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The following op-ed piece by Dr. Kevin Smith appears in The Globe and Mail.
Health care needs a course correction that only Ottawa can deliver
Now that the election dust has settled and the new minority government is finding its way, a priority must be a frank conversation about preserving and protecting what defines our country: universal health care. While much divides our country, one thing unites us: compassionate, safe and high-quality care for all Canadians. Without definitive action, it’s never been at greater risk.
The challenges we face have an extensive history – those privileged to provide care have long sounded the foghorn. But never before has there been such a perfect storm. We are seeing the ill-timed collision of several factors: a growing and aging population, clinician burnout, mental health and addiction issues, high occupancy rates of hospitals, crumbling infrastructure, funding that doesn’t keep pace with inflation, an increasing need to help vulnerable patients, and rising expectations about the use of technology from patients and providers.
Many have spent entire careers working to improve the system through efficiency and redesign – and many including myself will continue to do so – but without increasing capacity in our health and social-services systems, we will not enjoy the kind of care and innovation Canadians deserve and have paid for.
At University Health Network, we are proud to offer world-class care, research and education. For the first time in my career, though, I feel that I am failing those we serve and those who serve. I am consistently forced to admit that we can’t ensure they have access to the appropriate environments to care for patients, or protect their ability to undertake research in service of improving societal health, or provide the resources they need to educate the care providers of tomorrow, all while adequately supporting their personal and psychological well-being, which is in rapid decline.
I know I am not alone in this feeling. Canada’s and Ontario’s health-care systems are struggling more than ever. In Ontario alone, our hospitals are routinely operating at more than 100-per-cent capacity. Some days, more than 120 per cent. Expecting high performance and the best patient experience in these conditions is impossible. Overcrowded emergency rooms, long waits for inpatient beds or delays in getting care at home are the norm. Across Ontario, more than 5,300 people are in the wrong environment for their care or recovery. Most often they are in acute-care hospitals when they would be better cared for at home, in long-term care or rehabilitation.
Canada has retained and attracted some of the brightest clinical and scientific minds in the world, but their discoveries can only make it into practice at scale when delivered in partnership with dedicated colleagues, including nurses, social workers, therapists and home care providers. The fact is, we cannot budget-cut our way to success. We require expanded capacity now. When compared with similar jurisdictions, we have fewer services for every 1,000 people, in bed numbers, home care, long-term care and the list goes on.
We must correct course and soon. The original premise of medicare was a pact between the federal government and provinces to share the costs of publicly insured services. That balance has been eroded. The time for a federal investment – similar to that which began 15 to 20 years ago as a way to address the academic brain drain – is upon us. We must also increasingly engage municipal governments who now play an important role in public health, paramedic and ambulance care, public housing and transportation.
We need a renewed social contract for health care. We must see a significant investment fuelled by our federal government if we want universally accessible, medically necessary care to remain part of our national identity. Recent federal investments have been welcome and needed, but a return to the true-shared 50-50 funding model must result in expanded access and capacity. I am not advocating for a simple transfer of resources, but an explicit investment in expanding capacity that can be measured, monitored and evaluated. We need solutions with a clear plan and timelines.
Whether through a first ministers’ meeting – or another immediate process – we need leadership that is action-oriented, honest and creates a shared vision for our future. Then we must implement it.