Health care capacity crisis? Wait 'til you see what Ford has planned.

Despite the current health care capacity crisis, the Ford government plans to cut health care service levels.

Hospitals: The news is bad for hospital services.  The new Financial Accountability Office (FAO) report  on the government's health care funding plan reports the government plans 3,000 new beds over the next decade.  That’s about an 8.4% increase in nominal capacity.  

Measured against need, however, this will mean a sharp decrease in service levels.  The public wants improved service levels, but the opposite is planned.

That "increase" won’t come even close to covering off increasing demand for services due to population growth, which according to provincial government projections will be about 15%. The demands on health care will be much more than this, however, due to a rapidly aging population. 

Health care needs are very sensitive to age.  People 65 and over use most of our hospital bed days  -- 58% in 2018/19. The population of the 65+ age group is projected to grow by close to 3% a year,  twice the rate of the overall population. We will have about a third more people aged 65+ in a decade.  According to the Ontario Ministry of Finance projections, the oldest parts of the 65+ age group (the 75+ and 90+ age groups) are projected to grow the fastest, compounding the need for extra hospital capacity.  

The rapid growth in the number of elders is driving up the need for hospital beds (and the hospital workers to staff them) by more than double the planned increase in staffed beds.  

Aging is a long term trend and should have been planned for decades ago -- capacity was not adjusted for that reality and crisis resulted.  In the midst of that crisis, it should, at the very least be planned for now. 

The plans for the years immediately ahead are even worse. The FAO estimates that (despite the current capacity crisis) only 1,000 new beds will be added in the next four years, less than a 3% increase.  That's enough for about two years of population growth, with nothing to offset aging, much less improve service levels to deal with the capacity crisis.  

The plan is to double down on long-term cuts in hospital service levels -- a very funny way to respond to a hospital capacity crisis.  Hospital service levels are going to take a plunge unless the Ford plan is changed and more capacity is added.

Home care: A similar dynamic plays out in home care.  The government trumpets new money for home care - -but (with aging and population growth) the FAO projects a decline in the number of nursing and personal support hours per Ontarian aged 65 and over, from 20.6 hours in 2019-20 to 19.4 hours in 2025-26.  That is down 5.8% -- almost 1% per year. Unless this improves there will be no relief of the pressure on health care through home care - - in fact just the opposite. 

Long-Term Care: There was one small bright spot in the Financial Accountability Office's report on the government's health care funding plan.  But it's a very tiny one, and only if you ignore longer term cuts.  

The FAO now sees a slight improvement in the ratio of long-term care bed to elders 75 years of age and over -- from 71.3 beds per 1,000 in 2019-20 to 72.1 in 2027-28.  The increase amounts to a 1.1% increase over 8 years.  That's an increase of 0.1% per year.   

This is the plan when almost 40,000 elders are on the LTC wait list and the government has just passed legislation to coerce hospital patients to move into long-term care?  

Even with this very modest increase, we are still far short of the 90 beds per 1000 elders 75 and over in 2010/11 -- 20% less. 

Like hospital bed capacity, governments  have long ignored the need to improve LTC bed capacity, despite the obvious growth in the elder population.  Ford's plans to build new capacity in LTC only very modestly improves the low level of capacity established over the last 20 years, when governments decided to all but stop the creation of new LTC beds.

Source: FAO

So, this may be better than nothing -- but an improvement? That's a stretch.  We are far behind where we were only a decade ago.

Surplus health care funding? The media focused on $4.4 billion "more than what is necessary" in planned health care funding reported by the FAO over four years.  

But the FAO was not measuring funding against need -- it was measuring funding plans against these miserable service level plans developed by the provincial government. It's not hard to have a surplus when you are actually cutting service levels.  And in any case, with the final defeat of the government's unconstitutional Bill 124, the FAO estimates that an additional $2.7 billion will be needed to provide higher hospital wages than it had forecasted through 2027/8 (on top of the $900 million already bargained for higher wages under the Bill 124 period). 

The bottom line is that the government is planning 3.9% annual health care funding increases from 2021-22 to 2027-28  and no one can credibly claim that is sufficient to keep up with rising demand. Even before the current wave of inflation, health care cost pressures were commonly put at over 5% per year.  

Despite the capacity crisis now driving unprecedented hospital closures, the plan of the Doug Ford government is to cut service levels further. We are in for a decade of trouble unless this changes. 

In 2018, Ford ran on a promise of ending hallway healthcare:  now there are more inpatients in hallways than ever, hospital ERs are closing, and staff vacancies sky-rocketed. 

Now we know know the response is to cut capacity relative to rising need.