Code Blue: A Global News series delving into Canada’s health-care crisis

Doctors, nurses, patients and their advocates are calling it a crisis.

Health-care systems across Canada are facing significant pressures, thanks to a perfect storm of challenges that have resulted in emergency room closures and reduced health services in every province and territory.

It’s a situation that has become “unsustainable,” says Dr. Katharine Smart, president of the Canadian Medical Association.

“The biggest challenge right now that we’re seeing is just generally how people in Canada are able to access basic health-care services because it’s really happening across all aspects of the system,” Smart said.

“What we’re really seeing is just the entire system is under incredible strain. And the result of that is Canadians really struggling to get the care they need in a timely way.”

Emergency departments, in particular, are bearing the brunt of the many issues plaguing Canada’s ailing health system, with many ERs across Canada having to close intermittently in recent weeks and months. But experts say what’s happening in emergency departments is a symptom of a number of complex factors that are all coming to a head at the same time.

They include:

• The ongoing COVID-19 pandemic, which continues to send patients to hospitals and is also regularly taking large numbers of health-care workers out of commission as they continue to become infected and must isolate. Pandemic reductions in health services over the last two-and-a-half years have also created backlogs for specialist care, surgeries, diagnostic imaging and many other medical and clinical services.

• Many Canadians are presenting to hospitals and health clinics with more advanced stages of illness after delayed medical care due in part to COVID-19 closures and also because some people have avoided hospitals and clinics out of fear of contracting the virus, according to multiple physicians and nurses who have spoken with Global News in recent months. This means patients are sicker and need more intensive care from health providers, which adds to their workloads and feelings of burnout.

• Health systems across Canada are seeing an unprecedented shortage of health-care practitioners. Many physicians, nurses, long-term care staff, paramedics and other allied health professionals were telling their professional associations even before the pandemic they were stretched thin and considering leaving their jobs.Now, after more than two years of working through the pandemic, many of these health workers, including nurses, are reducing their hours, retiring early, leaving the public system for private clinics or to work for temporary agencies that pay higher hourly wages, or simply leaving their jobs. Medical students are increasingly choosing not to study family medicine, leaving almost 100 normally highly competitive residencies unfilled this year alone, according to data from the Canadian Resident Matching Service (CaRMS).This is forcing many Canadians who cannot access primary care to turn to hospital emergency rooms for non-urgent care and leaves more work for the staff who stay, which further exacerbates burnout and workload pressures.

• Nationwide shortages in long-term care beds and alternate/home care availability mean hospitals can’t move patients from ERs into hospital units, as beds are being occupied by so-called “bed blockers” — patients who no longer need to be in hospital, but still require some additional care. This is also causing “off-loading delays” in some provinces, where paramedics are forced to wait, sometimes for hours, with patients who arrive by ambulance to an ER that is already over capacity and cannot admit them.

All of this has culminated in a higher-than-ever demand for health services in emergency rooms across Canada, and has resulted in significant wait times and a significant number of temporary closures of emergency departments, mainly in smaller hospitals located outside major cities across the country.

In the face of ongoing stories of patients, nurses and doctors pleading for help for Canada’s ailing health system, Global News is rolling out a series of stories carefully examining all these factors that are contributing to the current “crisis,” as Smart characterizes the situation in Canada, and what these problems have meant for patients, health workers and communities.

These stories will also delve into who is responsible for fixing the problems plaguing Canada’s hospitals and health systems:

• Teresa Wright and Jamie Mauracher look at how the problems plaguing ERs and the impact on communities varies across rural areas and larger cities.
  • Read it now

• When one part of the health-care system hurts, it leads to problems in other areas. Teresa Wright and Jeff Semple explore how shortages of family doctors and alternative care health worker leads to more people in ERs.
  • Read it now 

To date, politicians and leaders at all levels of government have been pointing fingers at one another, with each one saying a different jurisdiction is to blame for the problems and demanding more accountability, more action or more money to facilitate solutions.

2:17 Canada’s premiers put pressure on federal government for more health care funding

Provincial and territorial premiers have been collectively calling on Ottawa to increase the amount of funding the federal government sends in yearly health transfers.

But Prime Minister Justin Trudeau says he wants to see “tangible results” — that is, improved services — from the provinces with the $45.2 billion they will already receive this year for health care.

