RNAO says budget recovery plan leaves the health of Ontarians and nursing behind
The modest investments in nursing announced in Thursday’s provincial budget fall short of what is needed to solve the nursing crisis and the challenges facing a health system that is teetering on the brink, says the Registered Nurses’ Association of Ontario (RNAO).
Finance Minister Peter Bethlenfalvy announced $15 million to keep 100 mid-to-late career nurses working in the system and $22 million to support newly-graduated nurses working in hospitals. While welcome, the measures and funding pale in comparison to the enormous need facing the profession. RNAO remains concerned there was little to address the current crisis that grips the profession and affects the delivery of care across the province.
The funding to add nursing seats in Ontario college and university programs, including 1,000 for registered nurses (RN), 150 for nurse practitioners (NP) and 500 for registered practical nurses (RPN) is an important building block for the profession. “To ensure we have nursing capacity and safe workloads, we need a commitment of an additional 10 per cent annual increases in enrolments over the next five years,” says RNAO President Dr. Claudette Holloway.
“Nurses are the linchpin of the system and we need scaled-up retention measures to ensure they continue to serve, as well as massive recruitment of nurses to bring up staffing levels. Competitive compensation across all roles, sectors and domains will convince nurses to stay in the profession, but that wasn’t addressed in the budget. Years of wage repression under Bill 124 and the effects of inflation have resulted in a drastic reduction in nurses’ real income while they worked tirelessly throughout the pandemic and during periods of dangerous staffing levels. Such conditions prompted many nurses to leave and have left many others traumatized and exhausted,” says Holloway.
At a time when almost two million Ontarians lack access to a primary care provider, RNAO is shocked that funding was not approved for NP-led clinics (NPLC) as part of the government’s commitment to increase primary care access. “There are two NPLCs ready to open their doors in Orillia and Peterborough to help those who have been waiting for care. If the government is serious about increasing access to primary care, NPs are an obvious solution to deliver timely high-quality, cost-effective care,” adds Holloway.
RNAO supports measures to increase access to care and strengthen primary care, including the new authority for pharmacists to prescribe some medications. Another option is to extend this authority to RNs. “Why are we still waiting when regulation has been approved for RN prescribing? RNs have the education, skills and experience to take on this expanded scope of practice and they are ready for it. This authority already exists in many countries and jurisdictions across Canada, and Ontario is lagging behind. RN prescribing will improve access for Ontarians, save money and retain RNs who seek role expansion – enough waiting,” asserts Holloway.
The funding boost for home care is long overdue. The $569 million allocated for this year is crucial for home-care agencies, nurses and other health-care workers so they can deliver the services that people depend on to remain safely and comfortably in their own homes. These investments also alleviate pressure on other sectors.
One of the sectors hardest hit during the pandemic and most in need of recovery is long-term care (LTC). Despite investment in more beds, more funding must be dedicated to resident care. While the government has moved closer to its goal of four hours of direct nursing and personal care per resident, per day, greater focus on delivering high quality, safe care is needed. RNAO says that can only be achieved with a skill mix that consists of at least 20 per cent RNs, 25 per cent RPNs and a maximum of 55 per cent who are personal support workers, as well as one NP for every 120 residents.
Equally important to improving quality care for residents is ensuring that evidence-based assessments and interventions are embedded in their electronic medical records. Such a project already exists and is being implemented in 90 LTC homes across the province. Funding to expand RNAO’s Best Practice Guidelines (BPG) Clinical Pathways tool would standardize evidence-based care and measure health outcomes more consistently, benefitting residents and the staff who care for them.
Mindful that Ontario’s health spending plan includes a huge injection from Ottawa in federal health transfers and through a bilateral health agreement, RNAO has a message for both levels of government. “The federal government must ensure every penny it hands over is spent in the province’s publicly funded and not-for-profit delivered system. Taxpayers’ money must not be diverted to profitizing health care,” says RNAO CEO Dr. Doris Grinspun. “We are deeply concerned that opening the door to for-profit delivery of medically-necessary services and shifting funding to investor-driven enterprises contradicts the principles and the spirit of the Canada Health Act.
At a time when the government should be building up Ontario’s publicly-funded, not-for-profit health system to address backlogs and reduce wait times, the budget is diverting $72 million of taxpayers’ money to for-profit surgical clinics. Bill 60 undermines the health system through far-reaching legislation that invites further incursions of investor-driven health care. Its provisions will impair already-beleaguered health human resources within the public system and undermine existing self-regulation of health professionals, including nurses. Evidence from other jurisdictions shows that Bill 60 will not solve the current health crisis in Ontario. Instead, it will shift funds away from our publicly-funded health system, create new more costly health-care structures, disrupt the health services workforce, and dismantle the current health professions regulatory framework, which protects the public.
Nurses say solutions to surgical backlogs are right before our eyes. “Open up hospital operating rooms and diagnostic services evenings and weekends and bolster the nursing workforce. We can ensure the care needs of Ontarians are met within our public system. We need to shut down any initiatives that lead us towards a system of two-tier health care where patients’ best interests take a back seat to investors,” says Grinspun.
Understanding that housing is a determinant of health, RNAO welcomes $202 million in annual funding for a program geared to those at risk of being homeless, struggling with mental health and/or substance use, or those escaping partner violence. “It’s a modest investment for an issue that requires greater attention. We should be allocating one per cent of the total budget to deliver accessible and affordable housing, including rent subsidies for those who need it,” adds Grinspun.
For those struggling with mental health challenges, there is comfort in the form of $425 million over three years for increased support services. However, for those coping with substance use, Ontario should be doing much more. There were 1,278 toxicity related deaths due to opioids in the first six months of 2022, representing an average of seven deaths per day. Despite its commitment to act, only 17 of the 21 consumption and treatment services sites it promised to open in 2018 are up and running. RNAO also urges additional support and funding be allocated for overdose prevention and supervised consumption sites in every community that identifies a need as well as safer supply programs. “We cannot turn our back on people who are struggling. They are mothers and fathers, sisters and brothers, and sons and daughters. This is a crisis we must confront with tangible action. We need the government to step up,” says Grinspun.
Thursday’s budget did not provide a path out of poverty for the more than 400,000 people subsisting on the Ontario Disability Support Program (ODSP). A modest five per cent increase brought in last year was the first bump in payments received by ODSP recipients in years. Money set aside in this year’s budget only accounts for inflation. “The government must know it’s next to impossible to live on the estimated $1,200 recipients will receive each month. This is not enough to pay for food, shelter and other essentials. Rates need to be doubled to give those who depend on this support a livable income,” says Grinspun.
When it comes to the environmental determinants of health, RNAO is dismayed that the province is proceeding with plans to carve out huge tracts of Ontario’s Greenbelt for highways and housing. These are protected lands and essential for drinking water, fish habitats, birds and animals, including species at risk. “Developing the Greenbelt will harm the natural environment, exacerbate urban sprawl, increase pollution and worsen the climate crisis. There is a large amount of land already zoned for housing outside the Greenbelt, which is more than enough to meet the province’s housing needs,” adds Grinspun.
Overall, this year’s budget is of enormous concern to RNAO and nurses – it outlines a framework for a parallel for-profit delivery system in Ontario that will undermine Canada’s universal health-care system and does not go far enough in addressing other determinants of health. “The budget weakens the social foundations of our society by under-investing in health care, education and social programs; and by undermining environmental protections. We will see the impact in societal suffering and ill-health,” warns 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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