The news gods have been particularly cruel these past four years, but they do occasionally bestow blessings upon me. As I continue to speak with health-care-system participants about just how badly things are going in Ontario, the province finally agreed to terms with the federal government last week for almost $9 billion in additional health-care funding, which will be spread out over the next 10 years. The federal money does come with strings attached. Figuring out what those strings would be took about a year. In exchange for the first tranche of funding — $3.1 billion over the next three years — Ontario has committed to creating more primary health-care teams (doctors and nurses) and more spots for educating future health-care workers.
That’s what the feds squeezed out of Premier Doug Ford in exchange for the billions. For Ford, the good news is that it’s a pretty easy thing to agree to. We should all be so lucky to have people demand of us only what we should already be doing. The bad news for Ford and for the rest of us is that Ontario has now committed to keep doing what it has already been trying to do — unsuccessfully.
As I noted in my column here last week, about the expansion of a hospital facility in the Greater Toronto Area, adding additional physical infrastructure to the system is good. Really, it is. We need more infrastructure, including hospital beds and operating rooms. But where we’re really falling down is in our ability to staff our beds, operating rooms, community-care positions, long-term-care homes, family medicine practices, and so on. It’s one thing to provide a bunch of money to recruit new health-care workers. It’s another thing to actually recruit them or at least to recruit them fast enough to offset attrition.
And that’s where the news gods smiled upon me again. On Monday, the Ontario Appeal Court ruled that Bill 124 was indeed unconstitutional. Bill 124, as the reader will remember, had limited public-sector workers to 1 per cent annual wage increases during Ford’s first term. This is relevant for our purposes today because that included nurses. The bill, which was passed before the pandemic, was incredibly unpopular and controversial and had already been ruled unconstitutional by a lower court. Monday’s ruling upheld that prior one. We will have to see how Ford responds to this, but, at the very least, it’s possible that the issue of wages will now be addressed for nurses, which could help address the chronic staffing issues that are dragging our system over the edge of the abyss.
So, hey, that’s good news, of a sort. More money to spend and a court ruling that will encourage Ford to spend more on wages, which is obviously a key way to recruit and retain talent.
The concern I have, though, is that we are, yet again, talking about inputs. As I have long written, Canada’s political culture has a major “inputs versus outputs” problem.
Our politicians are extremely good at message discipline, which is the somewhat nicer way of saying “spouting talking points.” Present any politician across the land with a problem that might be annoying voters in their constituency, and that politician will cite chapter and verse telling you all the things they’ve done to address that problem. “Oh, yeah, dear voter, we know that’s a real hassle. But don’t worry. We’ve already established a review panel to look into it. The task force will report back to us in six months. And, in the meantime, we’ve pledged $12 million over the next two years to create 20 new inspectors or outreach workers or whatever.”
I made that up on the spot, as you can tell, but you all get the point. That kind of language is absolutely ubiquitous across our politics. If you actually tuned in to watch the press conference with Justin Trudeau and Ford last week, when the new health-care funding was announced, you saw a great example of it. Michael Tibollo, Ontario’s associate minister of mental health, was asked by Ford to respond to questions about a recent rash of drug overdoses in Belleville, a small city of more than 55,000 people between Toronto and Ottawa. The minister was quick to rattle off all the great things that Ontario has been doing to address the overlapping mental-health and opioid crisis. And it all sounded really impressive, until you stopped for a minute and realized that there had been dozens of overdoses last week in Belleville anyway.
Because there it is: the inputs versus the outputs. The inputs are all the things the minister wants to tell you that he and his government have been doing. The outputs are overwhelmed first responders in a small Ontario city being unable to keep up with the volume of overdose calls they’re getting, resulting in the declaration of a state of emergency.
The new federal money is an input. Creating new positions for the training of medical doctors is an input. Building a new tower at Toronto Western Hospital to house patient beds and operating rooms is an input. The only output that will matter is a health-care system that is better able to address both the emergency and the routine health-care needs of Ontarians.
Do any of you have any faith that that is what we will actually get? Or are we going to get years more of politicians deflecting every question from a journalist and complaint from a constituent by pointing to the fact that billions of dollars of federal funding are coming, that new physicians are being trained, and that a new tower is being built at Toronto Western?
That’s the cynical view. But the optimist’s take isn’t much more encouraging. Let’s say the new federal money is sufficient, that Ford spends it wisely, and that everything goes as planned. Let’s say that Bill 124 is finally abandoned and nurses flock back to the system, lured by higher wages. That’ll help. But it still takes up to five years to train a new nurse from scratch, and we won’t get back all the ones who left, plus all the ones that are retiring. A doctor can take a decade or more to train from scratch.
And, remember, this is the optimistic scenario.
Think of where our health-care system is today. And then imagine what will happen over the next five to 10 years. Even the optimist will have to watch things get a lot worse, for years, before they get better. The news gods may not like us much, but at least we know with certainty that we won’t lack for things to write about.
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