By Thomas Linner
Manitoba health care is at a crossroads. From emergency care to home care, the entire system is at a breaking point caused by Pallister-era decisions to close emergency rooms and privatize services. Instead of stepping up to fix these problems, Premier Stefanson has carried on the same agenda of cuts and privatization.
Budget 2023/24, for all its spending initiatives, does not materially address the threat of American-style, two-tier, user pay health care. In fact, from seniors’ care to surgical procedures, the final budget before October’s provincial election doubles down on private profit over public health care.
From rural paramedics to home care workers, from nurses and doctors to respiratory therapists and hospital support workers, Manitoba has a serious health human resources staffing crisis. Frontline workers, patients, clients and families were looking to Budget 2023/24 to belatedly address the staffing crisis facing Manitoba’s hospitals, clinics, Personal Care Homes and home-based services.
In advance of the budget, the Manitoba Health Coalition called on the government to appoint a committee of physicians, nurses and other frontline healthcare professionals to address the staffing crisis. This was not done. Instead, the government announced a $200 million Health Human Resources Action Plan in November of 2022 with no details and no metrics for success – a fact noted consistently by the MHC and others. We had hoped for more details to be made available in the main financial document of the government.
This was not the case. Despite the significant amount of emphasis placed on the strategy in the budget speech and documents, we are no closer to understanding several features of the plan, including:
- Under what time-frame will the $200 million and the addition of 2,000 healthcare professionals be accomplished?
- What specific targets are in place for the various professions included under this plan, including types of physicians, nurses, allied healthcare professionals, etc?
- From what baseline are the 2,000 additional healthcare professionals to be added?
Rather than providing clarity, the details contained within the budget documents add to the confusion and concern felt by frontline healthcare workers. The Budget 2023/24 line items for both nursing and physician recruitment and retention are flat year over year (Estimates of Expenditure Pgs. 95 and 96). There is no specific reference to recruitment or retention of any other category of healthcare professional or support worker in the Budget 2023/24 documents. It is also unclear whether ongoing contract negotiations with several health care unions have been priced into budget expenditures or not. Settling long-standing negotiations would go a long way towards establishing clear recruitment and retention goals.
More confusingly, the Action Plan is billed as a $200 million strategy but only $123 million is accounted for in Budget 2023/24- comprised entirely of measures previously announced. At that announcement the Minister stated: “I want to assure all of Manitoba’s health care providers that more supports are on the way as the Health Human Resource Action Plan is rolled out.” If this is true, they will evidently not be accounted for in the budget documents that lay out the fiscal plan for the provincial government in 2023-24. Embarrassingly, the government also attempts to refer to operational decisions with no human resource, recruitment or retention elements – such as the Virtual Emergency Care and Transfer Resource Service – as part of the Plan.
This leads to the conclusion that what we are seeing is not the roll-out of an action plan, but rather a poorly thought-out communications strategy that fails on its own terms. And it also raises concerns that, despite the large year-over-year increases across several line items, Budget 2023/24 could be the most vastly underspent health budget in Manitoba history due to chronic understaffing in our core hospitals, clinics and long-term care facilities.
Surgical and Diagnostic Backlog:
Nowhere is this government’s ideological predisposition to risky privatization more prevalent, and damaging, than in its response to the surgical and diagnostic backlog.
Funding for the surgical and diagnostic backlog increased from $120 million in Budget 2022/23 to $130 million in Budget 2023/23. This does not reconcile with the statement that “Net changes in Federal transfers includes a $72-million one-time federal payment to the Canada Health Transfer to address the backlog of surgeries and procedures” (pg. 10). The province appears to be using this one-time federal transfer to back-fill existing health funding. Moreover, the private contracts for out of province surgical procedures are not available to the public for scrutiny. They are not.
As noted by Doctor’s Manitoba in their budget response, the real issue here goes back to the previous section: the lack of action to recruit or retain physicians and other critical frontline healthcare workers.
The budget also provides this information in regards to those out-of-province contracts: “So far, this (patients who travel out of province) includes 176 patients who received surgical care out of province at approved partner provider organizations, including Sanford Health, Cleveland Clinic, North West Ontario/Big Thunder Orthopedic Associates, and at upcoming agreements with the University of California at San Francisco and the Mayo Clinic.” This does not bode well for the province’s plans to bypass Manitoba’s public healthcare system. Recall that sending patients out of the province was an urgent priority identified at the December 2021 launch of the Diagnostic and Surgical Recovery Task Force.
