Une vision de l’avenir : Les grands titres qu’on aimerait voir en Ontario
Le taux de pauvreté baisse à des niveaux record
Pour la première fois depuis des décennies, les délais d’attente dans les hôpitaux diminuent
L’économie est en plein essor tandis que la dette personnelle diminue et la confiance des consommateurs atteint des niveaux sans précédent
Le taux d’obtention du diplômes d’études secondaires monte en flèche
Le sans-abrisme « quasi éradiqué » tandis que la crise du logement se dissipe
L’espérance de vie augmente dans tout l’Ontario
La dernière banque alimentaire de l’Ontario ferme ses portes… les besoins sont assouvis
Après des années de crise, le système correctionnel ontarien est devenu un modèle pour le monde
Du carbone au propre : l’Ontario atteint la neutralité carbone
L’Ontario sur une lancée… les solides investissements dans les services publics se traduisent par de formidables profits
Summary of Main Recommendations
- Invest in all public services to address the widespread and growing problem of understaffing, unfilled vacancies, and unsustainably high case and workloads.
- End the use of privatization in all its forms, and systematically re-examine currently privatized services with a view to bringing them back under public ownership and control. In particular, abandon active privatization plans in:
- Alcohol sales and distribution
- Employment services
- Health care
- Repeal the unconstitutional Bill 124, which effectively cuts public service wages against inflation.
- Reduce the number of public sector managers, and reinvest any savings in bolstering frontline staff.
- Give frontline public sector workers, through their unions, a meaningful voice in the design and delivery of public services.
- Commit to increasing ministry budgets by at least the rate of inflation every year, and increase investment in the health care services by at least the health care inflation rate to meet population growth, aging, and increased utilization.
- Invest the funding needed to provide equal pay, sustainable workloads, and permanent positions to faculty and staff at the province’s universities and colleges.
- Give municipalities the right to choose the LCBO as the cannabis retailer in their communities.
- Invest in creating and enforcing strong regulations governing the Passport program to ensure that developmental services clients are served by a well-trained stable workforce that earns a living wage.
- Invest in all areas of corrections in order to address the overcrowding and understaffing that are the root causes of the Crisis in Corrections.
- Invest in the creation, inspection, and enforcement of strong regulations that keep Ontarians safe and healthy.
OPSEU is the democratic voice of 165,000 Ontarians who deliver public services from one end of the province to the other.
We have a vast array of job titles, but we are united in a simple goal: delivering the best possible public services that help make life safer, healthier, and more affordable for each and every person in the province.
In preparation for this submission on the upcoming 2020/21 budget, we asked the leaders of our members in each government ministry, broader public service sector, and college division to identify the challenges they face delivering the services that people need.
From across the union, we heard the same basic things over and over:
- There are not enough frontline workers to meet the demands. Decades of budget stagnation and cuts are taking an extreme toll. Layoffs, hiring freezes, unfilled vacancies, and buy-outs have left us with too few frontline workers doing too much work. The result: longer wait times, worker burnout, lower quality services, and outright service cuts.
- The rise of precarious work is eroding service quality and leading to recruitment and retention problems. Particularly within public services that have been privatized to for-profit companies or non-profit organizations, our members report that substandard working conditions are hurting the services they provide. In some sectors, working conditions have deteriorated so badly that employers are struggling to attract the workers they need.
It’s a grim picture. But we didn’t just ask our members to identify the problems in the public sector, we also asked them to talk about the possibilities.
What would Ontario be like if its public services were doing all they could do?
Their responses are inspiring.
They shared remarkable visions of a brighter future – an Ontario firing on all cylinders where everybody can thrive and prosper. Children born into safety and security. Adults who are healthy and well-educated and ready to take on the biggest challenges. Seniors who can retire with their health and their dignity. Homegrown businesses flourishing and offshore businesses flocking here. People born here happy to stay. People born elsewhere eager to join us.
As frontline workers, we are always thinking about how we can turn these visions into reality. It’s possible – Ontario is wealthier than it has ever been. Our economy is solid. Our resources are vast. Our people want to work.
The only limit is our imagination.
It’s time to build a budget that imagines the best we can be.
Better Approach, Better Future
With 165,000 members in communities across the province, OPSEU is one of the most diverse groups of people in Ontario. A significant majority of our members are women, but we represent frontline workers across the spectrums of gender, race, religion, ability, age, and political leanings.
A segment of our members identify with former Ontario Premier Bill Davis and his style of Conservative values, historically referred to as Red Toryism. They understand that Conservatives once had a long, proud history of honouring community and family, and striving to invest in and build our greatest strengths.
Davis embodied these values. He built one of the most successful political careers in Canadian history not by forcing families and communities to make do with less, but by supporting them with investments in public services.
Davis helped Ontario prosper by creating and expanding a long list of public services: the first Ministry of the Environment, TVO, the income supplement and drug plan for seniors, the Human Rights Commission, municipal transit, French-language services, and rent control. And, of course, the entire community college system.
Former federal Finance minister Jim Flaherty was another Conservative who recognized the value of public services – not just for the people who depend on those services, but for the people who provide them.
“Public service is good for you,” Flaherty told a business school graduating class in 2011. “It features long hours and relatively lower rates of pay.
“Some of you might then ask: ‘If the hours are long and the pay low, why would I do it?’ The answer is simple: it is the most satisfying and personally enriching career you will ever find. You will have opportunities to change the world around you.”
That’s why OPSEU members were drawn to public service – they want to change the world around them, make it better.
But for years – decades – they haven’t had the tools or support they need.
Their funding and numbers have been squeezed through an age of austerity that stretches back to the 1990s, in particular the divisive and destructive Mike Harris years, when the Ontario P.C. Party lost its way. A steady parade of tax cuts have made the situation worse, leaving government with less money to invest while needs have increased in lockstep with population growth and inflation. The result: Ontario now has the dubious distinction of investing less of its GDP per person in public services than any other province.
It’s a dangerous downward spiral. Our public services are being stretched ever more thinly or outright hollowed out. From health care to education to corrections, our services are becoming more and more like a movie set – the facade may appear stable but there is less and less substance behind it.
