Prioritizing community care, improving social determinants of health and addressing nursing shortages – foundational to future pandemic preparedness, RNAO says

The COVID-19 pandemic revealed deep gaps in Ontario’s health system and emergency preparedness. That’s why the Registered Nurses’ Association of Ontario (RNAO) welcomes the report of chief medical officer of health (CMOH) Dr. Kieran Moore, which says we must avoid the same mistakes during future health crises. Yet, the report doesn’t go far enough to protect the health and safety of Ontarians. Lacking is the provincial government’s commitment to act on all findings that repeat what past reports have recommended – only to be later shelved – such as addressing social determinants of health.

Being Ready’s focus on preparedness, sustained investments in public health and data collection on social and economic inequities is correct. RNAO agrees that the “boom and bust” cycle of funding must end to allow for stable investments in public health. Community care must be on the front lines of the pandemic response, which RNAO insisted on from its start, to no avail. “The response to future outbreaks must be anchored in the community – primary care, home care and congregate care – with safe and well-protected staffing levels across our health system,” says RNAO President Dr. Claudette Holloway. “In March 2020, Ontario's primary care and home care services were shut down and congregate care services – our elders and other vulnerable people – were abandoned to their fate. Hospitals were tasked with providing both acute and community care – an extraordinary burden linked to the massive surgical backlogs that ensued. This approach is the exact opposite of what must happen during a health emergency.”

The report wants to ensure staffing shortages are addressed in advance of the next pandemic. RNAO agrees – with Ontario having the lowest number of registered nurses (RN) per capita in Canada, RNs in acute care and long-term care were left exhausted. “Patients and residents in these settings paid with their lives during the pandemic because of the longstanding policy of unsafe workloads for RNs. Meanwhile, the expertise and energy of nurses in primary care and home care were not leveraged to respond to the crisis,” says Holloway.

The crisis resulting from RN shortages is still causing emergency room closures and driving surgery backlogs. “We don’t need more reports to tell us that RN shortages are making Ontarians sick, or even worse, killing them. The time is now for our government to take action and fast-track retention and recruitment of nurses, and in particular RNs and nurse practitioners. RNAO has provided the roadmap, complete with recommendations. “We urge government to act decisively,” says Holloway, pointing out the Financial Accountability Office warned in its latest report that the government cannot deliver promises to add beds and nurses without increasing funding.

The CMOH’s report highlights the need to collect data on social and economic inequities. While nurses agree data collection is important, addressing the problems identified by the data is crucial. The report is silent on how the government plans to remedy the disparities exposed through COVID-19 and says the next health crisis will exacerbate them. The deeply harmful plan of the Ontario government to build a network of for-profit, investor-driven surgical clinics will advance a two-tier health-care system and worsen the nursing shortage.

“Since day one of the pandemic, RNAO urged the government to practise the precautionary principle – prepare for the worst and hope for the best,” says RNAO CEO Dr. Doris Grinspun. “We must identify vulnerabilities. And, to prepare for the next pandemic, government must address the sources of inequity. Indigenous peoples, Black and racialized communities, 2SLGBTQI+ people, social assistance recipients, casualized workers and other vulnerable populations will remain in insecure situations until government improves their economic and social supports and ends systemic racism and discrimination across the board.”

Key to the social determinants of health are a dignified income and benefits, affordable and accessible housing options, and tenant protections. “Too many Ontarians experienced homelessness, overcrowding and the inability to isolate during COVID-19 – unacceptable in our wealthy society,” says Grinspun.

For Indigenous communities, Grinspun says the government needs a nation-to-nation response negotiated with Ontario’s Indigenous communities to account for their public health needs and address their strengths.

RNAO is pleased the report identifies the need to counter false and misleading information using evidence-based methods, but says it lacks recommendations to regulate social media platforms. This spread of misinformation – described by the World Health Organization as an “infodemic” – puts lives at risk, especially in vulnerable populations. “Social media has pervasive impacts on ill health, and aggressive regulation of the platforms is overdue to mitigate the damage and prevent further death during the next health emergency,” adds Grinspun.

For a successful national response in the future, it’s important that all levels of government work in tandem. “Our governments must immediately start emergency preparedness by creating legislation and initiatives that will support our most vulnerable people indefinitely,” says Grinspun. “Federal-provincial agreements must condition funding on targeting goals that strengthen our publicly-funded and not-for-profit health system, build up robust primary care and home care sectors, and end the human resource crisis – this is the only way to advance the health of Ontarians at all times,” says Grinspun.

The Registered Nurses’ Association of Ontario (RNAO) is the professional association representing registered nurses, nurse practitioners and nursing students in Ontario. Since 1925, RNAO has advocated for healthy public policy, promoted excellence in nursing practice, increased nurses’ contribution to shaping the health system, and influenced decisions that affect nurses and the public we serve. For more information about RNAO, visit RNAO.ca or follow us on Twitter, Facebook and Instagram.

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