“The federal government will be there with more investments in health care. Absolutely we’re going to do our share, ” Trudeau told reporters during an event in Nova Scotia July 21.

“But we need to make sure that, with the tax dollars we’re flowing into provincial health systems, Canadians are seeing results, that they’re actually getting access to a family doctor, that they’re getting a mental health appointment within days or a week or two, that we’re reducing the backlog of surgeries, that we’re using newer technologies, that we’re combining data from across the country to better understand what the issues are.”

While all 13 premiers are united in saying they need more money from Ottawa, each province and territory has its own unique needs and priorities, and each has its own idea of how to address the problems in their jurisdictions.

2:02 Federal Liberals face criticism about $875M in missing mental health spending

Global News asked each province and territory what they believe are the key challenges facing their individual health systems and what they believe could help alleviate current pressures.

All of them identified recruitment and retention of health-care workers as the primary challenge, noting that they all are competing with one another for a shrinking pool of health practitioners across the country.

All of them also listed investments and strategies their governments are already working on to address service gaps and build up their health-care systems, and all of them said more money from Ottawa is essential to help in these efforts.

Here are summaries of the responses provided to Global News from each of the provinces and territories that responded to requests for comment.

British Columbia and New Brunswick were contacted, but did not provide responses for this story by the deadline.

The territory said recruitment and retention efforts are made more difficult for Nunavut due to its remoteness, as all 25 communities in the territory are fly-in only. Lack of housing for health-care staff, wage competition from other provinces and shortages in physical space and technology also contribute to difficulties in delivering and maintaining health-care services.

More funding from Ottawa would allow Nunavut to better attract and retain nurses and other health-care workers, the territory said in a statement. It would also support training to increase Inuit employment/representation in the health workforce, developing new models of care including enhanced virtual care, improved mentorship and leadership training opportunities and renovation of health centres to meet growing clinical space needs.

As in all the territories, Yukon said its ability to attract nurses, physicians and other staff is made more difficult due to its remoteness.

Yukon believes a Canada-wide licensing scheme for health-care practitioners like nurses and doctors would reduce barriers and mobility of medical professionals and help address the pressures in the territory.

The Yukon government says more federal health funding is needed to help implement
“major, system-level changes” prescribed by an expert panel that examined Yukon’s health system in 2020, which included 76 recommendations, and to help alleviate the strain of the pandemic.

Remoteness and increased competition for health-care workers are challenging the Northwest Territories, but increasing costs of services and rising patient volumes are also major challenges, the territory said. The 2021 total health spending in the territory, both public and private, per resident was $20,365, which is over 2.5 times higher than the average cost per Canadian, according to data provided by the NWT government.

The territory believes streamlining and fast-tracking foreign-trained health workers and increasing availability of post-secondary training and education spots would help ease the health-care staffing shortages.

An increase to Ottawa’s health transfer is “urgently needed” to be able to attract professionals to cover an area measuring approximately 1.2 million kilometres whose 45,500 residents are widely spread across 33 remote-access communities, the government said.

As is the case in other provinces, Alberta EMS is under particular strain, and surgical wait times are also a significant issue.

To address these pressures, the provincial health budget was increased to $22 billion for 2022-23, which the department says is its highest allocation ever and it will continue to be increased by $600 million annually for the next three years, according to a statement from Alberta’s health department.

These investments are targeted in areas of greatest need, including in EMS and ambulance services, increasing surgical capacity and “rebuilding the health workforce” — efforts that include adding nurses and training programs for RNs, health-care aides and others.

“Increased Health Transfers from the federal government would directly help Alberta continue to address these issues as well as aid in attracting more family doctors, supporting emergency departments, and other services would benefit from increased funding,” the health department said.

The Saskatchewan government recently announced new investments as part of a four-point plan to “recruit, train, incentivize and retain health care staff.” This money will help fund a new agency dedicated to recruiting and retaining health workers, boosting the number of family medicine residency training seats and nurse training seats and increasing funding for paramedics, long-term care and home care, a spokesperson said in a statement.

Saskatchewan wants Ottawa to increase its share of health-care funding to 35 per cent from the current 22 per cent and to maintain it at this level over time to allow provinces to “address their diverse needs and accelerate progress in delivering better access to care for Canadians,” its statement said.