Hospitals, jails, schools, and countless other public services from home care to probation and parole – they are overcrowded and understaffed and it is getting worse by the day.
If the government continues with its current approach – cutting taxes, cutting services – there is little hope that we will escape the downward spiral.
Late last year, the province’s Financial Accountability Officer warned that public services like health care and education will have $5 billion less than they need by 2022.
The main thrust of our submission is simple: stop the downward spiral by changing direction. Stop cutting and start building. This will require government to do four basic things:
- Acknowledge basic economic facts about Ontario’s economy and public debt. Keeping careful watch over our finances is a basic and worthy value. But the truth matters: Ontario’s economy is healthy, and government debt is no where near the problem that the Ford Conservatives would have us believe. In one breath, the premier boasts about hundreds of thousands of new jobs being created; in the next, he stokes fear about the debt. Instilling fear may help get easy attention and votes in the short term, but the hangover is long and brutal. The honest and courageous approach is to use the province’s record-high wealth and revenue to build a more equitable Ontario by investing in the great equalizer: public services
- Recognize that cuts and privatizations have costs, which are often greater than the cut itself. When privatized home care can’t properly take care of its patients, for example, those patients end up back in hospital, where their care is much more expensive.
- Listen to the frontline. For years, the frontline workers in OPSEU have been telling government that there aren’t enough workers to properly deliver public services. Understaffing is rampant. Unsustainable workloads are chronic. Retention and recruitment issues are on the rise. The solution: stop laying people off, start filling unfilled positions, ensure all positions are paid properly, and expand staffing where needed.
- Have the courage to build on our strength: people. Most Ontarians want to live fulfilling, productive lives. They want to do work that, as former federal Conservative finance minister Jim Flaherty said, changes the world. In other words, they want to do work that sorely needs doing in the public sector. But right now, many are stuck in precarious and low-paying jobs that leave them drained financially, physically, and emotionally. Instead, give them the opportunity to do work that matters – public service work – and we will all prosper.
Problems and Recommendations
OPSEU members are divided into groups based on the OPS ministry, the BPS sector, or the college division in which they work.
In preparation for this submission, we asked each group of members to identify the top issues facing them in the workplace. Their concerns and recommendations are detailed in the rest of this document, but a common theme throughout is chronic and even severe understaffing.
Years of government budget stagnation and reduction, along with profit-driven corner-cutting in privatized public services, are causing real damage.
Jobs are being cut. Vacant positions are being left unfilled. For those who remain, work and caseloads are increasing to unsustainable levels, leading to less effective services, worker burnout, and growing problems with recruitment and retention.
These problems are being made even worse by the Ford government’s unconstitutional attempt to legislate effective wage cuts through Bill 124. This bill must be repealed.
The long-term solution to these problems is simple: more investment.
In the upcoming 2020/21 budget, the Ford government must commit to providing the increased investment that’s needed.
What does increased investment look like? This chart shows the bare minimum budget allocations each ministry will need in order to begin rebuilding our public services.
It starts with what the Ford government spent during 2018/19, its first full year in office, and shows the increases needed in the 2020/21 budget just to keep up with inflation. Anything less will effectively mean another year of cuts, and another year of deterioration.
Ministry / 2018/19 budget ($ millions) / Bare minimum 2020/21 budget to keep pace with inflation
Agriculture, Food and Rural Affairs / 1,066 / 1,112
Attorney General / 1,714 / 1,788
Board of Internal Economy / 371 / 387
Children, Community and Social Services / 16,862 / 17,595
Colleges and Universities (Total) / 11,984 / 12,505
Economic Development, Job Creation and Trade / 922 / 962
Education / 30,425 / 31,747
Energy, Northern Development and Mines / 5,721 / 5,970
Environment, Conservation and Parks / 682 / 712
Executive Offices / 38 / 40
Finance / 1,637 / 1,708
Francophone Affairs / 6 / 6
Government and Consumer Services / 1,757 / 1,833
Health and Long-Term Care* / 61,904 / 69,555
Heritage, Sport, Tourism and Culture Industries / 1,562 / 1,630
Indigenous Affairs (Base funding) / 75 / 78
Infrastructure / 513 / 535
Labour, Training and Skills Development / 307 / 320
Municipal Affairs and Housing / 1,479 / 1,543
Natural Resources and Forestry / 716 / 747
Seniors and Accessibility / 52 / 54
Solicitor General / 2,681 / 2,798
Transportation / 4,718 / 4,923
Treasury Board Secretariat / 1,346 / 1,404
*Reflects the rate of inflation in the health care sector, which is roughly six per cent
Enacting any of the recommendations that follow will take real leadership and real investment. It will demand a course shift away from the chaos of the Harris years and the first year of the Ford agenda towards our historical core values of sustainability, equality, fairness and province building demonstrated by the Bill Davis era.
When the 2020/21 budget is tabled in the spring, we will use this chart to quickly judge whether this government has chosen to alter course.
Public services work best when they are accountable, transparent, and their primary motive is to help people.
Privatized public services are the opposite: they are rarely held accountable, they are not transparent, and their primary motive is to make money for the owners.
The result is that privatized public services almost always cost more and deliver less. Decades of evidence from across Ontario and the entire developed world show this to be true.
Just a few of many examples:
- Ottawa’s privately financed and constructed LRT system has been a disaster from the start and has featured a parade of secrecy, cost over-runs, delays, and incredibly low service quality.
- Privatized medical lab testing takes longer than traditional hospital-based testing and costs up to 50 per cent more. And as the massive data breach at LifeLabs has shown, it has also jeopardized the private health information of millions.
- Since hydro privatization began in the late 1990s, rates have tripled and the province has lost billions in revenue.
- The auditor general examined a decade of privately financed infrastructure projects and found that the people of Ontario were overcharged by more than $8 billion. Even worse, these “P3” schemes have left us saddled with facilities such as Waypoint Mental Health Centre and the Toronto South Detention Centre, which are dangerous because of shoddy design and construction.
Despite this overwhelming and growing body of evidence, the Ford government is choosing to repeat these expensive mistakes of the past.
The entire alcohol system. Health care. Employment services. These are just some of the public services the government is opening up to privatization, setting us down a path towards even higher costs and lower-quality services.
