Ever since we’ve been dealing with COVID-19, we’ve been worried about overflowing hospitals and a collapsing healthcare system. And for almost exactly as long, various provincial leaders have been promising to correct that.
Doug Ford Clip
Today, I can also announce that we’re investing $125,000,000 to get 500 additional surge beds in Toronto, Windsor, Durham, Kingston, and Ottawa.
John Horgan Clip
We will be securing additional space capacity for a field hospital in the lower mainland and could have a hospital set up in five to seven days.
Doug Ford Clip 2
We’re investing $2.8 billion in our Covid-19 fall preparedness plan. It’s a plan that will add nearly 1500 hospital beds, including 139 critical care beds, to ensure we have the capacity to care for patients and fight this deadly virus.
There’s no way to quantify exactly how many hundreds or thousands of extra hospital and ICU beds Canadians have been promised during this pandemic. But it is safe to say that number is substantially more than we have actually added. And of course, as we all know by now, hospital beds without the staff to care for the patients in them are just beds. So two years later, we’re still failing at the basic stuff. The question is why? How was Canada’s pre-pandemic healthcare system built to enable exactly this kind of crisis? And how have decisions made during the pandemic worsened it? Right now, it’s clear that some kind of change is inevitable. The system is not working as is. So what kind of change should it be? Like it or not, at some point there will be a discussion about private companies providing some of the capacity our system is missing. And if that capacity doesn’t come from anywhere else, the answer to that question will have to be yes, simply to keep Canadians alive. Private health care is not a road that most Canadians want to go down. So right now, while we’re at the crossroads, we need to talk about that.
I’m Jordan Heath-Rawlings, this is The Big Story. Justin Ling is one of Canada’s best freelance journalists and podcasters. His latest show is called The Flamethrowers and It’s worth your time. His latest piece is in Maclean’s, where he took a deep dive into our healthcare system and the capacity it doesn’t have. Hi, Justin.
Hey, how’s it going?
It’s going pretty well. Our health care system is on the verge of collapse, but is holding on by a thread right now.
That’s about right.
So take me back to the beginning of this pandemic when we realized that our hospital system was maybe not up to the job. What did premiers around the country do about it?
So listen, there’s a metric that I think people point to in our healthcare system as though it’s something bad and it’s the fact that we have relatively few ICU beds and hospital beds per capita. This is something we’ve heard a lot recently. And this is the reality that we had going into the pandemic. Canada just does not have that many ICU beds. But actually that’s not necessarily a bad thing. Coming into this pandemic, we ran a relatively efficient healthcare system. We didn’t waste a lot of money on things we didn’t necessarily need. If you don’t want necessarily to have ICUs sitting half empty, that implies you have twice as many beds as you actually need. And those beds are really expensive. So coming into this pandemic, we didn’t have a lot of ICU capacity. That wasn’t necessarily a bad thing.
But as soon as we started seeing the impact on our health care system that came with these high case counts, we started hearing Premiers say, well, it’s time we get that surge capacity in place. It’s time we start adding new ICU beds. It’s time we start making sure that our hospitals can sustain the number of patients that we may start seeing in the coming months. You heard in particular, Ontario Premier Doug Ford come in and say that he was going to try and double the size of Ontario’s ICUs. He was going to try to add or in some cases, he said he already did add about 1500 new critical care beds. And that, he said, would really strengthen Ontario’s health care system to make sure that there wasn’t sacrifices being made in order to look after those who are getting sick with COVID-19. To make sure that surgeries weren’t being canceled, to make sure that the critical procedures weren’t being put off, because there wasn’t enough space in the hospital, because there wasn’t enough resources, not enough staff, and so on.
And that’s exactly what we wanted to hear. From the beginning of this pandemic, we wanted to hear our leaders say that they were going to work feverishly to make sure we had that capacity, to make sure we had that ability to respond quickly and agilely. The unfortunate reality is that it was all a mirage. Those beds that Doug Ford promised never materialized in any great way. We have not seen really any province significantly increase its ICU capacity. In many cases, we’ve actually seen a precipitous decline in our healthcare system’s ability to look after influxes of patients. And it’s a really frustrating realization of how dire our health care system is. And we should be really worried that we may never recover from where we’re at right now.
