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FAO: Ontario to be short 33,000 nurses and PSWs in five years

Christian Fernsby |
The Financial Accountability Office of Ontario (FAO) released a report that reviews the Province's health sector spending plan and discusses the Province's plans for five priority areas: hospital capacity, long-term care and home care, surgical waitlists and wait times, emergency departments, and the health sector workforce.

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The FAO projects that the Province's health sector spending plan has a net funding shortfall over the six-year period from 2022-23 to 2027-28 of $21.3 billion. The shortfall means that the Province has not allocated sufficient funds to support existing health sector programs and announced commitments.

To address the shortfall, the Province will need to either add new funding to the health sector spending plan (such as from the contingency fund or new federal health transfers) or make changes to existing programs or announced commitments.

The Province plans to address capacity issues in Ontario hospitals by adding new hospital beds, continuing to fund beds that were added during the COVID-19 pandemic and introducing measures to free up existing capacity occupied by alternate level of care (ALC) patients.

If successful, the Province's measures would add 4,500 new hospital beds from 2019-20 to 2027-28 and free up 2,500 existing beds occupied by ALC patients, for a total increase in available capacity of 7,000 hospital beds.

However, the FAO expects that it is unlikely that the Province will achieve its target due to significant risks with permanently freeing up 2,500 beds occupied by ALC patients.

Furthermore, even if the Province achieves its plan, the FAO projects that Ontario will still be 500 beds short of the 7,500 beds needed by 2027-28 just to serve the growth in demand for hospital services from Ontario's growing and aging population.

The Province plans to significantly expand home care and long-term care capacity. This includes adding 30,000 net new long-term care beds by 2028 and spending an additional $1.0 billion over three years to increase the supply of home care services.

Combined, spending on long-term care and home care is projected to increase at an average annual rate of 10.0 per cent from 2019-20 to 2027-28, double the growth rate in the health sector as a whole.

Despite these significant investments, the FAO estimates that there will still be a slight decline in home care and long-term care capacity relative to need compared to 2019-20. This is due to high growth in the number of Ontario seniors over the forecast period, which will significantly increase demand for home care and long-term care services.

The reason the surgery waitlist increased by only 50,000, when 398,000 fewer procedures were performed from 2020 to 2022, is that fewer Ontarians were added to the surgical waitlist compared to pre-pandemic levels.

There has also been an increase in the number of patients on the surgical waitlist who are waiting longer than the maximum clinical guidelines for their surgery (referred to by the ministry as "long-waiters").

Of the 250,000 patients on the surgery waitlist, 107,000 (43 per cent) were long-waiters, up from an average of 38,000 (20 per cent) before the COVID-19 pandemic.

The Province's target is to reduce the surgery waitlist to the pre-pandemic level of 200,000 and the number of long-waiters to the pre-pandemic level of 38,000 by March 2023.

Assuming no further interruptions, similar volumes of surgeries being performed and similar volumes of patients being added to the waitlist, the Province is on track to reduce the surgical waitlist back to 200,000 patients by July 2024.

In addition, the Province has yet to record any sustained reduction in the number of long-waiters. Consequently, without additional measures, the Province will not achieve its goal of reducing the number of patients on the surgery waitlist classified as long-waiters to the pre-pandemic level of 38,000.

As patient volumes in emergency departments have returned to near pre-pandemic levels, emergency department wait times have increased significantly and there have been at least 145 unplanned emergency department closures in Ontario in 2022.

ntario hospitals have identified a lack of available staff, including nurses and physicians, as the key issue causing longer emergency department wait times and closures.

The Province has announced measures that address physician shortages in rural emergency departments, which is a contributor to emergency department closures, but the measures do not provide for a sustained increase in emergency department staffing across the Province. From 2017-18 to 2019-20, emergency department wait times were significantly lower despite higher patient volumes. As a result, Ontario's success in addressing emergency department strain depends on the success of the Province's measures for expanding the health sector workforce.

The FAO projects that in order to return to pre-pandemic vacancy rates and meet government program expansion commitments in hospitals, home care and long-term care, Ontario needs 86,700 additional nurses and personal support workers by 2027-28.

This represents an approximately 26 per cent increase in nurses and a 45 per cent increase in personal support workers employed in these sectors. The Province is implementing a number of measures to increase the supply of nurses and personal support workers, including measures targeting pay, training and regulatory barriers.

Based on the FAO's analysis, the health workforce policy measures announced by the Province, along with natural growth, are expected to add 53,700 nurses and PSWs (Personal Support Workers) over the six-year period to 2027-28.

Nevertheless, this increase in nurses and PSWs will still result in an expected shortfall of 33,000 nurses and PSWs in 2027-28. Failure to address this projected shortfall in nurses and PSWs will result in the Province being unable to meet its expansion commitments in hospitals, home care and long-term care.

The shortfall will also have additional impacts on health sector service levels, including in hospital emergency departments, the waitlist and wait times for surgeries, and average hours of direct care provided to long-term care residents.

Given that the Province's capacity expansion commitments in hospitals, home care and long-term care will not meet growth in demand for these services from Ontario's growing and aging population, the Province has not allocated sufficient funding to the health sector to support its programs and commitments, and the Province has not taken sufficient measures to supply the nurses and PSWs needed to deliver on its expansion commitments, challenges are expected to persist across Ontario's health care system.

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