By Thomas Linner

On March 15 – the day that the Government of Manitoba lifted all remaining public health measures including mask mandates, vaccine passports and isolation requirements – the “COVID-19 Health System Recovery Plan” was released. The Manitoba Health Coalition was encouraged to see a document put forward which could act as a road map for the coming months in Manitoba. Unfortunately, it became apparent that there is little in the report designed to address the concerns of Manitoba healthcare workers, patients, seniors in care or their families. This is concerning because the report is meant to help assuage fears as public health measures are abandoned.

Patients and families would be right to question why, if the time is right to move on from practices designed to stabilize the health care system, that a report on the proposed “recovery” of that same system would continue to rely on the controversial and often time traumatic policy of inter-region transfers. But the report states plainly that “[i]nter-region transfers will continue and may increase in the coming weeks as weather can be expected to play less of a limiting factor” and that this is “necessary to maintain capacity for COVID and non-COVID patients”.

MHC firmly believes this is a wrong-headed approach. Surely the point of everything Manitoba families have done over the past two years is to ensure the capacity and integrity of Manitoba’s hospitals, clinics and care homes. The necessity to continue inter-region transfers on an ongoing and even increased basis should make it clear that capacity is still deeply affected by COVID-19. The logic for removing public health measures at this time falls down at the first hurdle.

This logic is even further tested when we look at the report’s discussion of arguably the area of greatest concern for health care recovery in Manitoba: long-term and seniors’ care. The deadly second wave of COVID-19 laid bare the inadequacies at the heart of the long-term care system. None of this receives any mention. Instead, the report points to the December 2021 publication of a “Provincial Long Term Care/Personal Care Home Pandemic Plan” – designed as a “how-to” on dealing with outbreaks of COVID-19 and potential future pandemics in care homes on a go-forward basis. No mention is made of changes to policy or practice.

This is disconcerting. If we truly are coming out of the pandemic period, then nowhere is the reform of staffing levels, accountability structures, minimum care standards and the role of privatization more urgent than in the area of long-term care. Private, for-profit operators saw the worst results in Manitoba as well as across Canada. It is MHC’s position that this model – which is accountable to shareholders instead of patients, residents or families – should be removed in Manitoba.

In a related discussion, while the “Recovery Plan” may not be the place for it, MHC is also of the view that Manitoba should follow the lead of British Columbia and establish the Office of a Seniors Advocate with the power to conduct investigations and make recommendations to the Legislature.

The report speaks glowingly about the contributions of front-line health care workers over the course of the last two years:

“Manitoba’s health-care workers have made enormous contributions to the health and well-being of their patients, clients and residents over the past two years and will be key to our health system’s recovery“.

Such recognition is welcome and warranted. Practically every functional element of the “COVID-19 Health Recovery Plan” relies on what the report calls “the availability of a professional and highly skilled health workforce.” But the report gives no specifics and sets out no principles under which this availability will be ensured.

At no stage does the report set timelines or targets for the recruitment of new staff. Moreover, the word “retention” does not even appear in the document. This would seem to indicate that the government does not understand the scale of the problem it is facing despite the clear evidence.  Nurses – as a prominent example – have been clear that many are seeking to leave the profession. The most recent data available for Registered Nurses sees a sharp decline since Pallister-era cuts began to take hold: a decline of 500 as of 2020.

Part of the problem may lie in the government’s stated objectives for the health care system in the recovery period, which the report terms “the urgency of a return to pre-pandemic operations.” The government may choose to reflect that, one year prior to the emergence of COVID-19, its policies had led to what the WRHA called a “valley of despair” for health care workers. Returning to the status quo of cuts, chaos and privatization is no promised land. A comprehensive health care human resources strategy, with input from the front lines, is crucial to recovery in Manitoba’s health care system.

No one wants to see a new wave of COVID-19, or new variants with increased transmissibility, lethality, or both. But hope is not a plan. The report does state: 

“Health system indicators, including surveillance testing, hospitalizations and ICU admission, are being closely monitored to inform decisions in the event of a surge in COVID-19 activity.”

This is good. But what Manitobans deserve is a set of benchmarks – along the criteria established in the report – for what indicators would trigger a return to well-established, popular and effective measures like mask mandates, vaccine passports and isolation requirements. In addition, if we are indeed currently seeing a lull in hospitalizations, efforts should be taken immediately to reinstate widespread public PCR testing to inform decision-makers before lagging indicators like hospitalization, ICU admission and death have already reached unsustainable levels. This has happened too often in Manitoba’s handling of the pandemic, with dire consequences for families and the health care system.

One of the most severe consequences of the government’s repeated failures to act quickly and decisively in the face of growing waves of COVID-19 has been the mounting surgical and diagnostic procedure backlog. Doctors, nurses and front-line health care workers have identified the Pallister-era re-organization of health care as a key ingredient in what went wrong. Taken together, this delayed reaction combined with the consequences of pre-pandemic decisions led to a perfect storm and a waitlist topping 160,000 delayed procedures. 

With this track record, accountability is important. The government must establish firm timelines for when the backlog will be cleared so that families know how long they and/or their loved ones will be waiting. Doctors Manitoba has made this recommendation repeatedly and MHC supports this call. It should also be made clear that private and out-of-province providers are not a silver bullet. We know that Manitoba has a shortage of health care workers like nurses and respiratory therapists, amongst others. Opening up more slates to private operators risks poaching staff from an already stretched system; relying on out-of-province providers ignores the staffing capacity needs in Manitoba and leaves patients vulnerable to conditions in other jurisdictions.

We need structured and sustained investment in Manitoba’s public health care system to address the backlog efficiently and effectively for Manitoba families.

Finally, the simple fact is that any report dealing with the recovery of Manitoba’s health system from the ravages of COVID-19 is incomplete if it does not address the pressing need for an independent and timely public inquiry into the government’s management of the pandemic. This is a crucial step to restoring public confidence. Families and health care providers have expressed serious concerns that have seen no resolution. It’s vital that we ensure that lessons are learned, and mistakes are not swept aside. 

Health care is a fundamental right for every Manitoban. The pandemic has shown us all how important public, universal health care is for families in Manitoba and across Canada. Years of cuts and privatization put our health care at risk – at the worst possible time.

The time is now to invest in real solutions that strengthen public health care for Manitoba families and support front-line health care workers.

That is the true path to recovery for Manitoba’s health care system.

Thomas Linner is the Provincial Director of the Manitoba Healthcare Coalition