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Monday, July 15, 2024


Health care is Job One for the Ontario government. Shouldn’t they be better at it?

Premier Doug Ford makes a health-care announcement with Health Minister Sylvia Jones in Toronto on January 16. (Frank Gunn/CP)

ANALYSIS: The auditor general’s annual report is a stark reminder that spending less does not always mean spending well

Health care is the provincial government’s single biggest expense. In the 2023 budget, the broadly defined “health sector” accounted for $81 billion of the total $190 billion in program spending — that is, spending that doesn’t include debt service. Ontario dedicates more than twice as much money to health as to education (the number two expense), and the amount it spends on health is larger than the entire government budget for some provinces.

One major question you may find yourself asking in the wake of the auditor general’s annual report: If we’re going to spend this much money on something, shouldn’t we be better at it?

Three substantial chapters of the report, presented Wednesday by acting AG Nick Stavropoulos, detail government failings related to emergency-room access, issues with health-care access in northern Ontario, and serious problems facing the administration of Public Health Ontario.

Nobody who has been paying attention to the news this year will be surprised to learn that the province has struggled to keep emergency rooms open consistently. In Minden, an ER was closed entirely, but for people who need medical care, the much more common temporary closures — more than 200 in 2022-23 — are likely to be at least as disruptive. The root causes of such closures are the province’s lack of nursing staff and its failure to develop a serious strategy to build and preserve Ontario’s workforce. In the meantime, to keep ERs open, hospitals have been relying on a patchwork of programs, such as a “locum” program that pays physicians a premium to cover shifts when needed. The program is working in the sense that it averted more than 400 closures last year, but the AG’s report notes that the only long-term solution is hiring more physicians and filling permanent positions in rural and northern Ontario.

Northern Ontario’s health-care challenges get particular attention. The AG notes that hospitals in the province’s north are only inconsistently making efforts to recognize the value of Indigenous healing practices and to build the number of Indigenous professionals in the sector. Hospitals there that are designated as serving the Franco-Ontarian community have, the AG finds, done a good job of meeting their requirements to offer French-language services (as one would hope), but as the Ministry of Francophone Affairs doesn’t always complete evaluations in a timely manner, some francophone speakers may be facing health-care barriers the government is unaware of.

Perhaps the most critical point here about the north: unlike other provinces, Ontario has no dedicated health-care strategy for its northern region. Ontario has a provincewide strategy (released earlier this year), but, according to the auditor, it fails to recognize and address the specific challenges of the area, where less than 10 per cent of Ontario’s population is spread over 90 per cent of the landmass.

While labour shortages are critical everywhere in the province’s health-care system, they’re particularly acute in the north. The AG notes that a physician shortage has closed the obstetrics departments in both Wawa and Moose Factory — these closures, which force pregnant people to travel hundreds of kilometres for care, have lasted more than four years.

Health Minister Sylvia Jones defended the government’s record at Queen’s Park on Wednesday after the report’s release, saying that Ontario is seeing a record number of nurses both actively practising and in the training pipeline. Jones said that the province has also seen a decline in the use of so-called agency nurses — temporary workers hired by hospitals or long-term care homes to fill gaps in their workforce. Agency nurses cost substantially more than staff positions, and the auditor concludes that the province is spending more than it would have to if it filled permanent positions.

News that somehow manages to be both shocking and totally unsurprising for those of us who remember 2020-22: the auditor finds that the government seems basically not to know what it’s doing with Public Health Ontario, the agency created after the SARS outbreak in 2002 to better prepare Ontario for future pandemics. PHO saw its funding cut prior to the pandemic, as the Tories were preparing for major structural reforms to the province’s public-health administration. Major reforms were cancelled when COVID-19 arrived, but so was a plan to consolidate some of PHO’s epidemiological labs, which test samples for infectious disease. Both reforms and lab consolidation were used to justify reduced funding for the PHO, but its funding wasn’t restored when those policies were put on the back burner.

Beyond infectious disease, the auditor notes that the PHO wasn’t consulted on major policy changes — such as those related to expanded alcohol sales and internet gambling — that have obvious impacts on public health.

The auditor general’s annual reports regularly highlight cases of waste and mismanagement, but this year’s reports on the health-care system are a reminder that spending less is not the same thing as spending well and that, in some cases at least, you need to spend more public money to fix important policy problems. Ontario may be training a record number of nurses, but if we want them to stay in this province, we’ll likely need to pay them more than we currently do — not least because Ontario currently pays nurses less than does any other province.

More fundamentally, there’s almost literally nothing more important in the halls of government than keeping the health-care system functioning, and the job will only get harder as our population ages. You’d think, for all the billions of dollars that the government taxes and spends to keep the system running, it could keep ERs open or hire some OB/GYNs so that an expectant mom in Wawa wouldn’t need to drive hours to see her doc.


John Michael McGrath
John Michael McGrath
  John Michael McGrath is a staff writer at TVO.org covering provincial politics and policy.
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