hospitals.