Host: Hospitals across the province are feeling the crunch. More than 100 are forecasting year end deficits. And before this year's provincial budget, the Ontario Hospital Association said the sector was facing a $1.8 billion deficit in working capital. So did the budget move the needle? Natalie Mehra is executive director of the Ontario Health Coalition, and Doctor Otto Kapoor is an adjunct professor of emergency medicine at the University of Ottawa and member of the Public Affairs Committee at the Canadian Association of Emergency Physicians. Great to have you in studio, Otto. Great to have you on the line. Natalie, we're going to start off first, $1.1 billion promised in the Ontario budget for this next year for for hospitals to make ends meet. Does it do the job?

Natalie Mehra: >> Well, yeah. In context, what the budget said was up to 4% increase for hospitals. So up to 4%. That could mean a lot of things. But even at 4%, it's less than what the hospitals actually need.

Host: >> What do they need.

Natalie Mehra: >> 6% just to maintain essentially existing services to meet population growth and inflation and ageing pressures. The truth is that we already have a problem in hospitals, as you know, very serious staffing shortages. Too few beds left, staff did an operation or are sitting there unused because they're not staffed to be run the majority of the time. So we have all kinds of capacity that isn't being used in our public hospitals because they don't have the funding. So they're already very severely underfunded. That point that up to 4% doesn't get us out of the situation we're in, and nowhere near to where we should be. That said, we have world class hospitals. We still have amazing world class hospitals in Ontario. It's just that they're stretched too far.

Host: >> All right. Let's let's get your your reaction.

Doctor Otto Kapoor: >> Well, as Natalie said, the hospital needs 6% just to keep up with the status quo. And we're talking up to 4%. But that assumes we're in a good position to start with. And we know we're not even the even the Ontario Hospital Association says we've got about $1 billion structural deficit, and we're seeing the effects of this in the emergency department, which is where, you know, the community and the hospital problems all meet at once. So we're seeing we've already been seeing the effects of hospital overcrowding, which leads to emergency overcrowding, which means leads to long waits and delays in care and sometimes, unfortunately, dangerous delays in care.

Host: >> Odawa. The government has also promised $64 billion in health care funding over ten years, some allocated towards operating budgets, hospital projects, additional beds. With this begin to ease sort of the crunch that hospitals are facing.

Doctor Otto Kapoor: >> It would begin to ease the crunch. But what I'm not hearing as much as the urgency we've been doing cutbacks, we've been doing efficiencies, we've been doing more with less for years and years. And I'm not seeing the urgency. Ten years is a very, very long time to wait for stuff that we need to have started years. Five, ten years ago.

Host: >> When I asked that question, I saw you shaking your head. Does it not?

Natalie Mehra: >> It's so frustrating. You know, this sort of down the road, we'll deal with the hospital problem. I mean, this people literally get sent home five times from the emerg without a diagnosis. People that ten, 20 years ago would have been admitted to hospital and observed, you know, had health professionals watching them and so on. So they get a diagnosis and finally get some care. We've got the frail elderly out the other end being pushed out of hospital in ways that are absolutely inhumane in the last months of their lives. I mean, this is human suffering on a scale. Like what I see now is, is just completely unacceptable in a modern country, in a modern health system. And it's so frustrating because we're literally watching money being poured into privatisation. It's not like there's no money. They are pouring millions upon millions into privatisation. They've just pushed our public hospitals into deficits on purpose to force cuts. It's cut the public, create a crisis, force privatisation. That's exactly what we're seeing.

Host: >> I would imagine that the Ontario government would say that they are dealing with the current issues, with the funding that they've put. We have seen also, you know, Atul has said, you know, hospitals, emergency rooms, usually a catchall for a lot of these issues. We have seen funding for family doctors. We've seen some money for home care as well. Does that help alleviate sort of those issues as well?

Doctor Otto Kapoor: >> Well, I mean, Ontario funds health care at the lowest rate of all the provinces and countries. So again, in context, we see funding being announced and there's a lot of PR around that. But in context, we fund all of health care at the lowest rate in Canada. We fund our hospitals dead last in Canada. Actually, I think Quebec actually just dropped beneath us, but we vie for the bottom with Quebec, and the consequences are experienced by patients. So no, there isn't enough funding and we're billions of dollars behind the other provinces. And it's not like we can't afford it. Like we're literally our province is spending billions on spas and, you know, alcohol stuff, you know, etc. but not on health care, which is a priority of people. But if we look within healthcare, there's all kinds of money, like one about $1 billion a year now being spent between hospitals and Long-Term care on For-Profit staffing agencies, 300 million just announced in the last year alone for 61 new private clinics.

Host: >> All right. I want to look at sort of the finer lines here, but yeah, let's get your thoughts on their.

Doctor Otto Kapoor: >> Yeah, I think part of the frustration from our from my point of view and for clinicians generally is that there are good solutions. We know what works. It's going to take time. It's going to take effort, but there are evidence based solutions. And what we're asking for is for that money to be invested in the solutions that we know already will work.