“Short-term, one-time targeted funding cannot repair the foundations of our health care systems; but increased, predictable and recurrent federal funding can make a direct and tangible difference in the lives of Canadians.

Manitoba notes jurisdictions across the country are facing “unprecedented challenges in health care,” which it says has been caused by the global COVID-19 pandemic.

A statement from a government spokesperson also pointed to recent “historic investments” in its health budget, including new funding of a special task force to address surgical and diagnostic backlogs. The province is also moving to address health-care staffing shortages with new education and recruitment programs for nurses.

“But no provincial government can address all of these national challenges without a renewed funding partnership with the federal government,” the spokesperson said, pointing to the call from all premiers for Ottawa to increase its share of health funding to 35 per cent “to ensure sustainable health care services are available for all Canadians when they need them.”

Ontario says its residents “continue to have access to the care they need when they need it” and that hospitals are responsible for their day-to-day operations, including staffing.

A statement from a provincial spokesman pointed to investments that have added thousands of new hospital beds and health-care workers and hundreds of internationally educated nurses to hospitals across Ontario.

The government knows more work needs to be done and continues to work to address challenges, the statement said.

Last week, the Ontario government also announced a suite of changes to help stabilize the health-care system, including increasing publicly covered surgeries performed at private clinics, waiving the exam and registration fees for internationally trained nurses, and sending patients waiting for a long-term care bed to a home not of their choosing.

If Ottawa meets the provinces’ request for more funding, this would inject more than $10 billion more every year for health care in Ontario, the statement said.

“We aren’t asking the federal government to do anything we aren’t prepared to do ourselves. We’re making historic investments to build and expand hospitals, hire new doctors, nurses and personal support workers, build 30,000 new long-term care beds and dramatically expand home care services across Ontario,” the statement said.

Quebec pointed to a sweeping, three-year plan released earlier this year that promises to reform the province’s health-care system, which has been beset by many challenges similar to those in other provinces.

Part of this plan involves introducing a single portal that Quebecers can use to access front-line health services, including booking appointments with a family doctor for those who don’t have one. The province estimates about one million Quebecers do not have a family physician.

In its statement to Global News, a Quebec health spokesperson stressed that it is up to Quebec to manage its own health system and that federal health transfers must be increased “without conditions.”

“Our request is clear and non-negotiable to the federal government: it is by increasing federal health transfers that Ottawa can help us and not by playing within our jurisdiction, in particular with targeted funds,” the statement said in French.

Nova Scotia is facing challenges in recruitment and retention, wait times, surgical backlogs, hospital capacity and the ongoing impact of COVID-19 — challenges that have been growing for some time.

A system-wide approach is required to address the root causes, a health spokeswoman said in a statement. The province is addressing this through its ‘action plan for health.’ It outlines steps to improve access to care, recruit and retain more health professionals, reduce wait times and surgical backlogs and create more efficiencies.

The statement also pointed to investments and steps already taken to address service gaps and pressures, including new doctor hires, more ambulance drivers and more training seats and student assistance for nurses as well as a job promised to every nurse who graduates in Nova Scotia.

“Increased funding from the federal government would allow us to advance steps to address some of the solutions in ‘action for health’ sooner,” the statement said.

P.E.I.’s most pressing health system challenge is a need for more human resources. The province has experienced a “real challenge keeping all facilities open and services fully staffed,” said a spokesman for the health department.

That’s why efforts at recruitment and retention of health workers remains a top focus, he said.

“We need to expand health human resources across the system to ensure we have the right number and mix of providers to meet the health care needs of Islanders.”

One of the department’s spending priorities is to improve access to care through key initiatives including primary care, mental health and addictions, seniors care, innovation, workforce development and recruitment and retention.

“Solving these issues will take time and there are no quick fixes,” the statement said.

As is the case for all its counterparts, the island province said its biggest challenge when it comes to health-care delivery and timely access to medical care for patients is a shortage of medical professionals and recruitment and retention of health-care practitioners.

The provincial government says it will continue to work on a number of additional initiatives with health-care professionals, including the launch of a recruitment campaign this summer and more resources for recruitment and retention initiatives, a spokeswoman said in a statement.

“We won’t solve these issues overnight, but measures we have implemented are steps taken to move our province in the right direction.”

Increased funding for health from Ottawa would be used to help offset the province’s current spending on health care and help to make “sound investments for the future of our people,” she added.