To provide public services that are efficient and effective, government must:
- Impose a moratorium on any new privatizations.
- Lay out a plan for bringing back into public hands the services and assets that have already been privatized.
Ontario Public Service
The frontline workers at the Ontario’s government ministries are the glue that holds the province’s vital public services together.
They are the program and administrative staff who help design government policy and put it into action. Experiences, professional, and accountable, they are able to help millions of Ontarians overcome the challenges of life every day.
And they do it efficiently and effectively. The Ford government’s own “line-by-line” review of public sector spending in 2018 clearly showed that the OPS provides the citizens of Ontario with the best value for money.
But OPSEU’s OPS members know they could be doing more. Much more. The problem is simple: lack of investment. Despite the fact that Ontario is now richer than it has ever been, the province invests less per person in its public services than any other province.
With proper investment, the possibilities are incredible: A healthy and well-educated population where everybody feels safe, valued, and productive, and a vibrant economy that makes sustainable use of our resources and ensures both business owners and workers are treated fairly and paid appropriately.
Along with increasing investment, the government can drastically improve the efficiency and quality of the OPS. To do that, it must:
Invest in proper staffing levels and filling unfilled vacancies
Unsustainably large caseloads and high overtime costs are neither efficient nor effective. And yet they are endemic across the OPS. OPSEU members in almost every ministry report staffing levels as one of the major challenges they face in doing their jobs well. Cuts and unfilled vacancies are taking a toll. Service quality is falling and staff turnover rate is on the rise.
And in the wake of the Ford government’s ill-advised buy-outs last year, those challenges are about to become even more severe.
Government ministries have important work to do. But they can’t do that work when they don’t have the workers they need.
Call a moratorium on privatization and set out a plan to bring back into public hands all the services that have already been privatized
Privatization is a failed policy experiment that rarely delivers on its promises, and almost always leaves governments poorer and citizens with lower-quality services.
Unfortunately, privatization in its many forms is rampant across the OPS. Services such as highway maintenance and snowplowing, driver testing and licensing, ServiceOntario Centres, and email and IT systems have been privatized. So have a number of health care services, such as medical lab testing. Quality has suffered, and costs have increased.
And the Ford government seems determined to privatize even more, from liquor sales to employment services, to health care.
The sell-off of publicly owned assets and entities has also cost Ontario billions upon billions of dollars in lost revenue and increased prices. The sale of Hydro One, Highway 407, and OLG casinos are just three of a number of examples of public asset sales that result in generations of financial loss.
Infrastructure construction projects financed through public-private partnerships and “alternative financing and procurement” contracts have ended up costing much more than if government had simply financed the projects with the low interest rates it can command. In 2015, the Auditor General found that Ontarians had been overcharged by more than $8 billion for privatized infrastructure projects over the previous 10 years. And the City of Ottawa’s recent experience with privatized transit construction is just another of many cautionary tales.
The overuse of private consultants is another form of privatization that costs more and delivers less. The Auditor General found in 2016 that Treasury Board Secretariat was using consultants 90 per cent of the time when filling staffing requests for IT workers, adding that each consultant costs $40,000 more per year than a permanent employee would. Revisiting the issue in 2018, the Auditor General stated that “there is still an over-reliance on IT consultants” and that “ministries at times used consultants for ongoing or operational work that could have been undertaken more cost-effectively by full-time permanent or term employees.”
Similar to the overuse of private consultants, the OPS has come to rely far too heavily on the rental of private workspace, private equipment, and private fleet vehicles.
Privatization is a losing strategy and must be stopped and rolled back. Privatized public services, including MTO services (licensing and highway maintenance and snow clearing), all regulatory enforcement, employment services, and private ServiceOntario delivery sites must be returned to the OPS.
Drastically reduce the number of managers and reinvest those savings in strengthening the frontlines
Over the past 30 years, the number of OPS managers has grown, while the number of frontline workers has shrunk.
Having too many managers is a waste of precious resources and reduces the quality of service that everyday Ontarians depend upon. The money spent on management salaries and perks is much more wisely invested in strong and effective frontline staff.
Even simply filling vacancies and hiring an appropriate number of staff would yield significant efficiencies and improvements, cutting the unnecessary costs of overtime, training temporary contract workers, and reducing the burn-out that inevitably results from unsustainable workloads.
Invest in the inspection and enforcement of strong regulations that keep Ontarians safe and healthy
Regulations are often derided as meaningless “red tape.” But the truth is that strongly enforced regulations save lives and, ultimately, money.
Cutting regulations, and the frontline OPS workers who enforce them, will end up costing Ontarians dearly. Time and again, we have seen examples of private corporations maximizing profits by cutting corners and ignoring problems. The results can be disastrous. The Aylmer Meat Scandal. The Sunrise Propane explosion. Walkerton. All could have been avoided with strong regulations strongly enforced.
Without strong regulations and the workers to enforce them, the environment is also left vulnerable.
Invest in improving OPS management’s human resources practices
A chronic and wasteful problem across the OPS is management’s inability to quickly and effectively resolve disputes over its collective agreement. Although many grievances can and should be solved by the direct manager, OPSEU stewards and ministry leaders report that in most ministries, almost every single grievance is being pushed to an expensive and time-consuming formal hearing. Training managers on collective agreement dispute resolution, and empowering them to resolve grievances quickly and effectively, would save significant amounts of money and lost productivity.
Listen to the frontline
OPS workers want to succeed. They want to be as efficient and effective as possible. They want to be trained to use new technologies to their fullest potential. And they have good ideas – much can be gained by taking those ideas into serious consideration.
Working properly, social assistance programs such as Ontario Works (OW) and the Ontario Disability Support Program (ODSP) help keep Ontarians as healthy and productive as possible.
But they’re also a bellwether. When other supports are cut or inadequate, more Ontarians find themselves relying on them. When the auditor general noted late in 2019 that ODSP costs had risen by 75 per cent over the past 10 years, she was flagging the consequences of a decade of cuts, austerity, and privatization.
While more people come to rely on OW and ODSP, there are fewer frontline workers to help them. Caseloads have become overwhelming, which means few clients actually get the support they need.
More troubling changes are on the horizon.
