Premier Doug Ford’s controversial wage restraint legislation contributed to the staffing crisis in Ontario’s health-care system, according to internal briefing documents given to the minister of health.
The admission was made in briefing notes prepared for Sylvia Jones in 2022, after she was appointed minister of health, and obtained by Global News through a freedom of information request.
They were contained in her transition binder, which is designed to inform an incoming cabinet minister of the inner workings of the ministry, decision-making frameworks and key issues the politician may be expected to handle.
One portion of the minister’s binder that dealt with “retention issues” in the health-care system stated that “concerns about wage disparity via Bill 124” were a contributing factor, along with wage disparities.
In another briefing note, the ministry acknowledged that Ontario’s health-care staffing problems worsened during the pandemic.
“Health human resources (HHR) shortages predate the pandemic; however, shortages of nurses and personal support workers have become worse,” one slide created for the health minister’s transition binder says.
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Ontario Liberal health critic Adil Shamji said the pages give a rare insight into the Ford government’s concerns about provincial health care.
“It is one of the first times I’ve seen an official source acknowledge the fact that health-care worker retention is one of the biggest challenges that they face,” he told Global News after reading the documents.
“Until now, the emphasis has always been on attracting more health-care workers in. This document shows very clearly that the government is worried about the number of nurses and PSWs (personal support workers) and other health-care workers that they’re losing — they just never talk about it publicly.”
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Wages — especially for PSWs — were identified multiple times in the documents as part of the Ministry of Health official’s assessment as contributing factors to staffing issues within the province’s health-care sector.
“Wages and working conditions continue as key drivers of attrition,” one slide said.
A separate briefing note, on Ontario’s post-pandemic surgical recovery, admits that “wage disparities are also causing (health-care staffing) shortages in home care.”
The revelation comes as the Ford government is set to appeal a ruling that threw out Bill 124. The legislation, introduced in 2019, capped public sector wages to a one per cent annual increase over a three-year period.
The law has been blasted by a coalition of public sector unions that took the Ford government to court over the bill, arguing the legislation caused a public-sector staffing crisis, particularly among nurses.
“Bill 124 has had an enormous impact on the province’s ability to retain and recruit nurses and, three years into the pandemic, this has taken an enormous toll on the health-care system and those who need to access the care our members provide,” the Ontario Nurses’ Association said in September 2022.
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Ontario’s health minister has publicly denied that, telling reporters in November 2022 that there had not been a “mass exodus” of staff from the health-care sector.
“We have not seen a mass exodus of nurses leaving the system,” Jones told reporters. “What we have are nurses and health-care practitioners who have a lot of options to choose when they want to practise nursing in the province of Ontario.”
A report tabled by the College of Nurses of Ontario broadly agrees, suggesting exits from the sector itself have remained relatively consistent over the past five years.
The report found that an average of 6,609 nurses per year have left the profession — with the year-over-year loss never rising above 7,000 or falling below 6,000.
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One explanation for the stable number of nursing registrations — at a time when hospitals have seen record vacancies — is that nurses who remain in health care are moving away from front-line care jobs.
That was the assessment presented to Jones by the Ministry of Health when she took over as the minister responsible for the largest government portfolio.
One page from the briefing documents obtained by Global News said nurses were moving away from front-line care environments, which, advocates say, have contributed to widespread burnout.
“Attrition is around five per cent per year and has not increased,” the internal document reads. “Nurses are not leaving the profession but are leaving front-line positions.”
Shamji said he believed nurses were renewing their licences but opting not to work.
“How you define nurses leaving the profession or not really depends on how you’re gathering that information,” the MPP, who worked as an emergency room physician before entering Queen’s Park, explained.
“Many nurses are leaving the profession but they’re still paying their college dues and keeping their licence alive in case of a time when circumstances and remuneration are more favourable.”
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A survey conducted by the Registered Nurses’ Association of Ontario (RNAO) in May 2022 found that over 75 per cent of Canada’s nurses were “burnt out.”
The survey was conducted between May and July of 2021, “during the height of Ontario’s third wave” of COVID-19 and collected responses from 5,200 nurses in Canada — most of which were from Ontario.
The report, titled Nursing Through Crisis: A Comparative Perspective, found that more than 75 per cent of Canadian nurses who responded to the survey were classified as “burnt out,” with higher percentages reported among those in hospitals and front-line workers.
A total of 69 per cent of nurses surveyed said they planned to leave their position within five years.
In the face of continued staffing issues amongst nurses, a slide prepared for Jones contained a stark call to arms: “We must retain the nurses we have and educate more.”
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Global News sent a detailed list of questions and a copy of the document to the Ministry of Health for comment. A spokesperson responded with a broad statement, despite a specific request to answer each question separately.
“The challenges facing our health care system are not unique to Ontario,” part of the statement read. “While there is still more work to do, early results are showing that we’re making good progress on our government’s plan to build a stronger health care system.”
In response to a request for more detailed answers to the issues raised by the government briefing, the spokesperson said, “our statement stands.”
— with files from Global News’ Hannah Jackson
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