I want to get your thoughts and the people you talk to thoughts about why in a second. But first, in terms of those numbers of critical care beds, when you were reporting this, how did you find those numbers and where did you get them and what did you look at? Because one of the things that I’ve really noticed in previous waves, and especially in this wave, is that provincial governments will tell us we have a certain number of beds. Doctors will say those beds are all full or those beds can’t be staffed. And I think just recently in Ontario, at least, we were told that we had 500 empty ICU beds and the capacity to add another 500 if necessary. Meanwhile, I’m seeing doctors on Twitter talk about, well, we’re transferring patients to other hospitals because we’re full. So I think everybody just finds it really confusing and lacking reliable certifiable numbers of what our capacity is.
Yeah. So it’s really hard to actually pin these numbers down. Because it’s really easy to throw around figures that don’t really comport with reality because there are different ways of measuring what your ICU can handle. There is one metric where you’re actually talking about physical beds. You’re actually talking about space. You recently saw Doug Ford show up at a convention centre touring empty beds that would someday, he said, probably house Covid-19 patients. So on one metric, you can go out and buy a bunch of beds, go out and buy a bunch of respirators and lease a bunch of space that can physically hold people. But if you don’t have the staff necessary to man those beds, well, then you don’t actually have that capacity, do you? You just have an empty room full of beds where people can’t be treated because there’s no health care staff available.
So it can be really hard to try to pin down governments on exactly how much capacity they have, not just how much physical resources they put into it. The Ontario Science table actually did this math and actually kind of dug into these numbers late last year, and they basically found that going into the pandemic, Ontario had the physical infrastructure and the staff to manage about 2000 adult ICU beds. They said as of the end of October 2021, that number had risen to about 2343. In real terms, Ontario added over two years, 300 beds to the ICU system across the country. That is a far cry from the thousand and a half, 2000 beds that Doug Ford promised the province earlier in the pandemic.
But there’s actually something even more worrying behind that number, because even if that’s its overall capacity, we’ve seen a significant number of healthcare workers flee the system in Ontario as well as the other provinces towards the end of last year and early this year. We’ve also seen waves of healthcare workers off sick after they contracted Covid-19 in the hospital system. So for every person you have outside that system off sick, you’re actually decreasing your capacity significantly.
What’s more is that the province, just like pretty much every province in this country, save for the Atlantic provinces, the provinces have dispatched fewer people to do more work. I was talking to doctors and nurses who told me that there were floors, usually Covid-19 floors, that normally would have run with maybe four nurses and are now running with two. I’ve spoken to respiratory therapists who told me that their normal workload is about five patients on respirators for every single respiratory therapist. Now you’re looking at 7, 8, 9, 10 patients per respiratory therapist. So in many ways we haven’t actually expanded capacity or staffing. What we’ve done is asked our healthcare workers to do, in some cases double the work, and that actually comes with a significant cost to the system. You are burning people out, you are losing staff, and that overall increases the workload on everyone who’s left, increases the likelihood that they’re going to leave and in effect, decreases your ability to handle more patients.
So we have to be really skeptical when we hear politicians talk about adding beds or expanding capacity because in real numbers, oftentimes they are doing no such thing. They’re making flashy announcements and they’re splashing money onto things that are not substantially expanding that capacity, but in fact are putting money in many cases in the wrong places.
This is going to sound like a really stupid question, but why didn’t we invest in that surge capacity at the very beginning? The Premier said that they were going to that they wanted to. It seems like this is a no brainer. We were spending money, if I think back to that period of time, on everything necessary, just throwing money at people to keep them afloat while we weathered this. This seems like the simplest thing we should have thrown money at. But we look back now and it didn’t happen. Do we have any idea why?
Well, I think on one hand you have to realize that the premiers just proved themselves completely incompetent at long term planning for this pandemic. I mean, look at every single metric: testing capacity, contact tracing capacity, good PPE, good effective scientifically based measures. Every time we’ve heard premiers talk about how they’re going to use the benefit of time between waves of this virus to prepare and strengthen our system for the next time the virus really kind of rips through the population, we’ve seen all those promises basically turn to sand.