One is the government’s potential move to narrow the ODSP definition of “disability” to render fewer people eligible. The consequences would be disastrous and would inevitably lead to increased homelessness and increased costs to the health and justice systems.
The other is the government’s plan to privatize the employment programs offered by Employment Ontario and the employment programs offered by OW and ODSP. Already, five corporations – including three multinationals – have expressed formal interest in taking over these programs.
When similar employment services were privatized in Australia, it did not go well. Since the companies were paid each time a person got a job, they maximized their profits by shunting people into an endless churn of poorly paid, short-term contracts.
For social assistance programs that actually help people, communities, and the economy, the government must:
- Invest in appropriate staffing levels to maintain sustainable caseloads.
- Upload Ontario Works and all of its workers from municipalities to the OPS. Social assistance would be more efficient and effective if it were delivered as a one-tier program by the province.
- Invest in appropriate social assistance rates, and guarantee that they rise by at least the rate of inflation every year.
- Retain ODSP’s current definition of disability.
- Abandon the scheme to privatize employment services.
Most people who are in custody or under supervision will one day return to our communities. The goal of the corrections system is to ensure they are more responsible and productive than when they entered the system.
Sadly, that is often not the case today. The longstanding and ongoing crisis in corrections means that inmates and those on probation or parole are often likely to reoffend upon release.
Overcrowded and understaffed jails are a recipe for disaster. Inmates and correctional workers are increasingly at risk of violence and neglect, leaving a long-lasting and destructive trail of PTSD and mental illness in its wake.
At the Toronto South Detention Centre, for example, judges have repeatedly called on government to increase staffing in order to improve conditions. On January 13, 2020, yet another outraged judge called the understaffing a “form of deliberate state misconduct,” adding, “The ministry has clearly chosen to save money rather than heed judicial concerns about the lack of humane treatment of inmates.”
The explosive situation is made worse by facilities that are inadequate, either because they’re too old and decrepit, too small for the current number of inmates or because they were shoddily built through the profit-driven “public-private partnership” model.
The crisis in corrections extends well beyond jail walls. Probation and parole officers in Ontario are saddled with the highest caseloads in Canada, putting them at direct risk of violence and burn-out. It also leads to more crime. When OPSEU negotiated the creation of 25 new Probation and Parole Officer positions in 2016, the recidivism rate fell by between two and three per cent.
This crisis is solvable, but it’s not going to solve itself. Government must:
- Invest in all areas of corrections in order to address the overcrowding and understaffing that are the root causes of the Crisis in Corrections.
- Address the overcrowding issues and classification issues leading to the backlog in our court system which is causing some of our overcrowding.
- Reopen additional mental health secure facilities instead of placing inmates with severe mental health issues in jail – they desperately need properly trained staff to help get stabilized.
- Address the remand challenges that are contributing to overcrowding.
- Invest in secure mental health facilities in order to decriminalize mental illness and place those in crisis where they will receive the proper treatment/supports.
- Review staffing in every institution immediately with a financial commitment to increase full-time Correctional Officer staffing levels.
- Increase investment in community staffing resources, including, but not limited to, hiring additional Probation and Parole Officers to start group offender rehabilitation programming six months prior to an inmate’s release. Establish a process of continuity of service from incarceration to community supervision.
- Install metal detectors into Probation and Parole Offices. Staff are the ministry’s greatest asset. Weapons entering Probation and Parole Offices pose a significant risk to staff safety.
- Bring back “Community Resource Centres” (formerly known as provincial halfway houses) for parolees who lack a parole sponsor and/or suitable housing), thereby reducing the overcrowding crisis of our Ontario Correctional facilities. Create employment programs for inmates housed in halfway houses and recoup costs by charging residents nominal room and board.
- Bring back forensic custody facilities for the mentally ill. Much of the inmate overcrowding in our institutions and the increasing levels of violence within our correctional facilities is due in large part to the ever-growing inmate population afflicted with mental health ailments. Offenders with mental health challenges often pose risks to themselves and others, requiring the use of segregation as a means to negate such risks. Forensic Correctional Centres would help solve the inmate overcrowding, violence and segregation crises, and would ensure that mentally ill inmates receive the medical services, supports and treatment they so desperately require.
Publicly owned and managed, the LCBO has always been an elegant solution to the issue of alcohol.
Free of the profit motive, its professional and highly trained workers never feel pressured to increase sales or to sell to youth or people who appear intoxicated.
And as a wholly-owned entity of the province, it pays billions in dividends back to the province every year. In 2018/19, that dividend was $2.37 billion – the 25th straight year that the LCBO dividend had been increased.
Those dividends are especially important because alcohol consumption costs the province billions of dollars every year in extra health care and lost-productivity costs. The Canadian Centre on Substance Use and Addiction found that alcohol use cost the province more than $5 billion in 2014 alone. The LCBO dividend helps to significantly defray those costs.
Another significant benefit of the LCBO is that it provides communities across the province with good, steady jobs.
Unfortunately, the Ford government is attempting to fundamentally privatize alcohol sales in the province. Along with drastically increasing the number of privatized “agency stores,” “LCBO Convenience Outlets,” and grocery stores allowed to sell alcohol, the government is also laying the legal groundwork to undermine the LCBO’s control of prices and distribution.
It’s a terrible decision for two reasons.
First, privatization will drive up alcohol consumption which will, in turn, drive up the costs the province must bear for extra health care and lost productivity.
Second, privatization on the scale envisioned by the government jeopardizes the LCBO, the communities that depend on the good jobs it provides, and the dividend it pays to the province.
In other words, as Ontario is forced to spend more and more on alcohol harms, it will be getting less and less from the LCBO.
Fortunately, it’s not too late to stop privatization and the damage it will do. In order to maintain a responsible and evidence-based alcohol policy, the government must:
- Support the public model of alcohol sales and freeze all plans to further privatize alcohol sales and to expand privatization into distribution and warehousing.
- Immediately act on the issue of theft. In some stores, thousands of dollars’ worth of alcohol is stolen in a single day. Theft is a critical health and safety issue and both LCBO management and the provincial government have a legal obligation under the Occupational Health and Safety Act to ensure staff are safe.
