‘You can’t operate a hospital sector like it’s a car’: Here’s why Ontario’s hospitals weren’t ready for Omicron

OTTAWA-Wayne Redekop has watched hospital care in his town get thinner for more than 20 years.

The five-term mayor of Fort Erie remembers the day in the mid-1990s when the local hospital's obstetrics unit shut down and moved to Niagara Falls, 30 kilometres away.

He recalls more vividly the anger in 2009, when the entire hospital closed after more than 75 years.

And just this week, amid a massive rise of COVID-19 infections fuelled by the Omicron variant, the regional health unit shuttered Fort Erie's urgent care centre - a temporary blow due to staff shortages that will force the town's roughly 33,000 residents to drive 20 minutes west to Port Colborne for emergency needs, Redekop said.

For him, it's all part of the same regrettable story: that a generation of cost restraint has left health care in Ontario stretched thin and vulnerable. And then along came COVID-19.

The pandemic has brought into full focus the shortcomings in our hospital and health-care system, and the lack of resiliency," said Redekop.

Resiliency requires money," he added. We don't have that and we haven't had it for quite a while."

To experts, it's no surprise Ontario is straining under the Omicron wave. Despite the widespread use of vaccines and predictions that Omicron is less likely to result in severe illness, indoor dining is banned again. Gyms are shuttered, and schools are closed. Once again, the provincial government fears hospitals will be overrun, with their limited beds and staff shortages, as infections of this particularly transmissible coronavirus variant spike to record heights.

The potential shortcomings of Ontario's hospital system have long been known. The province's hospitals were operating at almost full capacity (96 per cent on average) even before the pandemic, in 2018-19, when nearly a quarter of the province's hospitals were actually chugging along at above 100 per cent capacity, according to Ontario's fiscal accountability watchdog.

In December 2019, the same month COVID-19 emerged as an ominous new respiratory virus in China, the Ontario Hospital Association published a report that said the province was tied with Mexico for the lowest number of hospital beds per capita of all countries tracked by the Organization for Economic Co-operation and Development (OECD). The current situation," the report concluded, cannot realistically be sustained."

And that, again, was before the pandemic.

You've taken a system that was really kind of teetering on the edge, and you've pushed it over," said Dr. Katherine Smart, president of the Canadian Medical Association, which has long called for increased health-care funding from provinces and the federal government.

The result has been the need to cancel surgeries that aren't deemed to be life-saving and redeploy staff to intensive care units, a strategy that resulted in roughly 560,000 fewer surgeries over the first 16 months of the pandemic compared to the 12 months of 2019, according to a data published last month by the Canadian Institute for Health Information.

Over the past 30 years in Ontario, yearly health-care spending has sometimes risen and sometimes fallen, but the overall government stance has been one of cost-restraint, said Anthony Dale, president and chief executive officer of the Ontario Hospital Association.

Health-care costs take up a huge chunk of the provincial budget - and did so even before the billions of dollars Queen's Park and Ottawa have spent to address the pandemic. In 2019, for example, health care represented 41 per cent of total program spending in Ontario, and the province's 141 hospitals accounted for the biggest slice of it at 36 per cent.

With this huge item on the balance sheet, successive governments of all stripes at Queen's Park have tried to keep spending in check while the population got bigger and older, Dale explained.

Former premier Kathleen Wynne admitted as much in a recent interview with Maclean's magazine.

The whole time I was premier we were working hard to balance the budget. We were holding health-care costs down," she said. If I had to do it again, given what I know about COVID, I probably wouldn't do that."

Part of the problem is that provinces have been under pressure to pick up a greater portion of health spending as the federal contribution to the shared project of public health care has declined over the years, said Smart. In the 1970s Ottawa split the cost 50-50 with the provinces. By 2019, the federal share stood at around 23.5 per cent, according to a report from the Library of Parliament.

Meanwhile, Dale said, the overall policy goal in recent years has been to find ways to beef up forms of care that prevent people from landing in expensive hospital beds. But he said this so-called revolution" in health care never arrived.

Instead, hospitals have been under pressure to become more efficient," something Dale said they have indeed accomplished. His association's report from the eve of the pandemic said Ontario, with the lowest hospital spending per capita in Canada, also had the shortest average stays for acute-care patients. It's hospital standardized mortality rate - a way to measure the standards of care - was also in line with the national average, the report said.

This occurred even as the report said the total number of hospital beds in the province fell in the 1990s and stayed relatively flat between 1999 and 2019, a 20-year period in which Ontario's population grew 27 per cent and the number of people over 65 increased by 75 per cent.

Yet despite this efficiency," Ontario hospitals were running at almost full capacity all the time. There wasn't much slack in the system for an emergency like the pandemic.

You can't run a hospital sector like it's a car, with the gas tank empty all the time," he said. Sooner or later, you're going to see that gas light flashing and you're going to run into trouble on the side of the road."

While it comes with downsides in the case of a crisis like the pandemic, there are obvious reasons why the Ontario hospital system ran so close to its limit before the pandemic, says Bob Bell, a former deputy minister of health for Ontario who ran Toronto's University Health Network for nine years.

I'm giving you as a hospital CEO $100 million to run your hospital, OK? What do you think I expect you to do with that as a government agent of the system? You think I'm expecting you to have a bunch of nurses who aren't doing anything?" he said. What I want you to do is to be fully employing everybody who is in your hospital, providing care for patients.

That's not really good, but that's why Ontario runs at $1,000 less per capita than Alberta."

For the CMA's Smart, the pandemic has shown the folly of operating so close to the system's limits. She argues governments across the country need to pump billions more into health-care spending - including Ottawa, which premiers are collectively pressing to increase its share of total Canadian health spending to 35 per cent, a difference that would cost roughly $28 billion per year.

Bell argued additional money is best spent expanding capacity outside hospitals in the area of transitional" care, where specialists can care for patients who need attention but don't need to be in the hospital. As of 2019, according to the Ontario Hospital Association, such patients occupied a record 17 per cent of hospital beds in the province.

Others, like the University Health Network's Dr. Andrew Boozary, want to see more money alongside reforms to integrate parts of the health and social systems that operate in silos, as well as improvements like the uniform use of electronic medical records.

But increased funding can't come from nowhere; it requires trade-offs, like reduced spending in other areas, increased government borrowing, or the politically difficult decision to increase taxes, said Phil Triadafilopoulos, a political scientist at the University of Toronto.

And when the system appears to work reasonably well - outside of the pandemic - there is little political incentive to make difficult decisions to prepare for a potential disaster or future challenges like the health needs of an aging demographic, he said.

Triadafilopoulos compared the situation to Aesop's fable about the ant and the grasshopper: the ant saved food and prepared for winter, while the grasshopper did not and was left hungry.

Most governments are grasshopper-like," he said.

They have, however, pumped more money into health care during the pandemic. Since the crisis began, for example, the Ford government has put an extra $5.1 billion into hospitals and says it has created 3,100 beds. In Ottawa, the Liberal government has also promised an additional $25 billion over the next five years to hire more nurses and doctors, eliminate surgery backlogs from the pandemic and improve long-term care and mental health care.

Redekop, the Fort Erie mayor, says the current crisis should spark a public conversation about increasing overall health-care spending in the coming years.

What do you want available to you as a citizen, as a taxpayer? Do you want a health-care system that will meet your needs and the needs of your family and your neighbours in your community, or not?" he said.

If you want it, you have to pay for it."

Alex Ballingall is an Ottawa-based reporter covering federal politics for the Star. Follow him on Twitter: @aballinga