Hallway medicine is what ails Ontario’s hospital system

TheStar.com – Opinion – Across the province, hospital staff are relying on hallways to handle the overflow from overcrowded patient wards. It’s no way to run a hospital and it’s no way to practice medicine, Martin Regg Cohn writes.
Dec. 13, 2017.   By

What ails Ontario health care today can be summed up in two words: Hallway medicine.

Across the province, doctors and nurses are relying on hallways to handle the overflow from overcrowded patient wards. It’s no way to run a hospital and it’s no way to practice medicine.

Health care isn’t just a health issue. It’s a political issue.

The Ontario Hospital Association is clamouring, as one might expect, for help. In the practiced language of alarmist lobbyists, the OHA warned this week that the system is “on the brink” of yet another “capacity crisis.”

To their credit, hospitals haven’t cried wolf in a while. In recent years the OHA had the good sense to acknowledge that more money should flow to longer-term care as a long-term solution.

Their goal was to get so-called “bed blockers” out of the way — shifting them into affordable and effective chronic care, long-term care and home care as a way to free up far more costly acute-care beds. The Liberal government proclaimed a similar objective.

But turning around a $54 billion health-care system is never easy — nor fast. When you’re rebalancing that many billions of dollars it’s easy to lose equilibrium — and momentum.

Pent-up patient demand that took years to build up can’t be tamped down anytime soon, not after years of government restraint over health spending. Added to the mix is what looks like the worst season for influenza in recent memory, clogging local hospital beds (get your flu shot now!).

The challenge is exacerbated in Brampton by a fast-growing population. But that excuse doesn’t hold in outlying communities, where populations are declining while aging, suggesting that even when the problem is more predictable it is no less intractable.

Complaints on the hospital floor are finding an echo on the floor of the legislature. And will gain traction on the campaign trail in next spring’s election.

Give Ontario’s New Democratic Party credit for jumping on the issue more than a year ago, well before it hit the headlines. Now, NDP Leader Andrea Horwath is trying to generate fresh headlines in regional newspapers by touring the hardest-hit communities — from Toronto to Hamilton, Brampton, London, Sudbury, Thunder Bay and beyond — often with her local MPP or NDP candidate in tow.

The party has made it a priority in part because it is paying attention to union allies who have acted as an early warning system, feeding information from nurses, orderlies, and other caregivers on the frontlines. NDP researchers have also been demanding numbers on wait lists and clamouring for more spending to redress the issue.

The Liberal government counters that hospital spending wasn’t cut — it continued to increase, but only by bending the curve to a lower, slower, more sustainable rate of growth. Mindful of the looming pressure points, the health ministry bankrolled a Band-Aid solution this year by reopening two mothballed Toronto hospitals. Extra beds are also going to Brampton Civic Hospital and other hot spots across the province.

The problem is that longer-term care hasn’t grown fast enough in the short term, nor has home care or community care. Yet it would be wrong to pretend these pressures are new, or worse than ever before.

In truth, the health-care crunch is a perennial problem in this province, going back decades to the old Tory dynasty of then-premier Bill Davis, which was pummelled across the province for cutting back on hospitals. If we have learned anything over the years, it is surely that better health care is about more than merely money — it is about spending smarter by reducing pointless procedures and reallocating to more promising approaches.

The NDP has identified a problem, but implementing the solution — and getting the mix right — is the painful part for any party in power. Reopening old hospitals stabilizes the system, but builds in more instability going forward. We need to unblock the bed blockers so that patients in need don’t have to depend on hallway medicine.

Spending more on acute-care beds is only a short-term solution. In the long term, as economists like to say, we are all dead. But long-term care, buttressed by community care and home care, can breathe new life into an ailing system. Until those other elements of the health-care system are fixed, hospitals will continue to be burdened by bed blockers — no matter how efficient any emergency department tries to be.

This issue may be a perennial, but so are elections. While health care is almost never a vote-determining issue at the ballot box, it has a way of gaining traction and creating static on the campaign trail.

Politicians know that. So do hospital lobbyists. We’ll soon find out how voters think about what ails the system, and who has the remedies.

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