Like alcohol, cannabis has the capacity to do incredible damage. Medical evidence suggests that cannabis use can have long-term health consequences for people younger than 25.
Its sale must be handled responsibly.
The Ford government’s abrupt decision to cancel plans to sell cannabis through a responsible public retailer and allow it to be sold instead only by private retailers has been anything but responsible.
In fact, it’s been a disaster from the start. The province is losing millions – and potentially billions – in public revenue to private profiteers. And the entire process has been a needlessly expensive boondoggle marred by lawsuits, shortages, and an incredibly slow rollout of retail stores that has allowed the criminal market to flourish.
It’s not too late for the government to do the responsible thing and:
- Allow the LCBO to sell cannabis. The LCBO has a long and proven track record of selling alcohol responsibly and maximizing public revenues. The government must give municipalities the option of choosing the LCBO as the retailer of cannabis in their communities.
“Hallway health care” is now an everyday word in Ontario. And while it conjures up heartbreaking images of beds lined up in the corridors outside emergency rooms, it’s actually a problem with cause and effect that stretches far beyond hospital walls.
Ambulance services, long-term care, home care, and community health care – they are all suffering from and contributing to the “hallway health care” crisis. It’s a crisis that is the direct consequence of decades of underinvestment and costly privatization and reorganization schemes across the health care sector.
For example, a just-released study by doctors at St. Michael’s Hospital in Toronto shows that Ontario’s home care system doesn’t have the investment required to meet the demand. When a home care patient can’t wait for the treatment they need, they go to the hospital. It’s the same with long-term care and mental health and addictions patients. The result is chronic understaffing and unsustainable workloads.
In long-term care, for example, our members report RPN-to-patient ratios of 1:32, and as high as 1:50 in for-profit residences. In community care, it can be as high as 1:60. And it’s also a problem in acute care and with ambulances workers.
Reorganization will not solve this crisis. In fact, it will likely only deepen it – Mike Harris spent nearly $4 billion in an amalgamation that only resulted in $800 million in savings.
Instead, what’s needed is investment – enough at the very least to keep up with the health care inflation rate which can be as much as six per cent a year. Right now, Ontario invests just $3,903 per person a year on health care, the lowest in Canada and $487 per person lower than the Canadian average.
The dangers of reorganization
Details of the Ford government’s plan to amalgamate all health care under a new “super agency” are scant. But our members have highlighted a number of urgent questions and concerns:
- How will this new system foster innovation, increase access, and strengthen quality of care?
- How much will it cost? Merging large organizations with huge budgets and hundreds of contracts and collective agreements will likely trigger expensive and long-lasting legal battles. These unnecessary costs will put additional pressure on health care budgets, leading to fewer beds and less care for more patients.
- Open the door to privatization. The government has indicated private corporations could have an expanded role in the new system. How much profit will they suck out of our already underfunded care?
- The board of the new super agency meets in secret and is not required to publish its minutes. Accountability is non-existent.
- Rural communities will suffer. History shows that mergers of health care in rural areas always leads to less services available.
- Indigenous communities will also suffer, as there is no indication the new super agency plans to implement programs that are culturally sensitive.
Instead of reorganization, the Ford government should focus on long-term planning. Health care is the single largest program expenditure in the Ontario budget, yet there has been no provincial capacity planning since 2000. This has resulted in a significant disconnect between population need and the levels of service and staff that are actually funded.
The clearest evidence that the “hallway health care” crisis extends beyond the walls of hospitals can be found right outside the door: ambulances waiting with their patients outside the entrance – sometimes for hours – before a bed opens up inside.
It’s a terrible waste of time and resources that could be better spent on things like community paramedicine programs have been proven successful when partnered with appropriate social, health and mental health services.
The problem isn’t going away. Demands on the system are growing by six per cent a year because of Ontario’s aging demographics.
To improve patient care, the government must:
- Reduce ambulance offload delays by investing in more hospital beds. The hospital bed crisis has had a system-wide domino effect, and its ripples are being felt on the frontlines of emergency medicine.
- Invest in the entire ambulance system in order to meet the annual growth in demand:
- Invest in increased staffing and resources to allow the appropriate triage of patients when 911 is called and the authority to either “treat and refer,” or” treat and transport to alternative destination.”
- Provide our 911 dispatch system with better tools to prioritize calls; including seamless integration and information sharing between all Ambulance Communication Centres.
- Invest in single paramedic response units, backed up by ambulances, in order to speed up response time and reduce the number of times when no ambulances are available to respond, which is on the rise.
- Build a registry of life-saving defibrillators and invest in more public defibrillators and CPR training.
- Expand community paramedic programs that deliver non-emergency, in-home services and reduce the number of 911 calls.
- Invest in appropriate tools, resources and staffing at Ontario’s Central Ambulance Communications Centres (CACCs) and hire more permanent, full-time Ambulance Communications Officers (ACOs). Too often, staff are working on a contract basis, with little job protection and high exposure to trauma and PTSD. This has undoubtedly resulted in high staff turnover and understaffing.
- The provincial government must hire more permanent, full-time ACOs immediately. Saving lives means focusing on permanent solutions, not makeshift mitigation tactics.
Hospital Professionals and Support
Chronic underfunding of hospitals is harming the delivery of acute care services. Hospitals face impossible decisions in choosing which health services will be cut. Hospital professionals play a key role in enhancing patient recovery, and when the services they provide are cut, the entire system is weakened.
To truly begin addressing “hallway health care” in our hospitals, government must:
- Increase funding by at least 5.3 per cent a year to meet population needs and conduct health care planning.
- Impose a moratorium on hospital closures and mergers.
- Improve hospital bed capacity to meet population needs.
- Expand inpatient and outpatient physiotherapy services across all hospitals in Ontario. The demand is exceeding the service, and better access to physiotherapy reduces the time patients spend in hospital.
- Bring privatized lab testing and diagnostic testing (X-ray, nuclear medicine, MRI) back into our hospitals as a public service. The benefits of providing more immediate results to physicians, quality inspection control and reducing patient travel far outweigh the fictional savings that have produced a private parallel health system that is actually costing Ontarians more.
- Bring back into hospitals services such as cataract procedures, hip and knee replacements, colonoscopies/endoscopies, diagnostic imaging and physiotherapy. They have all been privatized and outsourced over the years, leading to higher costs and lower-quality care.
