Recently, Alberta Health Services employees and physicians received an email from the new UCP Health Minister, Tyler Shandro. Mr. Shandro echoed Premiere Jason Kenny’s prior commitment to “maintain or increase health spending, and strengthen our publicly funded health system.” In the next paragraph among a list of the usual platitudes of improving this and that, was the goal of “bringing down Alberta’s health spending to national norms by 2022-23.” Here is the UCP pre-election health platform.
There’s no question that Alberta has been fortunate in the past due to the revenue provided by the successful monetization of our natural resources. Whether this excess was squandered or not is perhaps a matter of opinion, but Alberta has historically benefited from the ability to spend more on health care than other provinces. The UCP would have you believe that this extra spending is a frivolous excess that provides no real benefit, as alluded to in their above election platform- an assertion that seems mostly based on wait times for hip surgery. Perhaps patients and health care providers in other provinces who have lived with those smaller budgets would see it differently. Every system has its challenges; health care is expensive, and there’s always something that you could do better with more money. More hospital beds and more long term care beds means better care and lower waits times. So does hiring more nurses. Paying doctors a bit more than they can get elsewhere encourages them to work in your province and eases community and physician shortages. It also enables them to hire the essential clinic support staff to provide better care and jobs in the community. Did you know that your family doctor’s billing “income” is used to pay for clinic rent, supplies, administrative staff, nurses, nutritionists, psychologists, and anyone else who works out of the same clinic, before they get their own take home pay? The government does not directly pay for any of that.
Now that the oil gravy train appears to be on an extended, or maybe even permanent hiatus, there are tough decisions to make. Everyone gets that. Health care providers of all stripes have accepted little to no pay increases for several years in Alberta, despite living with the same rising costs as everyone else, and dealing with an aging population with increased health care needs. Physicians have helped identify antiquated fee codes that could reasonably be reduced or eliminated in a modern health system. We have all participated in multiple “streamlining” exercises over the last several years that have identified inefficiencies and cut down many AHS expenses. In this recent letter, the current president of the Alberta Medical Association section of family practice outlines some of the initiatives to cut costs and improve patient care that physicians have recently collaborated on, and expresses the professions interest in working collaboratively with the current government to further streamline care.
However, the actions of the UCP in the days and weeks before and after this mail out have me seriously questioning their actual commitment to the publicly funded health system. In addition to targeting education, post secondary students, and many other public sector workers, the government has used recent omnibus bills to give itself the power to withdraw from all previous or future contract agreements with doctors and nurses, and given itself the power to dictate where newly licensed doctors are allowed to practice in the province. Since then, there has been loud signalling towards doctors to expect deep unilateral fee cuts, and notice of hundreds of expected front line nurse layoffs. There is no way eliminating front line nurses is going to improve or speed up any aspect of patient care in an already struggling system. You can argue political ideology all you want about who should pay for what in health care, but when you directly remove front-line health staff, and provide dis-incentives for doctor’s to work in the province, there is no way that the public health system is not going to be severely weakened. Patients (you and your families) will suffer for it. Other provinces have tried to “force doctors where to practice,” and have abandoned it when they started running out of doctors. Who wants to work in a socialist dystopia where the government gets to tell you where to work, and unilaterally cut your income with little to no notice without negotiation or consultation? Just two months ago New Brunswick announced it was abandoning this approach, the health minister saying: “It is flawed because it restricts the number of physicians practising, restricts the mobility of physicians and impedes recruitment.”
How is it possible the Kenny government doesn’t know this? It’s very hard not to conclude that they are trying to decrease the number of doctors in this province, because that’s what these policies are designed to do. It will certainly lower costs if there are not as many doctors to pay- for a while at least. It will also cause a lot of other problems. Perhaps it will weaken the public system enough that the UCP will have a good excuse to “give private health care a try.” That’s a supposition on my part, but if that was my goal, this is exactly how I would start.
There’s a lot more I could say about this, but I have a different purpose in this post. The Kenny government wants to “bring down Alberta’s health spending to national norms.” As a member of the Canadian Association of Emergency Physicians, I receive a monthly email that contains multiple articles of interest on the current state of emergency medicine across Canada. Each one usually contains a handful of stories about challenges faced by various emergency departments across the country. I reviewed the last several months of those letters, and pulled out all the articles that describe a system challenge that results in poor or dangerous patient care because of a lack of resources- things that are going wrong because there is inadequate staff, beds or other resources. None of them were about Alberta. Not because we don’t have challenges- we face all the same challenges to some extent in parts of the province- but because ours are generally not as bad. Why? Because we have been able to allocate the resources necessary to prevent or minimize many of these problems. So I present to you below some of the “national norms” for emergency department care. All articles are from this year. This is just from the perspective of the emergency department, but the ER has always been the canary in the coalmine of health care- when it becomes overwhelmed and non-functional, it is almost always a symptom of unmet problems at other levels. Is balancing the budget a good enough reason to accept moving further in this direction? Is a modest provincial sales tax perhaps worth the pain to keep the good thing we have in Alberta going? Isn’t it easier and cheaper to maintain what we have rather than to try and rebuild it in some hopefully more prosperous future? Those are the questions Albertan’s should be asking themselves.