We have not substantially increased our testing capacity over the past year. We have not staffed up contact tracing to the point where it’s proven resilient in the face of high case counts. We have not acquired the PPE necessary to actually protect many of our frontline workers. We are still doing things that are useless, time consuming and expensive, like putting up plexiglass barriers around everything, a move that has been pretty much universally derided as useless and theatrical. We have not done any of the short, medium, long term planning necessary to protect our system, to keep people safe and to try and blunt the impact of this virus. We have consistently failed. So on that front, we shouldn’t be surprised that the politicians have done very little to address this problem because they’ve done very little to think long term on any front. They’ve used the lull between waves to basically go back to normal and forget there’s a virus. And then when the virus spikes again, they’ve defaulted back to the same measures, which are lockdowns and curfews. So that is one measure.
The other measure is that this actually is a really hard problem to solve for. To try to actually expand capacity quickly is incredibly difficult because expanding capacity functionally means hiring more people, getting more people trained up, recruiting more people into the system. And that is not something normally you make a big leap forward on over the course of two years. There were certain strategies that we could have employed, especially in the six to eight month period where we had relatively low cases in 2021. We could have employed some strategies to get people out of the public health system, back into the frontline health system, to recruit people from the US and abroad, to recognize credentials for immigrants and new arrivals in this country who are trained up in their home country but have not had their credentials recognized here. We could have worked harder to make sure that folks coming to universities and colleges were better trained and better prepared for ER and ICU care over the past six to eight months.
There’s a whole bunch of things we could have done that would have actually slightly improved the system. And we didn’t do many of those things. Many of those things were not prioritized. But I think fundamentally we could have done a ton of things that would have created resiliency, that would have decreased the number of staff leaving, that would have decreased burnout, decreased PTSD, and we didn’t even do those things. Throughout 2020 and 2021, you still saw governments in this country going to court to fight health care workers in their demands to get N95 masks for frontline health care settings. You actually saw the governments of Ontario and Quebec going to court saying nurses don’t need N95s because Covid-19 is primarily transmitted through droplets, not through the air. We know that is scientifically incorrect, yet there was money spent, there was time spent fighting healthcare workers in court on that front.
This brings me to what I really want to ask you about when it comes to the staff on the front lines that you mentioned, basically, are our search capacity now in terms of overworking them. You looked at a study from McMaster that tried to quantify the impact of all the stuff we just talked about, fighting them over pay and not hiring more and not recruiting more. Explain how that study works, because I found it very enlightening compared to what we usually hear about people on the front lines.
Yeah. I mean, through this pandemic, you’ve heard politicians extol the virtues of those frontline workers, call them heroes, call them those who are sacrificing the most. Yet in actual terms, we’ve seen so little support for those health care workers from our governments to the point of just absolute offensiveness. This survey really tried to gauge the mental health impact on doctors and nurses and in particular, respiratory therapists. These are the folks who are actually doing the intubations, who are managing the respirators, who in many cases are holding the hands of these patients when they die. Respiratory therapists are the unsung heroes of this pandemic, and they’re often not talked about or forgotten entirely.
What this research found is quite obviously that the prevalence of PTSD is rampant in many of these hospitals and clinics and ERs, and that shouldn’t surprise anyone. Many of these healthcare workers have never experienced the level of death and misery as they have over the last two years. That should surprise no one. But the thing that really jumped out for me is the prevalence of what they call moral distress. Now, moral distress is not just a metric of how hard this job is, or how depressing or kind of soul crushing it is, but it’s actually a metric of how these health care workers feel unsupported and sort of forsaken by their own system. Moral distress is the measure of how health care workers feel like they’ve had to compromise their own mandate, their own mission, their own code and ethos, and their own morals for the sake of actually kind of continuing on the job. So this could include everything from witnessing your colleagues not providing an adequate duty of care, not feeling like you can provide an adequate duty of care, providing care that you feel like is actually more harmful to the patients and helpful, or having to forsake one patient for another. These are the sort of awful choices that you’re forced to make in a system under strain. And what they found is that the prevalence of moral distress in health care workers across the country right now, respiratory therapists in particular, is significantly higher than normal times. You’re looking at 50% as much higher in these measures of moral distress.
