The front lines are down

Al McCulloch was prepped for cancer surgery and waiting on a gurney last August when he got the bad news. Although his surgery had been booked for three months – and had been cancelled once before – Ottawa General Hospital had no bed for him. He would have to go home and re-book the operation for another time. ‘

McCulloch, 68, didn’t take the setback lightly. “You don’t fool around with cancer,” says the retired medical products representative and current seniors advocate. He marched into the office of the hospital’s CEO and demanded answers. What he learned shocked him. The lack of a bed – or more precisely, the lack of staff to care for a patient in the bed – was not an isolated problem. There had been, McCulloch says, 18 other patients in the same boat that August day.

Stories like these – published regularly in newspapers and magazines or passed along in coffee shops and taverns – have shaken the confidence Canadians have in their healthcare system. Aging or non-existent diagnostic equipment, closed emergency wards, nursing shortages, hospital shutdowns … the symptoms of a troubled system go on and on. After all, if a major hospital is so short-staffed that ccer surgery has to be cancelled despite three months’ notice, something, it seems, must be seriously wrong.

New plan for healthcare
Last September, in response to this erosion of our healthcare system, the country’s first ministers agreed on a plan to reform healthcare and for the federal government to put an extra $23.4 billion into the system over the next five years. It was, say health policy experts, a good first step – and not only because of the money. The plan also provides for new diagnostic equipment, the beginnings of a national report card on healthcare, and some experiments in reforming primary care.

Depending on who’s doing the math, the cash infusion means that in 2006 the feds will be paying roughly the same or perhaps slightly more than they were paying in 1996, when Ottawa began slashing transfer payments for healthcare. In fact, though, the system is not plagued by a shortage of money. “As far as the overall amount of money in the system goes, it has never been higher,” says Saskatoon healthcare consultant Steven Lewis.

Dr. Carolyn Bennett thinks it’s a good first step. Bennett, a well-known Toronto doctor and currently a Liberal MP, has been a leader in trying to reform the healthcare system.

The money, Bennett says, isn’t the important thing. Instead, the key element – one that went almost un-remarked – is the commitment to reporting on the system. “The money,” she says, ” was the carrot that got us the report cards.”  She believes the healthcare system’s main problem is not crowded ERs, not waiting lists, not decrepit equipment. Instead, she says, it is that the system is not managed.

“What we have now is a health insurance plan, not a well-organized health delivery system,” she says. The report cards, she hopes, will start to change these inefficiencies because for the first time Canadians will have an idea what the system is doing in their community and how well it stacks up against other parts of the country. “If Newfoundland can do something, and Ontario refuses,” she says, “that will become a political issue.” Exactly how those report cards are designed and what they will say is still up in the air, but one obvious issue that should be graded is the number of healthcare providers.

Brain drain continues
However, despite all the positive reaction, the new plan includes no commitment to reverse the medical brain drain, to hire and train more nurses, to recruit or educate more doctors, to find more technicians. Saskatoon urologist Peter Barrett, the president of the Canadian Medical Association, says the deal left out what he calls the “labour-force issues,” issues that have led to angry confrontations between governments and healthcare provides in British Columbia, Saskatchewan, Alberta, Newfoundland and Quebec in the last two years.

Some money probably will go into training more doctors and nurses and into re-hiring some of those who were fired or switched to part time. For example, in January of this year, Ontario announced it would put $49 million into increasing the number of nurses trained in the province. But it takes time to train a doctor, a nurse, a technician.

In the meantime, who’s going to be minding the hospital, the lab or the doctor’s office? Answer: Aging, tired, overworked professionals who believe they are unable to do as good a job as they would like and who are continually invited to take their skills and talents to the lucrative land south of the border. Barrett likes to cite Statistics Canada figures on the medical brain drain: For every doctor who moves north, 19 move south; for every nurse who moves north, 15 move south.” They’re not going for the money,” he says. “They find they’re not practising the kind of medicine they were trained for.”
Canadian Nurses Association president Ginette Rodger believes the first ministers’ deal left out the most important part, repairing the effects of the “slash and cut” mentality of the ’90s. “They can add all the technology they want,” she says, “but if they don’t have the care providers, the system won’t work.” Rodger points out that most of the medical care in this country is in the hands of nurses. “In particular for seniors,” she says, “the nurses are really the main care providers.”

The healthcare “reforms” of the early ’90s involved cutting services, reducing the number of hospital beds, firing nurses and, perhaps most important, cutting enrolment in medical and nursing schools. “We’ve really lost a generation,” Rodger says. In the mid-1980s, Canada graduated 10,000 nurses a year; now a mere 4,000 get their caps. At the same time, enrolment in medical schools and opportunities for post-grad medical study were cut by 10 per cent.

The people are the system’s best protectors
So, are we doomed? Well, no. Both Barrett and Rodger say the system is still working but under severe pressure and will be for years. There have been some increases in medical school enrolments but “the reality is that it takes eight years to train a doctor,” Barrett says.

In the long run, if the system is to survive, we may need to re-think what it is we want, what it is we need and how much we’re willing to pay.  Steven Lewis says it may be that we are now expecting too much. “Ten years ago, if you had a headache for 10 days, you moved from Aspirin to Tylenol 3,” he says. “Now you think you need a CAT scan or an MRI.” Yet there’s no solid evidence that having such machines routinely makes a difference to most Canadians. Are we buying glitzy machines when we should be spending money on basics?

If you’re concerned about the healthcare system, Rodger says, the best thing you can do is open your mouth. “The best protectors of the system are the people,” she said. “If the politicians don’t get the message loud and clear, they will trade it off.”

Al McCulloch – who finally did get his surgery last September – agrees Canadians still need to fight for their healthcare system. “We have some very serious problems in the country right now,” he says, mainly because no one is planning and managing the system. That may start to change as a result of the first ministers’ deal. But in the end, he says, healthcare is too important to leave to governments. “It’s our system. It’s not the politicians’ system.”