One of a series of editorials on issues facing Ontario voters:
In an election campaign a simple phrase is paramount. Complex ideas, policy nuance and ambiguity fall victim to slogans: time for change, cuts or care, the six-million-dollar man.
In that vein, it’s hard to do much better than hallway medicine.
It evokes images of overcrowded emergency rooms, hospital beds tucked in public spaces, and harried doctors and nurses running around trying to cope with it all. It seems to sum up so much that’s wrong with our health care system.
No wonder it’s become such a popular catchphrase on the campaign trail, with the Progressive Conservatives and NDP blaming the Liberals for creating Ontario’s “hallway medicine crisis” and then promising to end it.
As with all things, though, the devil is in the details. And, much as it’s hard to tell from PC Leader Doug Ford and NDP Leader Andrea Horwath’s campaign rhetoric, this is not a new problem that arrived under Kathleen Wynne’s Liberal government. And it won’t simply be swept away by electing a new one.
Chronic overcrowding of hospitals won’t be solved until Queen’s Park comes to grips with the systemic problem and, just as crucially, stays the course long enough to actually fix it.
The hospital, no matter how many beds there are, will always be the place people go when they have no other options. But that’s not good patient care and it’s not an option taxpayers can afford, especially with a growing and aging population.
Ontario’s hallway medicine crisis, which manifests as backed-up emergency rooms, delayed surgeries and overly creative decisions about what hospital spaces can house beds — from patient lounges to storage rooms — can be traced back to just a few thousand people who are in hospital beds for weeks or months on end when they should be somewhere else.
Ontario needs to keep the people who don’t need the acute level of care that hospitals provide from winding up in those expensive beds in the first place. And it needs to make sure that patients who don’t need to be there anymore are discharged to a more appropriate level of care as efficiently as possible. That’s done through better home care, enhanced community supports and long-term care facilities.
On the face of it, all three parties are on board with at least one piece of that puzzle: more long-term care beds.
The Liberals’ last budget included funding for 30,000 new long-term care beds, new nurses to staff the homes and more hours of daily care for residents.
The NDP, as is the case with most issues, is offering a “Liberal-plus” program. So Horwath is promising to create 40,000 new long-term care beds and open them more quickly.
The PCs stick with the government’s 30,000 new beds but Ford also vows to deliver them faster, half within the first five years. That’s a rate that Ontario’s long-term care association says is “impossible.”
But most troublingly, Ford has not said what he thinks that will cost or how he’ll pay for it. And the dark cloud hanging over this — and all his other fast-growing spending promises — is one of his very first promises: to cut government budgets by 4 per cent. That amounts to some $6 billion of potential cuts to staff, services and programs that he does not explain.
Unlike Horwath and Wynne, Ford has said nothing about improving home care, the even cheaper and better option for keeping people out of hospital hallways. Those are vital services to help keep the elderly and those with chronic ailments healthier and living independently at home for longer.
To be sure, there are many other issues in health care — pharmacare, dental care and mental health services — that have also been the subject of election announcements. There’s not much, after all, that a politician likes more than to announce something new.
But the health care system doesn’t just need more independent programs to solve specific issues; it needs to deliver better outcomes overall. That requires far more integration between all health care providers and innovation in how services are delivered.
Early intervention can avoid the need for more expensive options down the line and prevention, wherever possible, is still the best medicine of all. Care in the community needs to be prioritized over institutional settings. And Ontario should expand the services that health professionals can provide so that nurses and pharmacists, for example, can free up doctors’ (and patients’) time.
Aging Ontarians have increasingly complex health needs so far more coordination between health providers, from doctors and home care to hospitals and long-term care facilities, is needed. Without that, a patient is just a 911 call away from filling a bed in a hospital.
But health care is a field of incredible silos and breaking those down to put patients first has proven to be difficult.
That’s the hard, often unpopular, bureaucratic work that needs to happen. It’s not flashy and it doesn’t lend itself to election slogans. Ford and Horwath have only a few weeks left to explain how they propose to do the necessary work to make their end hallway medicine promises a reality.
It isn’t just more health care Ontarians need; it’s better health care.
https://www.thestar.com/opinion/editorials/2018/05/18/fixing-ontarios-health-system-will-take-more-than-campaign-rhetoric.html
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