Hospitals plagued by staff shortages and ER closures under Ford government, auditor general finds

Posted on December 6, 2023 in Health Delivery System

Source: — Authors: , – Politics/Provincial Politics
December 6, 2023.   By Rob Ferguson, Kristin Rushowy, Queen’s Park Bureau

Plagued by shortages of doctors and nurses and persistent emergency room closures, Ontario lacks a province-wide strategy to fix the problems, the watchdog agency said in a wide-ranging audit of government performance. 

Hallway health care still ails Ontario despite Premier Doug Ford’s 2018 pledge to cure overcrowding in hospitals, says a damning new auditor general’s report.

Plagued by shortages of doctors and nurses and persistent emergency room closures, Ontario lacks a province-wide strategy to fix the problems, the watchdog agency said in a wide-ranging audit of government performance.

The annual report Wednesday also found hospitals and nursing homes are overreliant on temporary nurses from expensive staffing agencies, driver testing loopholes are rendering roadways more dangerous, and an incomplete cost comparison in the controversial decision to move the Ontario Science Centre to Ontario Place.

As universities sound the alarm over the need for more funding and the ability to raise tuition fees, the auditor also flagged financial risks at York University, where almost one-quarter of undergraduate programs have just 20 or fewer students, raising questions about viability.

A “common theme” among the many health-care concerns in the 823-page report was the continuing shortage of nurses, acting auditor general Nick Stavropoulos told a news conference.

Aside from 203 unplanned emergency room closures at 23 mostly smaller and rural hospitals, 10 northern hospitals shut down their obstetrics units, leaving parents-to-be in the lurch at a stressful time.

“Ontario Health, the provincial agency responsible for overseeing hospitals, does not centrally monitor all instances of service closures at hospitals,” Stavropoulos noted hours before the legislature adjourned until after the Family Day holiday in February.

The auditor said closures in Ontario’s 163 hospital emergency rooms were “very rare” before the 2019-2020 fiscal year, when the COVID-19 pandemic hit, but an estimated 400 additional emergency room closures would have occurred without a Ministry of Health program that provides doctors to fill gaps on an interim basis.

“While patients requiring immediate life-saving care are able to access it in a timely manner, emergency department wait times remain long, with patients waiting an average of two hours to be assessed by a physician, up 30 minutes in the last 10 years.”

The worsening staff shortages have been fuelled by the Ford government’s Bill 124, which limited nurses and many other public sector workers to maximum annual pay hikes of one per cent, the auditor found.

That has driven hospitals and nursing homes to increasingly rely on private staffing agencies that offer nurses “higher pay and flexibility’’ — a double-edged problem that costs hospitals far more than staff nurses and makes it harder to retain them.

“There has been no legislation that caps the amount for-profit staffing agencies can charge to hospitals,” said Stravropoulos.

Opposition parties and other groups have repeatedly called for measures to rein in nursing agencies.

But Health Minister Sylvia Jones would not commit to a cap on nursing agency fees, and took issue with the auditor’s contention the government lacks a strategy to fix health care.

“We cannot take tools away from our hospital partners,” Jones told reporters, adding the province has increased the number of spots for nursing students, making it easier for health-care professionals registered in other provinces to work in Ontario.

The auditor’s report found agency nurses can earn upwards of $75 hourly, compared with $35 to $50 hourly pay for full-time nurses employed at hospitals — resulting in a “significant” increase in nursing vacancies in the last four years.

“One emergency department’s vacancy rate of full-time nurses increased from six per cent to 26 per cent in that time frame, and the rate for part-time registered nurses rose from 23 per cent to 51 per cent,” Stavropoulos said.

NDP Leader Marit Stiles said a cap on nursing agency fees is needed for cost control in hospitals and nursing homes, where better pay would help retain nurses on staff.

“The Conservatives are rigging the system to benefit insiders, funneling public money into private pockets,” Stiles charged.

A group representing nursing homes said “price gouging” by agencies must end to ease a staffing crisis that is “eroding” levels of care for residents.

“We can’t have a system where some staff are being paid twice or three times what others are earning for similar work,” said Lisa Levin, chief executive of AdvantAge Ontario.

“The report paints a startling portrait of how Doug Ford deliberately allowed Ontario’s health-care system to deteriorate under his watch,” Liberal Leader Bonnie Crombie added in a statement.

On driver testing, the auditor found new drivers from cities who went to suburban or rural examination centres had collision rates 16 to 27 per cent higher than those who did their road tests near home.

He called on the Ministry of Transportation to reconsider its decision to axe “certain manoeuvres” like parallel parking and three-point turns from driver road tests to help ease a pandemic backlog that was cleared a year ago.

“Ensuring drivers have effective training and are skilled at driving safely before receiving their licenses is critical to keep Ontario’s roads safe,” said Stravropoulos.

On the move of the Science Centre to Ontario Place, the auditor said the decision was made “with preliminary and incomplete cost information” and a lack of consultation with stakeholders including the City of Toronto and the Toronto and Region Conservation Authority.

The government did not use “a complete list of costs for detailed comparison of relocating versus remaining at the same location,” he said.

Infrastructure Minister Kinga Surma told reporters the government relied on a “business case” for the move it released last week, suggesting it’s cheaper to move than stay — although critics said it was also incomplete.

Green Leader Mike Schreiner said the auditor’s findings make it clear the move is a “half-baked ploy” by the government “to prop up their luxury mega spa” at Ontario Place, with a parking garage to be located across Lakeshore Boulevard at the CNE grounds.

Toronto Coun. Jon Burnside (Don Valley East), whose ward includes the Science Centre, said the report seems to confirm local residents’ concerns that the decision to relocate the facility was made in haste.

“The decision itself came out of left field,” he said.

The centre provides educational opportunities to a disadvantaged and rapidly growing neighbourhood, and “we wanted to slow down and have a thoughtful approach to what happens to it,” Burnside added.

Meanwhile, the government announced it has appointed chartered professional accountant Shelley Spence, who has spent 30 years at KMPG, as the new auditor general for a 10-year term. Stavropoulos was the interim replacement for Bonnie Lysyk, whose tenure ended in September.

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