And one of the biggest problems facing these health care workers is a feeling like their governments are not there to support them. Most healthcare workers in this country have not seen an actual pay raise because of COVID-19 since April, May, June 2020. In many cases, in Ontario, for example, you’re still seeing governments who are actually fighting against cost of living increases. In Ontario, health care worker wages are limited, capped at 1% per year, even amidst rampant inflation. In Quebec, you’ve seen the government fighting against healthcare workers and taking away their vacation time. In some cases, you’re seeing forced overtime that goes days and days and days, if not weeks. You’re seeing healthcare workers who have not gotten a day off for weeks at a time. And even more acutely, I just mentioned it, but the fact that many health care workers across this country still can’t get N95s even as their governments are going up to the public and saying try and use N95s whenever you can.
The fact that governments are still not making them universally accessible for healthcare workers is egregious and healthcare workers are feeling the impact of those decisions. Healthcare workers are feeling like they’re being sent to war without armour, and that has a tremendous mental health impact. In this study, they actually found that health care workers are reporting that at least one to three days every month they are supposed to work, and they’re physically or mentally incapable or at least incapable of delivering the amount that they expect from themselves because they feel the mental health strain of these decisions. We are, in effect, burning out and harming our healthcare workers, and they’re leaving. They’re unable to work, incapable of coming to work, or they’re just leaving the system altogether. And that, in effect, is weakening our entire capacity across the board. You are seeing a hollowing out of our ability to take care of seriously ill patients in this country because our governments are pushing our health care workers to the brink and doing nothing to support them.
I know from speaking to other people and also from your piece and some of the data we’ve seen is that to your point, it might have been efficient before the pandemic, but it didn’t have a ton of capacity. Is there a world in which we actually learned from this and our health care system emerged better than it went into the pandemic? Because again, all the things that you’re detailing here seem pretty simply solved with money and time and it’s just not happening. I know you can’t speculate on why, but it just kind of blows my mind. And not only does it feel crappy to the people that are bearing the brunt of it, but it also just feels like a missed opportunity.
And the reality is that governments are more than happy to spend money, but seemingly not on the things that actually matter. I mean, think back to the start of the pandemic. You saw Premiers bending over backwards, jumping over themselves to try and source new ventilators, right? This was at a time where we worried that our ICUs would not have enough ventilators to manage the number of patients coming into the ER. And you saw government splashing money over towards companies who promised to make them, promised to retrofit them, so on and so forth. And in the end, they didn’t make the same investments in the workers who’d be running the machines. I heard from one healthcare worker who told me that in several hospitals, those brand new ventilators are sitting idle in the corner of a storage room because no one has had the time or capacity or brainwave to get trained up on them.
So governments are more than happy to spend money on things that they can cut ribbons on and stand around and lob themselves for, but they’re all too unwilling to spend that money on the staff we actually need to make the system operate because you can’t really hold a big press conference, unveiling new nurses and doctors. It just doesn’t work quite the same way. It’s not as politically advantageous to you. So what does long term resiliency, what does the reimagining of our health care system actually mean? It means getting new staff in the system. It means getting them trained up better and faster. It means a system that is more flexible and dynamic and able to move resources more quickly and acutely.
And it’s not as though we haven’t got this advice before. After the H1N1 pandemic of 2010/2011, you actually saw the Canadian Medical Association come out and say, we were not ready for this. We were not able to handle this effectively. There’s a Senate hearing from 2011, the head of the Canadian Medical Association sat down in front of the senators and said, we do not have the surge capacity in our system to handle a pandemic. He said point blank, if H1N1 had been slightly mo1re severe, it would have been a catastrophe. And what we’re seeing now is basically a more severe H1N1, and it has been a catastrophe. We are still seeing horrible decisions being made to put off critical surgeries, to put off necessary care because our healthcare system has not actually expanded or built in that surge capacity to handle these COVID-19 cases. Like I said, in many cases you’re actually seeing a decrease in the ability of these systems to handle new patients. And that is unconscionable to me.
What we’re going to need out of this after this pandemic is over, maybe we need to start now, we need a conversation about what a reimagining of our healthcare system looks like. Step one, we need more money. There’s no doubt that our health care system is underfunded. And some of that is going to have to come down to the federal government increasing transfers to the provinces. But a lot of it’s going to come down to provinces actually spending the money they have wisely and efficiently, which in many cases they do not do right now. We’re also going to have to have a conversation about delivery that is more efficient, but that also has capacity that can be built out. We don’t have that right now. That’s going to be a difficult conversation.