MHC is also concerned that the Task Force is still referring to its actions in regards to the “known backlog” or surgical and diagnostic procedures. Despite repeated media scrutiny and public outcry, we still do not have a full picture of the backlog and its impact on our hospitals and clinics.
It is telling that the Manitoba government has chosen to double-down on expensive, inaccessible and unaccountable contracts with out-of-province and U.S.-based surgical centres, rather than prioritizing expanding public surgical capacity which will be with us for the long haul.
On October 31, 2022, over 80 community-based organizations (including MHC) signed on to an open letter to the provincial government organized by Sunshine House, Main Street Project and the Manitoba Harm Reduction Network. The letter called for “immediate and robust actions that are grounded in human rights and a public health approach”, including the introduction of supervised consumption sites.
MHC has documented the Premier and then-Mental Health Minister’s dismal response to that practical and moral call – including their outright fabrications and bizarrely misleading commentary – here. We had hoped that with a new minister assigned to the Department of Mental Health and Community Wellness that we might see a new approach in Budget 2023/24.
That we have not stands as an indictment of a government dedicated to ideology over evidence as the death and chaos of the drug poisoning crisis ripples out across our streets, communities and emergency rooms. Investments in recovery and treatment are important.
No one receives treatment, of any kind, when they are dead.
In January of this year, following a process motivated by the grotesque failure of Canada’s long-term care system (especially the for-profit sector) during the COVID-19 pandemic, the federal government released new voluntary standards for long-term care facilities. The Manitoba Health Coalition, our sister organizations across the country, and the unions representing workers who provide care and seniors advocates have all called for these standards to be legislated at both the national and provincial level.
Budget 2023/24 does nothing to address the need to reform – in legislation – staffing levels, accountability structures, minimum care standards and the role of privatization in the area of long-term care. Private, for-profit operators saw the worst results in Manitoba as well as across Canada during the COVID-19 pandemic. It is MHC’s position that this model – which is accountable to shareholders instead of patients, residents or families – should be removed in Manitoba.
While funding to health authorities for both long-term care facilities (5.6 per cent) and home care services ( 5.8 percent) do see an increase (after the shockingly meager 3 per cent and 1.7 per cent increases in Budget 2022/23, respectively), the Budget documents do not respond at all to the desperate need for increased accountability in the sector. Nowhere has privatization been more rampant with less scrutiny than in seniors’ care. Too often, we are only learning about the tragic outcomes in Manitoba home care because clients and/or their families are desperate enough to go to the media. Worryingly, Manitoba Health does not even license private home care companies or agencies.
From residential and home-based care to affordable housing and across the board, Manitoba seniors are increasingly at the mercy of private companies geared towards profit rather than community. This commodification of our seniors must stop.
We once again call on the provincial government to establish and fund the Office of a Seniors Advocate with the power to conduct investigations and make recommendations to the Legislature.
Health Equity and Reconciliation:
One of the most significant and life-changing items in Budget 2023/24 is the decision to expand eligibility for advanced glucose monitors and insulin pumps to all eligible Manitobans with Type 1 and Type 2 diabetes. In Manitoba, this is a major health equity win. As we were reminded most recently in the 2022 Health Status of Manitobans Report: “There is significant regional disparity in the prevalence of diabetes in Manitoba. Manitoba residents from the Northern Health Region are almost two times as likely to be diagnosed with diabetes.”
In that vein MHC is also encouraged that Budget 2023/24 commits to develop a provincial suicide prevention strategy in collaboration with Indgenous communities, and applaud the focus on at-risk youth. Likewise, the establishment of a RAAM Clinic with the Aboriginal Health And Wellness Centre is a positive move forward.
While these are important measures to take, the Health Status of Manitobans Report also reminds us that “[o]nly 25 per cent of overall health outcomes are influenced by the health care system and its services. The social determinants of health contribute up to 60 per cent to a population’s health status.”
The impacts of racism, discrimination, colonialism and poverty continue to reveal themselves in poor outcomes for affected communities in relation to other Manitobans. It is also clear that years of cuts and privatization in health care and across government have had a severe impact on the most vulnerable. There is much work to do in the healthcare system – and in our society as a whole – to address systemic racism and advance true health equity.
Budget 2023/24’s big spending does not make up for seven years of cuts, chaos and privatization. While there are positive decisions and initiatives in the budget – one would hope so after years of neglect – the priority clearly remains the continuation of unsustainable tax cuts and handouts that primarily benefit the most wealthy individuals and corporations.
Thomas Linner is the Director of the Manitoba Health Coalition.