- Establish a human resources plan to address recruitment and retention issues. Specifically, there are many classifications in areas such as labs and diagnostic imaging in which a significant percentage of employees are about to reach retirement age.
Mental Health and Addictions
Mental health and addictions issues have been getting plenty of attention in the media. Now it’s time for action.
Chronic underfunding and understaffing mean that people can’t get the mental health care they so clearly need. Understaffing is particularly dangerous for thousands of mental health workers, who are facing increasing exposure to violent assaults. If staff are not safe, neither are patients.
To address this growing crisis, government must:
- Invest in facilities and in increasing staffing levels and implementing better risk assessment procedures, including the system-wide use of the Violence, Aggression and Response Behaviours Tools (VARB) for assessing security, conducting organizational risk assessments and assessing individual client behaviour.
- For frontline mental health workers who have experienced trauma, it is crucial that the PTSD presumptive legislation be extended so that health care workers are entitled to WSIB. By extending the legislation, mental health care workers would have faster access to the resources and treatment they require. This would improve health outcomes and reduce longer-term health care costs.
- Invest in more supportive housing for mental health and addictions patients that is appropriately staffed. Supportive housing is an integral resource for mental health and addictions patients, but improved investment is required. These homes must also be staffed at appropriate levels by professionals, including Social Workers, Occupational Therapists, Recreational Therapists, Registered Nurses and Registered Practical Nurses.
- Provide all mental health and addictions services on a fully public, non-profit basis with full public accountability. Like many other health sectors, the mental health and addictions sector has been plagued by costly privatization schemes.
The Ford government has earned praise for its pledge to create 15,000 new long-term care beds, but it must do more: the waiting list for long-term care beds is more than double that, at roughly 40,000.
And even when an Ontarian does get a long-term care spot, they face the lowest standards in Canada, and among the lowest care levels among comparable jurisdictions even though patient acuity and the complexity of care are growing.
Since 2010, only those with high or very high care needs have been deemed eligible for long-term care, and many of them have cognitive or behavioural problems. Staff are increasingly overworked and expected to do more with less.
- Increase long-term care staffing levels to ensure a minimum care standard of four worked hours of personal care, per resident, per day, is achieved. Long-term care residents deserve the highest quality of care possible.
- Invest more to reduce the large and growing wait list for long-term care by creating more publicly owned and managed long-term care facilities. With the proliferation of privately operated homes, residents are increasingly forced to pay massive out-of-pocket costs or face an impenetrable wait list for publicly funded long-term care. As a result, residents and their families are suffering.
- Provide appropriate staff training to minimize exposure to workplace violence, including training on responsive behaviours. Today, nearly half of long-term care residents exhibit some level of aggressive behaviour.
- Strengthen and enforce minimum standards of care. People living in long-term care must be able to count on safe, professional, and high-quality care. Minimum standards must be strengthened for all long-term care facilities, particularly those that are privately owned and managed. And those standards must be enforced by an appropriate number of professional frontline OPS inspectors.
Community Health and Home Care
We’re all happy to have hospitals, but nobody wants to go to hospital. If they can get the care they need at home, everybody wins: costs can be lower and outcomes can be better.
But chronic underinvestment and understaffing in our community health, public health, and home care are just driving up costs and intensifying “hallway health care” because more people than necessary are ending up in hospital.
The province’s already stretched municipalities are being forced to pick up the slack for the Ford government’s cuts to public health programs, like infectious disease control and smoking cessation programs.
And just last week, an international medical journal published a report confirming what OPSEU community health care workers have been saying for years: the province is not providing enough home care, and hospitals are being left to pick up the slack.
But a dangerous feedback loop is developing. As hospital overcrowding reaches crisis levels, patients are being sent home and into home care too early. They’ll either have to suffer in silence, go back to hospital or – in the worst-case scenario – die without the care they need.
To address the shortcomings of community health and home care, government must:
- Immediately increase investment to cover the true cost of home care. Home and community care workers need the resources to keep people at home safely and to ensure positive patient outcomes.
- The Ontario government should end home care contracting-out by exploring all options for termination or non-renewal of existing contracts with provider agencies and focus on investing in a fully public, non-profit home care system instead; one where quality patient care is the focus.
- Promote fairness and stability in Ontario’s home and community care sector by reviewing the work being done by registered nursing staff to improve the recognition of their skills and abilities.
- Abandon the 70/30 public health cost-sharing plan with municipalities and return to funding 100 per cent of important public health programs.
Canadian Blood Services and Diagnostics
The blood diagnostic, donation, and distribution systems are the literal lifeblood of Ontario’s health care system.
But there remain vast differences in the wages and working conditions of the people working in the systems – which are overseen and supplied by a mix of public and private organizations – even if they’re doing exactly the same kinds of work.
For example, the 1,000-plus lab professionals working in Toronto for the private corporation LifeLabs are paid less and have vastly inferior working conditions than others doing similar work in the industry.
Consistency is the key to safety, and the government must invest in ensuring that all of the workers in our blood systems have the tools, supplies, and working conditions they need.
- Invest in ensuring fairness for laboratory technicians, regardless of their workplace. The diagnostic testing done by laboratory staff at Public Health Ontario is vital work that prevents public health crises like Walkerton, SARS, and other outbreaks. This work keeps our communities safe, and it is vital to the health of all Ontarians. But public services are stronger when workers are treated fairly. OPSEU is calling on the government to harmonize the pay and working conditions for all laboratory technicians, regardless of whether they work in community hospitals or community-based laboratories.
- Maintain the ban on private blood and plasma-product collection to ensure the ongoing safety of Ontario’s blood supply, and invest in public plasma collection facilities. The government must invest in public plasma collection facilities to reduce dependency on world markets for the fractionated plasma products used to produce medications, much of which is collected by paying donors. To achieve the highest quality and standards of safety, the government must stem the growth of private clinics.
We all need help sometimes, and Ontarians pride themselves in the notion that we have strong social services to provide that help whenever and wherever it’s needed.