We are going to have to give up something. Now, is that going to be giving up in terms of increasing taxes? Potentially. Is that going to be a decrease in provincial authority? Because we’re going to have to start normalizing bureaucracy across the provinces and breaking down barriers so that we can have more of a national system? That’s potential. Or we’re going to have to start talking about private care. I mean, if we are unwilling, if we refuse to fund the system adequately with taxpayer dollars, then we’re going to have to talk about other models of delivery. People hate that idea. I understand that. But if we can’t do the former, we’re going to have to do the latter. So if you’re somebody who really intently believes in a taxpayer funded universal system, you’re going to have to stand up and start saying, I’m willing to pay more, I’m willing to do more to fight for the system so we don’t have to go down the private road, because if we’re not willing to pay for it, the money has to come from somewhere.
I’m glad you mentioned the privatization of healthcare, because I want to ask you about a school of thought that it kind of sounds like a conspiracy theory. But if you hate certain conservative governments enough, maybe it doesn’t. But the theory I’ve seen floated around is that one of the reasons that we haven’t invested, even though it would be so straightforward to build this capacity, is so that we can use the crisis and the lack of ability to care for patients adequately to push for privatization. Have you heard that when you talk to advocates or people that worry about our health care system?
I mean, I’ve certainly heard that train of thought. And listen, there’s some truth to it. For years you have seen politicians refusing to put more money into the health care system even as they’re trying to forge new ways to let health care providers charge people directly for their services. You’re seeing this in Quebec, the number of fees being charged to patients has gone up dramatically over the last number of years. But at the end of the day, I still think that there is a recognition amongst conservative parties that full on privatization is unpopular, won’t necessarily fix the problems inherent in the system. And there has to be a way to spend this money but get better bang for our buck. And I think it’s a really good impulse.
I mean, look at Nova Scotia, where a progressive conservative party just came in in a total upset election running on a pledge to spend the money we need to actually create the health care system we want. And I think the jury is still out as to how they’re going to do on that pledge over the next couple of years. But I still think that there is a feeling in the conservative movement in this country that if nothing else, health care should be a universal right. Maybe there is some limited ways in which the private sector can get involved, but that it is still primarily a public system and should be funded as such. And I think it’s a really good impulse.
I still think there are Conservatives certainly in this country who want to move as far away as possible, as feasible as will be supported by the public from a universal system towards more private delivery. There’s some wisdom behind that. I mean, surge capacity could be kind of saddled on the private sector if and when we get to a situation where our public hospitals are at the brink, maybe it’s not totally unreasonable to say that the private sector can take up some of that slack. I think it’s worthy of debate, and I think we’re going to have to have that debate in the coming years. I think there’s going to have to be both sides made here.
But I think fundamentally the point I want to make to people is that the status quo is untenable. We can’t continue running the system as we did before. We can’t continue alienating our health care workers and pushing them to the brink like we have recently. We have to do something differently. If you believe that that something different should be a universal, entirely taxpayer funded model, then fight for it. If you believe that that system should include the private sector so that we can have that flexibility, so that we don’t have to rely on our politicians, well fight for that, too. I think it’s going to require a real big national conversation where all sides are involved for us to figure out what model is going to work here.
The one thing I can say for absolute certainty is that we shouldn’t trust any of the current complement of premiers, at least those west of the Bay of Fundy to be part of that conversation because they prove themselves woefully inept and indifferent to the crisis facing our health care system. We shouldn’t trust John Horgan or François Legault or Doug Ford or Jason Kenney to be part of this conversation because they have shown themselves incapable of doing what needs to be done, of actually respecting our health care workers, of paying them better, of buying them the PPE they need. They’ve shown themselves indifferent to those problems. So why should we trust them to be part of this conversation? Because apparently they do not have the competency to recognize the faults in the system.
Justin, now that all our listeners are incandescent with rage, thank you so much for this and we’ll talk soon.
Thanks for having me.
Justin Ling writing about the healthcare system for Maclean’s. That was The Big Story. For more from us, head to thebigstorypodcast.ca, find us on Twitter at @TheBigStoryFPN. And email us, tell us how much you want private healthcare in Canada, if you must, at firstname.lastname@example.org [click here!].
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Thanks for listening, I’m Jordan Heath-Rawlings, we’ll talk tomorrow.
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