Hospitals maintain required levels of care without adequate support from provincial coffers; MPP critical of private sector support
MANITOULIN—The Manitoulin Health Centre (MHC) is faced with health human resource (HHR) challenges unique to small, rural hospitals. With the shortage of nurses, the MHC has had to enter into contractual agreements with travel nursing agencies (up to five nurses at a time in the trauma area) to maintain minimum service levels, with no support from the province. And the MHC has to face the huge costs associated with it.
“Through the encouragement of Ontario Health to maintain service levels, MHC has entered into contractual agreement with travel nursing agencies to maintain minimum service levels,” Paula Fields, president and chief executive officer of the MHC told The Expositor after a meeting hospital officials and board representatives had with Algoma-Manitoulin MPP Michael Mantha last week. “The projected incremental cost of the travel nurses in the 2022/23 fiscal year is $700,000 above nursing staffing costs and an estimated cost to maintain services for the 2023/24 fiscal year is $1.4 million, which is inclusive of the requirements of providing lodging and travelling. MHC is deeply concerned about the inability to secure lodging during the summer months due to the influx of tourists.”
The impact of the shortage of nursing has resulted in the potential closure of the Mindemoya site’s emergency department, however, due to the commitment of our clinicians, creative staffing approaches, the assistance of nursing leadership and community partners this has been averted. Obstetrical services are diverted to Health Sciences North (HSN) when there is insufficient nursing support to safely deliver at MHC, said Ms. Fields. MHC has introduced personal support workers (PSWs) and nursing students throughout the year when available, as having students during the summer months has been a practice of MHC’s for over 30 years.
“In meeting with Mr. Mantha (at the Little Current Hospital) we had the opportunity to sit and explain the issues, and he posed lots of questions,” said Ms. Fields. The group then moved to the Mindemoya Hospital site where MHC representatives outlined the improvements that have been made to the hospital. “We embarked on the renovations to the hospital with no government funding and now with the cost of hiring travel nurses from agencies, COVID supply issues and other costs increasing, we need support from the province.”
“We have been told by the ministry (of health) that we need to keep our doors open at all costs. So that is what we are doing,” said Ms. Fields.
“They (MHC) relayed the challenges and hardships that all rural hospitals are currently facing, especially in Northern Ontario,” stated MPP Mantha. “The ongoing nursing shortage and maintaining emergency locums has caused astronomical expenses to the MHC budget. There has to be assistance provided by the government to fill the needs for additional nurses in hospitals and the costs involved in this and other issues. The MHC is having to contract travelling nurses (hired out to them by for-profit agencies) to cover the needs of the hospitals. And the hospital budget has been keep at a bare minimum, even with inflation and increases in area. They have been cutting but can’t cut any more than they have.”
“The government needs to step up and deal with the shortages being faced by hospitals, with nurses, other health care personnel, recruiting and maintaining doctors and staff and all the costs involved,” said MPP Mantha. “The province needs to deal with the crises in health care that they created.”
MPP Mantha said, “We need to deal with the crises that the province created in hospital care, but also in home care, and the reason why people are having to go to hospital emergency departments instead of being able to remain at home with properly funded care and personal support worker coverage.”
The MHC outlined that, despite the pandemic, MHC has continued its efforts and ability to provide safe, quality care for patients. This is evident through being awarded the highest accreditation award of exemplary standing, meaning MHC has met and exceeded the standards for providing safe and quality care.
The MHC is a two-site facility providing inpatient services including cardiac, mental health, ALC, medical, hospice suites at both sites and 24/7 emergency departments. The Little Current site has a visiting specialist program and endoscopy suite and the Mindemoya site has a chemotherapy program, (a satellite program of the Northeastern Ontario Regional Cancer Centre), all staffed by MHC nurses and support services. The physiotherapy department provides a HSN satellite program; Northeastern Joint Assessment Clinic (NEJAC) and Rapid Assessment Clinic (RAC), are supported through MHC’s advanced practice (AP) Physiotherapist.
MHC serves seven Indigenous communities and at least 50 percent of the care provided is to Indigenous patients. The population of Manitoulin has grown over the past 5-10 years, including an influx of tourists during the summer months and an aging population. This is evident through the increase in admissions and emergency room visits over the past five years.
The MHC is globally funded with limited opportunities for revenue-generating programs that other hospitals have access to (Quality Based procedures, volume-based services). Ontario hospitals have the lowest level of per-capita provincial government expenditures in comparison to all other provinces. Historical funding models have encouraged hospitals to control expenses through innovation, cost cutting and creative means to meet the needs of their population, the MHC explained to MPP Mantha.
It was further explained that, during the pandemic, hospitals were funded through incremental expenses submissions that provided relief for Covid-related costs. However, the incremental revenue that hospitals relied on ceased. “While some minor relief is promised for small hospitals, the majority of the continued Covid support was directed to larger facilities that have quality based procedures (QBP) funding, utilizing unearned revenue. Deficits continue to increase with small hospitals being one of the worst-hit sectors. Total margins continue to plummet as the demand for agency nurses to maintain operations in the small hospital sector is four times more than the average in Ontario.”
“Operational and capital financial pressures continue for 2023/24, with the appeal of Bill 124 leaving a lot of uncertainty surrounding retroactive and future costs,” said Ms. Fields. “While capital is typically self-funded, the lack of operational funding has led to MHC utilizing its capital allocations for operational purposes, leading to aging equipment in use past its useful life.”
