Ontario's fiscal watchdog says the province needs to spend $21.3-billion more on health care or it will face a significant staffing shortage.Chris Young/The Canadian Press
The Ontario government needs to spend $21.3-billion more on health care to meet its own expansion targets and will be short about 33,000 nurses and personal support workers by 2027-28, says a new report from the province’s fiscal watchdog.
The report, which delves into the government’s health care spending plans over the next six years, says that while the province has committed to making “significant investments” to expand capacity in hospitals, home care and long-term care, the pace will be hampered by Ontario’s growing and aging population and continuing staffing shortages.
Health care systems across the country are grappling with staffing shortages and long waiting times made worse by the COVID-19 pandemic, which backlogged surgeries and caused significant delays in treatment.
Late last month, the federal government struck a $46.2-billion, 10-year health agreement with the provinces that fell far short of their demands for an annual $28-billion increase in federal health funding. Ottawa also announced $25-billion for bilateral agreements, of which Ontario is set to receive $8.4-billion over 10 years. The report did not factor in the new health care agreement with Ottawa.
Financial Accountability Officer Peter Weltman estimates that Premier Doug Ford’s government has allocated $21.3-billion less than needed to fund current health care programs and expansion plans in hospitals, home care and long-term care, and will need to dip into contingency funds or new federal health transfers to fulfill its commitments. Otherwise, the government will have to add new funding in coming budgets and fall economic statements, make program cuts or change its plans, according to Mr. Weltman’s report. It also notes that Ontario currently has the lowest wages for nurses in Canada, although the provincial government disputes this assertion based on information from the Canadian Federation of Nurses and Statistics Canada.
“The funding shortfall is only part of the story. The more pressing issue I think is that Ontario is currently experiencing shortages of nurses and personal support workers which are projected to persist throughout our six-year forecast,” Mr. Weltman told reporters at Queen’s Park.
He added the government is “doing a lot, but they have a lot to do,” and he looks forward to seeing the provincial budget, which will be released by Finance Minister Peter Bethlenfalvy on March 23.
In the report, the Financial Accountability Office (FAO) projects health-sector funding shortfalls, starting at $1.6-billion in 2023-24 and growing to $6-billion in 2027-28, for a net funding shortfall of $21.3-billion.
Asked about the shortfall, Premier Doug Ford on Wednesday said the FAO report was only a “snapshot.”
“The FAO, they only take a snapshot in time … they don’t include the health transfers, and they aren’t including any additional money that’s going forward,” Mr. Ford said at an unrelated announcement in Pickering, Ont.
“We’re throwing everything in the kitchen sink at health care. But this is the reason we need to do things differently,” he said, referring to his government’s recent announcement to allow for-profit and not-for-profit clinics to do more cataracts and other outpatient surgeries outside hospitals. “This is the reason we’ve got to get caught up on backlogged surgeries. This is the reason that we need community surgical clinics.”
Mr. Ford pointed to numbers from the Ontario College of Nurses, which he said had registered a record 12,000 new nurses. Plus, he said, there are 30,000 people studying nursing in the province. He also pointed to the government’s retention bonuses and pandemic pay hikes for personal support workers. He said the government is spending $75-billion on health care and the province “can’t do it alone.”
“We need the federal government to support us. And again, I thank the government, the federal government for the down payment,” he said, referring to the federal health transfers.
The report also contains details about significant waiting times in hospital emergency rooms, with patients staying on average 20.9 hours in 2022-23 – the longest average waiting time recorded in more than 15 years – and at least 145 unplanned emergency department closings in Ontario last year.
Meanwhile, the report predicts the province’s health care staffing woes will continue, with an expected shortfall of 33,000 nurses and personal support workers (PSWs) by 2027-28. While the FAO projects the government will add 53,700 nurses and PSWs by 2027-28, it says Ontario will need 86,700 additional nurses and personal support workers by 2027-28 – an approximately 26-per-cent increase in nurses and a 45-per-cent increase in PSWs.
Ontario has already legislated a cap of nurses’ wages, which was recently overturned in court. The government is seeking to appeal.
Staffing shortages will have an impact on the entire health care system, the report says, affecting hospitals’ ability to admit patients from emergency departments and reduce waiting lists for surgery down to pre-pandemic levels. As of September, 2022, there were approximately 250,000 patients on waiting lists for surgical procedures, with 43 per cent of patients waiting longer than the maximum clinical guidelines for their surgery.
Sharleen Stewart, president of SEIU Healthcare, said her union has repeatedly warned the provincial government about front-line health care worker shortages.
“As health-care jobs become less safe and more stressful, Premier Ford’s cruel wage restraint law was seen as another signal to burnt-out workers that they’re just not valued anymore,” she said.
The province is looking to increase capacity in hospitals to 7,000 beds in the next five years, as well as significantly expand home care and long-term care capacity, the report says. This includes adding 30,000 new long-term care beds by 2028 and spending an additional $1-billion over three years to increase the supply of home care services. Still, the FAO estimates there will be a “slight decline” in home care and long-term care capacity compared with 2019-20, because of the growing number of seniors.
Ontario NDP Leader Marit Stiles called the report “devastating” and said Mr. Ford’s government should repeal its wage-cap legislation. “I think this government has manufactured a crisis, is putting people at risk, because their ultimate plan is to privatize our health care system,” she said.
With a report from Jeff Gray
Health sector spending projections
FAO vs. Ontario government, $ billions
FAO projection
Government projection
Historical
$100
95
90
85
80
75
70
65
60
2019-
2020
2020-
2021
2021-
2022
2022-
2023
2023-
2024
2024-
2025
2025-
2026
2026-
2027
2027-
2028
Recovery period
Medium-term
Historical
the globe and mail, source: Financial
Accountability Office (FAO)
Health sector spending projections
FAO vs. Ontario government, $ billions
FAO projection
Government projection
Historical
$100
95
90
85
80
75
70
65
60
2019-
2020
2020-
2021
2021-
2022
2022-
2023
2023-
2024
2024-
2025
2025-
2026
2026-
2027
2027-
2028
Recovery period
Medium-term
Historical
the globe and mail, source: Financial
Accountability Office (FAO)
Health sector spending projections
FAO vs. Ontario government, $ billions
FAO projection
Government projection
Historical
$100
95
90
85
80
75
70
65
60
2019-20
2020-21
2021-22
2022-23
2023-24
2024-25
2025-26
2026-27
2027-28
Recovery period
Medium-term
Historical
the globe and mail, source: Financial Accountability Office (FAO)
Laura Stone