A child in a vulnerable situation. An adult with developmental disabilities. A family struggling to make ends meet after a job loss or tragedy. Our social services are founded on the idea that we’re all better off when nobody is left to fall through the cracks.
Working properly, they can ensure that as many of us as possible are able to live contented and productive lives, contributing positively to their community and the province as a whole.
Sadly, successive governments have chosen to neglect our social services. Whether it’s because those using social services are not considered politically important or because of the myth that strong services would invite widespread abuse, governments have chosen not to invest.
Last year, the Ford government chose to accelerate this terrible trend, slashing $1 billion of social services investment over three years while throwing open the doors to increased privatization.
The consequences are stark. Ever more understaffed and under-resourced, our threadbare services are leaving thousands upon thousands trapped in poverty, loneliness, and neglect. It’s both a moral failure and an economic disaster. Instead of participating in our prosperity, they are made to feel like pariahs.
And when some inevitably fall through the cracks and into a world of extreme poverty and homelessness, we all pay the price through the increased strain on our health care and correctional systems.
A developmental disability does not need to be a life sentence. With care and support, most people are willing and able to participate in their communities as productive and engaged citizens.
But underinvestment and privatization run rampant have trapped people with developmental disabilities in neglected, overcrowded, and understaffed homes with a rotating door of low-paid and under-skilled employees.
The growth of “direct-funding” programs like Passport are accelerating the decline. Giving families money so they can hire their own care workers doesn’t give them choices, it gives them chores – forcing them to become their own HR experts.
And with no regulations governing who can be hired at what rate, Passport is helping to drive down the sector’s already low wages and terrible working conditions. That in turn is driving huge problems with recruitment and retention.
It’s a downward spiral that can only be reversed with investment and a commitment. Government must:
- Create a regulatory framework for the Passport program that will protect clients, promote access to services, and ensure a well-trained, stable workforce that makes a living wage.
- Create a central bargaining table. This will create standards for working conditions that would realize the goal of making developmental services work a career of choice, stemming chronic retention problems, and reducing the number of developmental services workers stuck in part-time positions (which now stands at 75 per cent).
Children’s Aid Societies
Children’s aid is meant to protect children in vulnerable situations and, as much as possible, help to improve the situation so that they’re no longer vulnerable.
It’s difficult, emotional, and painstaking work. Child protection workers are like first responders. They face numerous health and safety hazards ranging from vicarious trauma to physical assault.
But instead of supporting child protection workers, government and the employers are leaving them short-staffed and with ever-growing caseloads. The stress is taking its toll, and the sector is grappling with high turnover rates.
Compounding the workload problem is an increasing body of administrative and reporting work. Reporting and accountability are important. But if they are increasing, staffing must also increase – it isn’t. Instead, child protection workers are forced to spend less and less of their time providing the prevention services that are key to keeping more children and families healthy and safe.
To improve children’s aid, the government must:
- Address key health-and-safety issues. Establish a provincial requirement for workers to co-team when making home visits.
- Reduce the administrative burden. Child protection workers now spend up to three to five times longer to complete administrative tasks using the new Child Protection Information Network database.
- Establish provincial caseload benchmarks to guarantee a consistent quality of service and the ability to meet provincial standards.
Children’s Treatment and Mental Health
The vast majority of mental illnesses and developmental challenges faced by children can be overcome. We know which treatments work, and which medicines help.
In other words, it’s theoretically possible to help all kids in need. But because of underinvestment and understaffing, many are being left to suffer. There are thousands of children and youth stuck on waiting lists that can stretch over 18 months.
Ontario has 35 per cent fewer mental health beds today than it did in 2006.
In 2016, the Auditor General flagged this problem and demanded that government implement “as quickly as possible” a funding model that would meet the actual need. When the AG revisited the issue two years later, “little or no progress” had been made.
In order to progress, investment is needed to:
- Eliminate the wait times by investing in more mental health professionals and treatment bed across the province.
- Harmonize the pay and working conditions in order to address recruitment and retention problems. Now that this sector’s Children’s Mental Health professionals are now being funded directly by the Ministry of Health, they deserve wages and working conditions on par with the other health professionals funded by the Ministry of Health.
When families have access to affordable public child care that is staffed by a stable and qualified workforce, we all benefit.
The children get the early education they need to build a strong future for themselves, while all of us benefit from the economic boost that comes when parents are able to return to full-time work.
Unfortunately, Ontario still has the highest child care fees in the country and not enough quality child care spaces.
The Ford government is making the situation worse. It has opened the door to further privatization by removing the “For-Profit Maximum Percentage Threshold.” And it has jeopardized the creation of new public and affordable child care spots by forcing municipalities to pay 20 per cent of the costs.
To build a child care system that will benefit us all, the government must:
- Invest in the promised 100,000 new child care spaces — part of the space expansion plan initiated in 2017.
- Remove the requirement for municipalities to cover 20 per cent of the costs of new child care spots.
- Ensure the expansion of public child care by restoring the “For-Profit Maximum Percentage Threshold.”
- Implement a workforce strategy to ensure all staff have professional pay and decent work.
Legal Aid Ontario and Community Clinics
Justice is meant to be blind. It can be with a strong legal aid system that ensures everybody has access to the support they need, regardless of how much money they have in the bank.
Unfortunately, years of underinvestment and understaffing have forced Legal Aid Ontario (LAO) – and the network of community legal clinics it supports – to ration their services. Their caseloads are simply too high to meet the demand, and a two-tier justice system is becoming more and more entrenched.
The Ford government made the situation worse last year when it announced a massive 30 per cent cut to the legal aid system.
It’s an affront to justice. The government must reverse course and:
- Invest in and staff LAO so its caseloads are manageable and staff at all levels have the wages and job security required to provide their vital services in a professional and timely manner.
- Ensure LAO has the resources to fund vitally important services provided by the province’s network of nearly 60 community legal and specialty clinics, which help people assert and defend their rights as parents, tenants, immigrants, and workers.
The youth justice system is based on the idea that mistakes you make as a child or teen shouldn’t ruin the rest of your life.
With proper investment and a well-trained, stable workforce, the youth justice system can provide youth with constructive consequences for their actions and set them on the path towards a productive and responsible adulthood.
