Soon after the Budget, the government announced they would spend $27 billion on hospital infrastructure over ten years and create 3,000 more hospital beds.
For a moment, it may have seemed that we had prized a small victory from the Ford government. The movement did, after all, force them to run on a promise of ending hospital hallway healthcare, and squeezed out a bit more in-year funding for hospitals last fall.
Unfortunately, as with so much from this government, the rhetoric does not match the reality. Here's why this is much less than it might appear on first blush.
Unfortunately, as with so much from this government, the rhetoric does not match the reality. Here's why this is much less than it might appear on first blush.
[1] While the government promises to “create” 3,000 more beds over ten years, they do not promise that the hospitals will operate 3,000 more beds than they currently do. There is no promise to increase hospital bed capacity.
There isn't even a promise to have 3,000 more spaces for beds. As our hospitals are aging, spaces for some existing beds will no longer be usable in ten years. Will they be replaced? The announcement doesn't say. So it is not at all clear from this announcement how many usable spaces for beds will exist ten years from now.
As will be discussed in next week's post, the provincial government is cutting the real funding for hospital operations -- so it is quite possible, or even likely, that hospitals will cut staff, and with that, the operation of some beds. As has already been happening for years, hospitals will have to ship patients out quicker and sicker.
So 3,000 new spaces for beds may be created in ten years, but there is no promise that there will be 3,000 more spaces for beds, much less that 3,000 more beds will be open and in operation.
There isn't even a promise to have 3,000 more spaces for beds. As our hospitals are aging, spaces for some existing beds will no longer be usable in ten years. Will they be replaced? The announcement doesn't say. So it is not at all clear from this announcement how many usable spaces for beds will exist ten years from now.
As will be discussed in next week's post, the provincial government is cutting the real funding for hospital operations -- so it is quite possible, or even likely, that hospitals will cut staff, and with that, the operation of some beds. As has already been happening for years, hospitals will have to ship patients out quicker and sicker.
So 3,000 new spaces for beds may be created in ten years, but there is no promise that there will be 3,000 more spaces for beds, much less that 3,000 more beds will be open and in operation.
[2] Even if the government was actually promising to operate 3,000 more hospital beds that would not create enough new beds to keep up with population growth and aging. By our estimate, those factors will mean operating hospital beds will have to expand by 6,000 just to keep existing service levels. In other words, the Conservatives are actually promising to reduce capacity relative to population by about 3,000 beds -- almost a 10% cut. This is similar to the PC announcement for new LTC beds – a promise which also does not keep up with aging and population growth -- except the cut relative to population for the hospital sector is even larger.
[3] The projects will be developed through privatized P3s in many cases. This system has been consistently shown to waste tax dollars. Approximately $8 billion has been wasted on over-priced P3 risk transfers.
[4] The last Liberal Budget (2018/19) revealed that the Liberals spent $2.74 billion in 2017/18 on hospital infrastructure and planned to spend another $2.74 billion in 2018/19. The new annual average spend for the next ten years is supposed to be $2.7 billion – almost as much as the Liberals budgeted for the last two years. But, over ten years, the PC promise of $2.7 billion will be worth significantly less than what it is currently worth due to inflation. So this will be a decrease in spending. A larger and older population in the province will also reduce the impact of the spending.
[5] The PC 2019/20 Budget reports that they actually only spent $2.63 billion in 2018/19, about a hundred million less than the Liberals’ Budget plan.
[6] For 2019/20, the PCs plan to spend only $2.36 billion. This is the only estimate that counts for very much, as the government can easily change their promised spending with every Budget. (Indeed the 2019 Budget does not even commit to a specific hospital infrastructure spend in 2020/21). As noted, $2.36 billion is less than what has been Budgeted in recent years -- and $380 million less than what the Liberals spent the last year they ruled the roost.
[6] For 2019/20, the PCs plan to spend only $2.36 billion. This is the only estimate that counts for very much, as the government can easily change their promised spending with every Budget. (Indeed the 2019 Budget does not even commit to a specific hospital infrastructure spend in 2020/21). As noted, $2.36 billion is less than what has been Budgeted in recent years -- and $380 million less than what the Liberals spent the last year they ruled the roost.
[7] The total spend over the last ten years on hospital capital projects has been reported in Budgets at $27.5 billion - - a little bit more in nominal terms than the PCs plan for the next ten years, but much more than the PCs plan once inflation and population growth are factored in.
[8] It is also noteworthy that for the five years 2011-12 through 2015-16, the Liberals actually spent almost $3 billion a year on hospital infrastructure, significantly more than the average annual spend the PCs project for the next ten years, even in nominal dollars. Notably, just at the conclusion of this five year five year period, the Auditor General reported (in late 2016) that hospital infrastructure spending was falling far short of need. Click here for more details.
[8] It is also noteworthy that for the five years 2011-12 through 2015-16, the Liberals actually spent almost $3 billion a year on hospital infrastructure, significantly more than the average annual spend the PCs project for the next ten years, even in nominal dollars. Notably, just at the conclusion of this five year five year period, the Auditor General reported (in late 2016) that hospital infrastructure spending was falling far short of need. Click here for more details.
Bottom line: our hospital bed capacity problem is set to get worse, not better.
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