Our health system is failing us on so many levels, but through no fault of its own. It’s a failure that has been a long time in the making as political decisions have slowly undermined the health system. Today we contemplate the results, emergency rooms full to over capacity, elderly left waiting for care, pediatric hospitals overwhelmed, nursing homes being put under tutorship, and health workers ‘jumping ship’ because they feel like their job is just not worth it.
It is through a series of decisions on the different political levels that, in my humble opinion, have brought the system to the brink.
Funding — The money allocated to health in any provincial budget comes in part from the Federal Health Transfer Fund. The escalation factor was set at six percent per year but some years ago was cut to three per cent. So provinces were left with less transfer money for their health budgets. We all know that no government wants to increase taxes to compensate, so provincial health budgets have all been under the levels required to offer all the services needed. Now, in the face of ever-increasing needs, why is the federal government holding off on offering more transfer funds?
Changing needs of an aging population — The baby boom generation has contributed greatly to society, but as they get older, they naturally put more demands on the health system. Was that foreseeable? Yes, of course and many have been ringing the alarm bell for years. But the plan to shift from hospital centered services to home care services, as has been done in many countries, was never fully implemented here.
While we do have one-day surgeries with home care to a certain extent, home care for the elderly instead of at a nursing home is not happening as much. Nor is it for terminally ill patients. These measures would alleviate the stress we are seeing in hospitals when many patients could and should get care elsewhere. Why is home care not fully implemented?
Changing work force — As baby boomers are retiring, many more jobs are becoming available. Younger generations have many opportunities opening to them. As they seek a better work family balance, they are easily willing to change path during their career and even go back to school to find a job that offers that balance. This puts health services at a great disadvantage. Who want to work every other weekend? Who wants to be forced into overtime because of missing workers? Who wants to work that hard for an average salary and little recognition? Who wants to work for a system that seems unwilling to listen to the suggestions you offer in order to make your job better? Who is willing to work in a job that offers private workers better schedules, conditions and salaries than your own job? The pandemic has heightened all these irritants and we are seeing many health workers changing or at least looking into changing the path they are on. Are there Health Ministers willing to tackle these major challenges to help improve work conditions?
Promises of more…
There have been promises of more services being offered by other workers in the health care sector. Negotiations with the medical profession have enabled pharmacists to diagnose and treat minor health issues and have raised the level of engagement of nurse practitioners in providing medical services and, in turn, of regular nurses as well. But these negotiations were long and hard and one wonders why they were not launched many years ago in order to have more health workers ready to pitch in now?
With the promise of a cohort of 2,000 nurse practitioners, only 1,100 have been certified so far. It seemed like an interesting venue for nurses wanting to do more, but are conditions not attractive? Is the pay not enough? Are they too restricted in the services they can provide? Has enough effort been put into recruitment?
Regarding the promise of more family doctors
The number of admissions to medical schools in Quebec per year is typically fewer than 1,000, and only 45 percent of those choose to go into family medicine, resulting in approximately 400 new family doctors per year. In 2022, one out of four doctors is over 60 years of age and is on their way to semi or full retirement. The probability of any of us being able to have a family doctor is not that great. Why has the number of medical school admissions not been increased as the population needs more doctors and more doctors are retiring?
If subsequent governments would have made good decisions, been more proactive and acted quickly in changing parts of the system that needed it, our hospitals might not be on their knees. In view of the major decisions and significant shifts that need to be made, and that should be made without regard to scoring political points or with a view to upcoming elections, we have to ask whether politics should play so large a role in managing our health services?