Host: >> What are they?

Doctor Otto Kapoor: >> And I think that's we need to we do need to do improvements in the way we deliver care that needs to be looked at. There are ways that we can improve the efficiency and productivity of what's being done in hospitals. Natalie mentioned some of them, if that we could expand the use of ORS that are currently in hospitals that aren't being used. There are other ways of looking at how are we providing elder care. Those need to be done. What I haven't seen so far is a thoughtful plan to consult with the physicians, the other caregivers, the providers to make sure that's happening. Cape can, the emergency physician Organization. We've put a lot of time into a project called empower, which says that we need to look at the various ways that we're investing in the system and that we're delivering care, and that is a way to get to a sustainable solution.

Host: >> All right. Earlier in this episode, we heard from authors of an investigative report on hospital finances that they are seeking bank loans to stay afloat, to keep up with operating demands. I need to get your thoughts. Why should Ontarians be concerned about this?

Natalie Mehra: >> I think it's outrageous. I mean, this is really what what's been happening. The provincial government will announce a certain amount of money for the hospitals. They'll hold back till the very end of the financial year, their fiscal year, and then announced a whole bunch of money, too late for the hospitals to be able to use it to hire staff and stave off layoffs or, you know, program curtailments and so on and so forth. This has happened for years running. Now, it's no way to run an army, you know, skews the military metaphor, but we need boots on the ground in the hospitals. We need it now. Staffing shortages beget staffing shortages. And because when you don't have staff there, you don't have enough people get injured. More people call in sick, more people do more overtime, and it destabilises the whole system. It also costs more. And that's what's happening. So I mean, this report, I think it's excellent. It's about time it was done. And it's shocking. So many the majority of Ontario's hospitals in deficit, you know 70% of them actually seeking loans. And we're paying as the public for interest on those loans for our public hospitals. The province has money. You know, we could be actually providing the hospitals with stable, multiyear funding if that was a political choice to do so. And instead, we're paying millions upon millions to banks and financial institutions for interest. After pushing the hospitals into crisis, completely unacceptable.

Host: >> Otto.

Doctor Otto Kapoor: >> Yeah, it's a significant milestone. For years and years, we've been doing more with less and more, with less and becoming more efficient and trimming fat. And we've seen the effects of it as growing waiting waitlists and growing crowding in the emergency department with no place for us to send our admitted patients. This is, I think, a significant milestone, an event where people have to say, wait a minute, we've crossed a yet another threshold. If hospitals are relying on bank loans to stay afloat.

Host: >> Abdul, I have to ask, you know, Natalie, Natalie and I have been talking, you know, she's been doing this work for quite a long time, and I want to get a better picture behind the scenes inside those emergency rooms. What is the what are the shortfalls do for patients? What are we looking at? What are you seeing in those rooms when the dollars aren't meeting the demand?

Doctor Otto Kapoor: >> Well, what you see is patients lingering in stretchers in loud, noisy places when they should be upstairs in a bed, getting the proper care they deserve. It's not just uncomfortable. It's dangerous for the patient. We know we've known for years that spending an extra day in the emergency department instead of being upstairs doesn't just mean that you get worse care while you're there, but you have increased morbidity, you have worse outcomes, and you even have increased mortality for that hospital stay. Just from an extra day of being in the in a emergency stretcher rather than upstairs. And that's been going on for unfortunately, many, many years. And it's just been continually getting worse. And it also has effects on our staff, our morale. We're seeing emergency doctors and nurses who are who are that's not what they were went into that field to do. And they're burning out and they're leaving. And it's a spiral going downwards. Unfortunately.

Host: >> If you had the ear of the government right now, what would you ask? In order to make progress in funding hospitals better in this province?

Natalie Mehra: >> Well, I think on the funding level, Ontario normally is the average of the country. We've got the biggest population, so we usually pull the average of the country. We're dead last in funding. So they do actually have to look seriously at the funding. They need to stabilise the staff because once you stabilise the staffing, everything else kind of falls into place. The care, there's no care without staff. And of course, when you have unstable staff, you're paying a fortune up to three times per hour for, you know, agency nurses and what have you. And you've, you've made your staffing worse by, you know, more absenteeism and so on and so forth. So they've got to stabilise the staff. That applies also to home care. It applies to long term care. It applies to primary care. We should just we need to have an actual plan to stabilise the health system. Now across the system.

Host: >> I'm going to give you the last word here.

Doctor Otto Kapoor: >> I think what I think, what I'd really like to see is a thoughtful plan based on consultation, based on the evidence that we know of, what we already know works. And fundamentally, it needs levels of accountability at every level, not just at the fundamental patient clinician level, but accountability all the way up to Organization and up into the government and the ministry itself.

Host: >> Well, we are going to have to leave it there. Natalie, I really appreciate your time and your insights. Thank you so much.

Natalie Mehra: >> Thank you.