The problems plaguing Ontario's health-care system have been around for a long time, but each wave of the COVID-19 pandemic makes things worse, says Dr. Chris Simpson.
Simpson is a cardiologist in Kingston, Ont., and the executive vice-president of Ontario Health, the provincial agency overseeing Ontario's hospitals.
Those hospitals are struggling with severe staffing shortages, especially of nurses. Things hit a breaking point in Ottawa over the weekend when two hospitals were forced to temporarily close their emergency departments. Similar situations have been playing out across the province, and the country.
Unions representing Ontario's health-care workers say the province must take "immediate steps" to address the crisis, including offering financial incentives to hire and retain more nurses, and repealing legislation that caps workers' wages.
In response, Ontario Health Minister Sylvia Jones ordered regulatory colleges for nurses and doctors to develop plans to more quickly register internationally educated professionals. It's a move that nursing unions say falls short.
Jones has repeatedly denied interview requests from CBC, including As It Happens.
Simpson spoke to As It Happens guest host Paul Hunter about the crisis in health care. Here is part of their conversation.
Dr. Simpson, what do these latest ER closures in Ottawa say to you about the current strain on the hospital system?
The emergency department is always a barometer for what's going on in the rest of the system. So when things are going well in the emergency department, that usually means the rest of the health-care system is in good shape. And then, of course, when things are not going well, it often shows up in the [ER].
We're seeing what I would call an unprecedented amount of sustained pressure and strain that has resulted in the need for several hospitals to have to reduce services in their emergency departments in numbers that we've just not seen before.
The word that the head of the Canadian Medical Association, [Dr. Katharine Smart], has used when talking [to the Globe and Mail] about the fact that a major urban hospital like the one in Ottawa had to close its ER ... was "shocking." What word would you use?
I would certainly call it unprecedented and, you know, very, very high pressure.
I think Dr. Smart is right that when we think about staffing problems, we've often thought about, you know, problems in northern Ontario, in remote communities. Those kinds of pressures are not new.
But what we're seeing now is medium-sized and even large community hospitals in bigger centres, and even some of the academic hospitals, are feeling these health human resources strains.
Ontario Premier Doug Ford told reporters last week: "Ontarians continue to have access to the care they need when they need it." Do you think that's true?
What we have very good data on is that the system continues to perform well when it comes to emergent and urgent needs. So if you have a heart attack or a stroke or, you know, you need urgent cancer surgery, things like that have largely been not impacted by the pandemic.
But I think a lot of people are aware from their own experiences, and those of their family, that anything that's not urgent or emergent is often accompanied by a longer wait time or more difficulty accessing services.
And so what do you say to those people ... with ERs closing in Ottawa, in Durham … in Niagara [and] in other places?
The challenge really has been that with every wave of the pandemic, it's been sort of a different problem. So early in the pandemic, you know, there was this need for all these ICU beds and that was the focus. And then a wave came along where, you know, ICU wasn't so much the problem, but the medical wards were really filling up with COVID patients. And now in wave seven, we're seeing not so much that the demand for services is up, but the health-care workforce is depleted.
Every wave has brought a different kind of challenge. And we haven't had really enough time between the waves to recover.
And so what is the answer?
I think the two biggest bang-for-the-buck initiatives that we can do right now would be, No. 1, accelerating the pathway to licensure for international graduates in all the health professions who are living in Ontario but not actually practicing in their field. So the announcement by [Ontario Health] Minister [Sylvia] Jones … around working with the regulatory colleges to try to get hundreds, and hopefully thousands, more people in the workforce safely and quickly, I think will produce results in the short and medium terms.
And then the second initiative is going to be trying to take a big chunk out of the so-called ALC patients, the alternate level of care patients. Those are the folks in acute care beds who are not acutely ill. But they're waiting for long-term care beds or waiting for home care and community supports at home. So if we can create capacity in hospitals by getting people to where they are better served, then that will better enable us, I think, to tackle what I suspect will be a wave eight in the fall.
WATCH: Ontario health-care unions unveil 5-point plan to fix staffing shortage:
Where do you stand on retention incentives, money, for you know, health-care workers who are underpaid and overworked and stressed beyond belief and just wanting out of the whole industry? What's your position on ways to keep them?
Putting on my hat as just a front-line doc, you know, working with nurses in particular, I've certainly seen [that] they've had to work many more hours. I've seen, definitely first-hand, an increase in, you know, violence in the workplace, a lot of unpleasantness that they just simply have to put up with and always do in their usual professional way. But I've seen the burnout that's been created. They're often demoralized.
So personally, I'm in favour of anything that supports my nursing colleagues who are, and continue to be, the backbone of the system. How that's done, I guess, is up to government. And I'm aware there's a lot of dispute around that.
Do you blame people who would be saying right now it just seems like nothing ever changes, that staffing shortages have been around before the pandemic?
When we think of all of the things that we've been chronically plagued with in Canadian health care over the last 30 years, the health human resources problem has always been there. But it's kind of flown under the radar. But the pandemic certainly has brought it into very sharp relief, just in the past few weeks in particular.
So no, I don't blame anybody for saying, you know, these problems have been around for a while. It is simply a matter of fact.
And just to those in Ontario — and really anywhere in the country — people who right now ... setting aside the high-urgency situations, but people who are older ... who are worried about what might happen if they have a health crisis, and worried, with cause, given everything that's happened. What do you say to people like that?
On the one hand, we have to acknowledge that the system overall is not performing, you know, as we would all want it to be. I think that's true.
But what I'm telling all of my patients is: Please still come and seek help if you're having difficulties.
The system is still there. It's struggling, but it's still there. And so I really would not want people to lose confidence in the system, even as we're frustrated with its performance.
Written by Sheena Goodyear. Interview produced by Chris Trowbridge. Q&A has been edited for length and clarity.
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