“Canadians are waiting longer to receive emergency medical care, according to new figures from the Canadian Institute for Health Information (CIHI), with patients in Quebec and Manitoba enduring the longest emergency room visits in the country. …Alberta and Ontario had the second and third lowest emergency wait times, respectively, with B.C. in fourth place.”
“Hospital closures have been a problem across Atlantic Canada. In Nova Scotia, 11 of the province’s 37 emergency rooms were forced to close in August due to the unavailability of doctors. One doctor said that she’d seen people who’d suffered cardiac arrests in the waiting room and triage area.”
“We need a much more efficient process for moving them from the hospital to the nursing home,” says Dr. Ken Gillespie. “Right now, the average length of time that patients are in hospital is about seven months. But we’ve seen that go longer. In some cases, even two or three years that patients are in hospital waiting for a placement.”
“Emergency room closures in Cape Breton, Richmond County, along with all other Nova Scotia county hospitals need to be addressed as a crisis throughout the health-care system.”
“A shortage of qualified nurses is to blame….She says there are other hospitals in rural Ontario that are “one retirement” away from facing a similar nursing shortage.”
“ST. JOHN’S, N.L. — Offload delays in which paramedics are left waiting in hospital corridors to hand over their patients to staff have ballooned from minutes to hours in just a few years at overcrowded St. John’s emergency rooms.”
“The problem isn’t unique to Ottawa: hospitals across the country deal with similar overcrowding issues in their emergency departments, said Dr. Howard Ovens, an emergency physician and chief medical strategy officer at Sinai Health System in Toronto.
“It’s just soul-destroying. It goes against every reason you’ve come to work that day,” Ovens said.
Paramedics are feeling the strain, too.
“Paramedics go into work and they feel despair. And we feel it for our patients,” Wilton said.”
“In June, when overcrowding should normally be easing off, HHS had an average occupancy rate of 107 per cent — meaning it had more patients than beds funded by the Ministry of Health. Known as hallway medicine, hospitals are forced to open up beds on their own tab, sometimes in unconventional spaces like sun rooms, hallways and family rooms.
The problem is now so severe that HHS hasn’t been below 100 per cent occupancy since August 2016.
It’s tough for Hamilton hospitals to afford the extra beds at a time when they’re also cost-cutting $42 million by March 31.”
“According to the province, as of the start of October, there were 201 Islanders waiting for long-term care services, and as of Oct. 10, 46 people were in hospital beds waiting for access to a long-term care bed. Nine of those people, like Gallant, were waiting for dementia care in Prince County.”
“In Toronto emergency departments today, many patients have to be ill, first of all, in a chair — so there are no stretchers available for many patients and many patients ask me directly: ‘Can I please lie down,’ and when they can’t lie down, they lie on the floor. They lie on the floor in the waiting room, they lie on the floor in treatment areas,” Venugopal said.
“patients are being treated on stretchers outside of emergency wards without access to bathrooms, privacy, or the ability to have a confidential discussion about their medical condition.
Hurley notes people have even died in these environments, and others have had to stay in broom closets and other inadequate accommodations.
“As recently as July 12, 2019 [Premier Doug Ford] said his government would eliminate hallway medicine within a 12-month period,” says Hurley. “It’s a great promise, but we’re very concerned because that’s not born out by the budget that was passed in the spring.”
Hurley explains Ontario has closed more than 20,000 acute care beds over the last 20 years.
“This leaves us with the lowest capacity in terms of beds to population, and staff to population, of any hospital system in Canada, or, in fact, of any country with a developed economy…,” he says.
This includes countries such as Turkey, Mexico, and the United States.”
“Newly released numbers show wait times this July were worse at all but two of Winnipeg’s emergency rooms and urgent care centres when compared to the same time last year.”
“Do the math. A 30-per-cent reduction in acute care bed capacity and a further 20-per-cent reduction due to patients with nowhere else to go. The healthcare dividend never materialized and now hospitals and more specifically emergency departments are crowded and dangerous.”
“On the Island of Montreal, 14 of the 21 emergency rooms have more patients than beds to accommodate them, according to an Index Santé report. This is also the case for the Cité de la Santé Hospital in Laval, three of the six hospitals in the Laurentians and eight of the 10 hospitals in the Monteregie.”
“10 of 37 emergency departments across the province will be closed at certain points this week. The ED at Musquodoboit Valley Memorial Hospital will be closed for a total of five days reopening its doors Saturday.”