Lack of official strategy affecting northern Ontario health-care: Auditor General report

The effectiveness of northern Ontario hospital care is the focus of one of the Auditor General's annual value-for-money reports released Wednesday.

Acting Auditor General Nick Stavropoulos concludes the lack of a northern Ontario health strategy and staffing shortages are affecting access to care at hospitals in the region.

The two issues create barriers to timely and equitable patient care, Stavropoulos said.

As a result, "residents of northern Ontario typically have poorer health outcomes, a shorter average life expectancy and a higher average rate of hospitalization due to injury" compared to the rest of the province.

"When we compared other provinces, other provinces have a strategy for northern hospitals," Stavropoulos told CTVNewsNorthernOntario.ca in an interview.

"The community in the north is quite different than the community in the south so without having a dedicated strategy for northern hospitals, I thing that’s something the ministry needs to take a looks at."

Physician and nursing shortages led to the closure of obstetrics services at 10 northern hospitals between July 2022 and September 2023, with three closed for more than a year.

"Ontario Health, the provincial agency responsible for overseeing hospitals, does not centrally monitor all instances of service closures at hospitals," the report said.

The report contains 20 recommendations and 48 action items to address audit findings.

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Northern hospitals received $1.9 billion from the Ministry of Health to operate its 36 public hospitals in 2022-2023, about an eight per cent share of provincial hospital operations funding.

The report identified at least two ways in which funds can be better spent.

First, caring for northern Ontario patients in hospital while waiting for a spot to open up at a long-term care facility or for home services cost the province an estimated $65 million, the report said.

"The audit also found more than 330 patients occupying northern hospital beds were waiting for long-term care or home care," the AG said in a news release.

"The cost to keep a patient in a hospital is higher than a long-term care home and a long-term care home costs more than home care."

HEAVY USE OF NURSE STAFFING AGENCIES

The use of these temporary agencies has increased since the COVID-19 pandemic and the passing of Bill 124 limiting wage increases for health-care workers.

"Northern hospitals became increasingly more reliant on agency nurses than other parts of Ontario. While these nurses fill important gaps, this comes at a much higher cost," said Stavropoulos.

“When we looked at the number of hours there was 15,000 hours of agency nurses used prior to the pandemic and now we’re using 391,000. So you can see that increase of 25 times is quite significant.”

Agencies were found to charge about three times the hourly rate of a full-time hospital nurse as well as accommodation and travel costs when required.

"At one hospital we visited, agencies charged the hospital an hourly rate of $83.75–$160 in 2022/23 for a registered nurse, significantly higher than the established wages of $35.50– $42 an hour for that hospital’s full-time, unionized registered nurses with up to five years of experience," the report said.

A total of about $88 million was paid to private staffing agencies to fill the shortage of nurses in 2022-2023, Ontario Health records show.

"When we looked at the number of hours there was 15,000 hours of agency nurses used prior to the pandemic and now we’re using 391,000. So you can see that increase of 25 times is quite significant," Stavropoulos said.

LACK OF ACCESS TO MRI, CT SCANS

Because all Ontario hospitals are expected to fundraise for their equipment, smaller hospitals have a harder time than urban centres pulling together enough money for big purchases.

As a result, access to MRI and CT machines used for important diagnostic purposes is far below the wait time targets for the north.

"We’re not getting the funding that we would get in southern Ontario to create that access to things like diagnostic services, surgical services," David McNeil, CEO of Health Sciences North in Sudbury, told CTVNewsNorthernOntario.ca in an interview.

"So there’s access to care issues that really drive quality rather than once you get into the system the quality of care that you get is good quality care. It’s that access point into the system."

TRAVEL GRANT NEEDS UPDATING

One of the ministry's programs to help northern Ontario residents access medical specialists not available locally is the Northern Health Travel Grant.

The audit shows the program's mileage reimbursement of 41 cents per kilometre has not changed since 2007 and is far below the current Canada Revenue Agency business travel rate of 63 cents per kilometre.

This is despite a 58 per cent rise in gas prices.

"Sixteen years ago the government said ‘we will pay you 41 cents a kilometer to get the care you need’ We will give you a $100 a night to rent a hotel. Fast forward 16 years later, in 2023, none of the numbers have been updated," Nickel Belt MPP and Ontario health critic France Gelinas told CTVNewsNorthernOntario.ca in an interview.

A review of the program and its uses could be helpful in informing which services could be added to local hospitals in order to address health inequities in the north.

FAILING TO PLAN LEADS TO PLANNING TO FAIL

"Although the ministry had started working toward creating a strategy back in 2009 when it established the Rural and Northern Health Care Panel, which recommended a framework for the region, a strategy was never finalized," Stavropoulos said.

"In addition, Health Quality Ontario -- now part of Ontario Health -- developed the Northern Ontario Health Equity Strategy in 2018. This strategy recommended that a network be established with representatives from different sectors to help achieve health equity."

Five years later, nothing had been done "because, according to Ontario Health, the ministry did not approve the required funding."

In response to the audit findings, the ministry said it recognizes the unique challenges presented in the north and is committed to working on addressing the challenges. 

However, it also said it would "conduct further analysis to determine the feasibility of a dedicated strategy."

While the province funds programs to recruit and retain physicians and nurses, the audit said they are not regularly evaluated for effectiveness, signalling an opportunity for improvement.

--File from Angela Gemmill