Emergency acts. Lockdowns. Stay-at-home orders. The directives since the beginning of the pandemic have forced Canadians to make many sacrifices to protect themselves from COVID, and people are reporting worsening mental health. The greatest impact has been on health care workers, who are leaving the field in droves suffering from burnout and post-traumatic stress disorder. Although the vaccination rollout is gathering traction, the threat from COVID variants and a potential fourth wave continue to cast a shadow on returning to normal.
The pandemic has seen a further challenge ─ it has exposed the many deficits in our overburdened health care systems and patients have fallen through the cracks. The lack of a national human resources strategy, ensuring there are qualified personnel, is at the root of the problem. We have seen this at play in the repeated deferment of nonemergency surgeries and nonessential procedures, as well as the terrible situation exposed in long-term care. Without a plan to ensure there are enough sufficiently trained health care personnel through a national human resources strategy, easing the barriers to cross-provincial/territorial practice for health care professionals, and recognizing the importance of families in providing care, Canada’s health care system will continue to let down both health care providers and patients.
Access to timely care
In July 2021 ─ more than a year into the pandemic ─ there were nearly 16 million deferred surgeries, medical exams and procedures in Ontario, which must be cleared. The Canadian Institute of Health Information has found there was a decrease of between 17 and 21 per cent in life-saving surgeries following the first wave alone. For example, the insertion of pacemakers, as well as bypass and cancer surgeries, were put on hold. Even more alarmingly, it’s unknown what the decline in these life-saving procedures means. The strain on patients after the first round of deferments was plainly evident, but the same policies were enacted with every subsequent wave of the pandemic. Similarly, to combat the waves of COVID, intensive care (ICU) beds were added, but beds mean little when there are too few trained ICU nurses and specialized health care staff.
In addition to other investments in the health care sector, investing in a national human health resources strategy will be vital in order to increase capacity and ensure everyone seeking care can access it in a timely fashion. The idea is not new. In 2004, Canada launched a Health Human Resource Strategy “to support effective co-ordination and collaborative health human resources planning across the country.” However, there is no sign of this being planned in the most recent federal budget of April 2021.
The idea of a national licence is also not new. Health professionals were requested across jurisdictions at the peak of the third wave. However, no policies were put into place to change the requirements permanently to ease the regulatory barriers.
It is well established that the relationships among patients and their support structures results in insights that lead to improvements in health care, health systems and patients’ health needs. At the height of the pandemic, one of the biggest hurdles was the blanket ban on all visitors for patients. This included essential care partners, who may have been family members, caregivers and even close friends who were involved in decision making, care co-ordination and continuity of care.
Yes, limiting transmission rates, lessening the burden on health care systems and ensuring the end to this pandemic is of utmost importance. But we must consider patients’ needs in the process. Separating them from their loved ones, through either visitor bans or transfers to far-off hospitals, should not be the typical practice.
Ontario’s Long-Term Care COVID-19 Commission report is a scathing look at the many failures during the pandemic, and a severe shortage of staff is repeatedly highlighted. Although this was a long-standing issue, during COVID the ban on visiting care partners had a tremendous effect on patients and the care being provided.
Healthcare Excellence Canada is a merger between the Canadian Foundation for Healthcare Improvement and the Canadian Patient Safety Institute. It is one of many organizations that have identified the serious harms the current policies have caused, not just to the mental well-being of patients and their loved ones, but also to quality of care, patient safety and outcomes.
It has published several reports on patient, family and caregiver engagement, including Essential Together, which offers policy guidance for reintegrating essential care partners into patient care. This is especially pertinent in the contemporary Canadian health care environment, with an aging population, increase in chronic diseases, the continuing pandemic and possible global pandemics in the future.
While it must be noted that in Ontario policies were changed in December 2020 to allow up to two visitors per person receiving care, and the restrictions were further eased in June 2021, there is still a major need for national health care human resource policies. At the provincial level, even before the pandemic, British Columbia and Ontario had patient engagement frameworks that stress the importance of transparency, building awareness, collaboration, empowerment and respect. The Canadian Medical Association released its first ever patient engagement framework in 2019, to lay the foundation of greater partnerships between physicians and patients.
This pandemic is far from over. Before the next one is upon us, HealthCareCAN, the national voice of health care and health research institutions in Canada, recommends that Canada urgently address the shortage of health care workers; ease the regulatory barriers to cross-provincial/territorial practices; and support and implement a robust national health human resources strategy.