“Throughout the pandemic, MHC has been faced with extraordinary challenges as a small rural hospital,” the MHC spokespersons told MPP Mantha. “We followed through with the renovation/expansion of the Mindemoya site emergency department despite the challenges of the pandemic-sourcing of supplies/equipment; isolation requirements; and increased cost of supplies/equipment. This project gives the MHC the ability to provide safe care for mental health patients, Ministry of Labour requirements for safe workspaces, the required infection control measures to protect staff and patients, best practices for patient-flow through triage and treatment, and supports for culturally appropriate care. Additionally, the renovation allows for MHC to meet NAPRA standards required to administer chemotherapy, potentially increasing the number of patients we can serve locally, providing care closer to home.”
This project is being funded by the MHC’s own funds and community fundraising efforts during the most challenging times of the history of hospitals in the country. “This ministry has not committed any funding to the project, even though this reno/expansion will enable the required standards of care of regulatory bodies and care that patients expect and receive in other facilities across the province,” explained the MHC spokespersons.
“MHC is faced with HHR challenges unique to small, rural hospitals,” said Ms. Fields. “There is the inability to draw for nonessential programming to staff units. MHC staffs with the bare minimum personnel to support safe care practices and treat patients with critical illness. Six nurses on days, four nurses on night shift. Requirements to send nurses on transfer to tertiary centres further depletes the nursing compliment during a shift. This is unique to rural hospitals. MHC has been innovative in entering an agreement with DSAB and ERHC for non-urgent patient transfer services, at a cost to maintain staffing levels. However, often patients still require a nurse to accompany them. The ministry does contribute some funding to the project; however, MHC is required to fund a substantial portion through global funding.”
MHC has also been creative in advertising the following for nursing recruitment, including the MOHLTC Tuition Support Program, Canada Student Loan Forgiveness Program, in-house, cost-free training, new employee incentives, and orientation incentive (paid shifts and accommodations), as well as attractive remuneration, a great benefits package and also through a video promoting Manitoulin lifestyle and the team atmosphere.
“We are deeply concerned about the impact of Ontario Nurses Association (ONA) bargaining, the outcome, and the financial implications. This includes the requirement to increase non-union wages.”
MHC, as is the case with other hospitals, is also experiencing HHR challenges in recruiting ultrasound technicians, laboratory technicians/technologists, physiotherapists and a Human Resource Director.
Ms. Fields and the MHC delegation said the province needs to consider practical solutions to maximize HHR, including: establishing a government-led provincial, multi-stakeholder strategy to advise, plan and implement system-wide solutions to address the HHR challenges in the short and long term; amend the Nursing New Graduate guarantee requirements to allow part-time employment at the completion of the program. The government also needs to create incentives and strategies for nursing students, including hospital funding to employ nursing students, providing funding to support nursing student placements in rural communities; creating opportunities and funding for late career nurses; establishing ‘rules’ that prevent overcharging of travel and agency nurses (a means to disincentivize nurses form leaving hospitals to work for agencies) and removing restrictions on executive compensation, union increases resulting in management increases, reducing the gap between staff and managers and executive compensation.
It was further pointed out by the MHC delegation that food, drugs, energy, supplies and equipment costs are increasing and are expected to continue to increase. There is also uncertainty and lack of information surrounding funding ongoing costs of Covid. This includes isolation expenses, PPE, testing, infection control and occupational health protocols. These costs are expected to continue into 2023/24 with no funding certainty.
Ms. Fields said MHC is one of 23 hospitals in northeastern Ontario that are creating a single electronic health information system to improve the delivery of safe, evidence-based patient-centred care. This is the largest cluster of independent Canadian hospitals to collaborate on a unified patient record.
MHC has continued to progress with preparation for this project, despite the pandemic. The estimated capital cost of the implementation is nearly $3 million, and the ongoing operating costs are expected to be $431,000, nearly three times more costly than the previous NEON costs. There has been no commitment by the MOH to provide capital or ongoing funding for this project. MHC is funding through investments and the global budget.
Dennis McGregor, MHC board chair, told The Expositor after the meeting, “the senior team and myself were pleased to host our local MPP Michael Mantha on January 20 for an open discussion on the many issues facing our hospitals. We discussed many issues, but most importantly are the ones we here at MHC are faced with as a result of budget constraints. MHC, as with most small rural hospitals in Northern Ontario has been impacted by the continued rising costs of operations, particularly in regards to shortages in human resources, inflationary increases of supplies, equipment, drugs and the introduction of our new single health information system (ONE) which will soon go live.”
“We were pleased that Mr. Mantha was able to spend the majority of his day with us and we also had the opportunity to provide a tour of both the Little Current site and the nearly completed expansion and renovations at our Mindemoya site,” said Mr. McGregor. “We pointed out that the $5 million dollar Mindemoya expansion was entirely funded by utilizing our own funds and through the generosity of all those who contributed to our $2.5 million dollar fundraising campaign with no government assistance.”
“Mr. Mantha was very receptive to our concerns, and well aware of the many issues within the healthcare system,” said Mr. McGregor. “We are confident that Mr. Mantha will bring forward our concerns to his colleagues as well as to the legislature once the house resumes its next session. We thank Mike for his continued support.”
MPP Mantha said, “the announcement by the government that it is funding more procedures for private clinics to provide, will see even more doctors and nurses lost by hospitals. Why can’t they put this funding into the public health care sector instead of private? This is very concerning.”
“They (province) created the crisis in health care,” said MPP Mantha. “I will be highlighting all of this, including all the very valid issues raised by the MHC reps at our meeting. The province needs to step up with a plan to solve the problem with a lack of nurses, doctors and other health personnel and provide more in financial support to public hospitals.”
“And the government has to stop reinvesting in private health care and provide more in public health care. Money provided to the private sector goes for profit to individuals or corporations, and this takes away from the public health care and affordable services Ontarians need,” added MPP Mantha.