But in Ontario, the youth justice system is a bewildering hybrid. Some youth get the care and attention of a stable workforce of well-trained and well-equipped youth correctional offices. Others are sent into a privately run facility with no consistent standards of training, compensation, or safety.
It makes no sense, and it leaves youth and workers at risk. The government must:
- Create a single, integrated system for youth justice, directly operated by government. A single system would improve and standardize training, hiring practices, health and safety, policies and procedures, standards and compensation.
Violence Against Women Shelters
Women and children should never face violence. If they do, they should never have to face it alone. They should always have a safe place to go.
Unfortunately, Ontario’s network of 400 violence-against-women shelters have had to endure years of underinvestment and understaffing. The result: some women and children fleeing violence have nowhere to go but back to their abuser.
This is unacceptable. The government must:
- Invest in the province’s network of violence-against-women shelters so they have the facilities and the stable workforce required to meet the need.
Municipalities and MPAC
Municipal governments are about communities, helping them thrive and prosper with safe roads, clean water, responsive services, and reliable police and water.
When it has the investment it needs, the entire community benefits and grows.
But many municipalities are struggling because of years of falling investment from the provincial government.
It’s a bad situation being made worse by the Ford government’s decision to begin downloading many of its costs – including portions of public health and child care – to municipalities. It’s leaving the municipalities unable to hire the staff they need to deliver their services properly.
Municipalities raise most of their money through property taxes, which makes the property valuation work done by the frontline staff at the Municipal Property Assessment Corporation (MPAC) so vital.
But like municipalities themselves, the workers at MPAC are feeling the squeeze with high workloads.
To make municipalities and MPAC as strong as possible, government must:
- Roll back its plans to download costs, such as public health and child care, to municipalities.
- Invest in municipalities to ensure the can meet the needs of their citizens.
- Invest in MPAC to ensure it has the frontline staff it needs to support municipalities.
Boards of Education and Cultural Institutions
Every person working in our public schools wants one thing – to be a positive part of a student’s life to help them succeed.
And when students succeed, so does all of Ontario – the next generation leaves school equipped to become engaged and responsible adults ready to tackle our biggest challenges and participate in the knowledge economy.
To succeed, schools require proper investment to maintain reasonable class sizes and appropriate staffing levels.
Unfortunately, schools are not receiving the proper investment. Classes are overcrowded and understaffed, leaving many children without the support they need and leading to growing incidents of disruption and violence.
To help our schools realize their potential, government must:
- Make the investments required to ensure proper staffing.
- Make the investments required to ensure that staff have the working conditions, training, and prep time needed to reduce burnout and high turnover.
- End the practice of hiring expensive and unnecessary outside consultants to develop educational support workers’ curriculum contributions. The workers themselves have the experience and expertise to do this work.
- Invest in expanding the educational opportunities offered by our Cultural Institutions at the ROM and the AGO.
Colleges and Universities
As former Progressive Conservative Premier Bill Davis understood so well when he created the province’s community college system, high-quality and accessible post-secondary education is key to the province’s future.
When our colleges and universities have the investment they need, they help lift entire generations out of poverty and prepare them to face head-on the biggest challenges we face.
Unfortunately, they don’t have the investment they need. Decades of underfunding have left our colleges and universities with the lowest per-student funding in the country, about 40 per cent below the national average.
It’s forced our universities and colleges to raise tuitions, lay off workers, and trap an ever-growing number of their faculty and support staff in precarious and low-paid work.
The Ford government is making this bad situation worse, slashing the budget for student financial assistance (OSAP) by 30 per cent while forcing universities and colleges to reduce tuition without providing investment to cover the shortfall.
Things could get even worse: the government has announced a performance-based funding model in which 60 per cent of government funding will, by 2024/25, be based on the institutions’ ability to meet key “performance outcomes.” This gives private corporations more control over our colleges and universities – far from Davis’s original vision.
But it’s not too late to help our colleges and universities reach their full potential. To do so, the government must:
- Immediately invest the funding needed to provide equal pay, sustainable workloads, and permanent positions to faculty and staff at the province’s universities and colleges.
- Immediately roll back the cuts to OSAP. Students currently owe $28 billion to the government. Tuition fees have tripled since 2001, and those costs increase year-over -year for families that must take out loans and pay interest.
- Abandon the appeal of the court’s ruling to strike down measure allowing students to opt out of fees for ‘non-essential services.’
- Invest the funding needed to rejuvenate aging infrastructure.
- Direct the College Employer Council to stop wasting millions in lawyers’ fees and agree to count the ballots cast by contract faculty to join OPSEU.
- Abandon plans to base government funding on “key performance outcomes.”
- Abandon plans to privatize the management and delivery of Employment Ontario programs currently provided by colleges and other non-profit providers.
- Direct the colleges and universities to recruit more domestic students.
- Direct the colleges and universities to cut the number of managers they employ and reinvest that money in full-time frontline workers.
- Direct the colleges and universities to restore the education and employment programming for vulnerable students with intellectual disabilities, new Canadians and those who were previously incarcerated.
- Direct colleges to end all partnerships with private colleges in Ontario and overseas. The evidence is clear: international students are seeking out colleges outside of the GTA – there is no need for partnerships with for-profit colleges.
- Implement collegial (shared) governance so that decisions that impact the quality of education are made by academic staff rather than administrators focused on balancing budgets.
- Impose accountability and transparency on the College Employer Council, or disband it altogether. There is, after all, a body called the Council of College Presidents that could fulfill the same role.
We can all agree that Ontario has incredible potential.
We are wealthier than we have ever been.
We have vast resources.
And we are blessed with people who are generally well-educated, healthy, and willing to work hard.
The 2020/21 budget is an opportunity to begin realizing our potential. But it will take the courage and leadership of a government that is willing to look clearly at the evidence about which public policy approaches have worked, and which haven’t.
Austerity hasn’t worked. Privatization hasn’t worked. Deregulation hasn’t worked. All three have led to higher long-term costs, a growing and dangerous gap between the rich and the rest of us, and the erosion of public safety and environmental sustainability.
It’s time to return to approaches that have worked.
Ontario has enjoyed its most successful and prosperous moments when it’s been led by governments that are willing to invest in ourselves and build the kinds of strong public services that lift us all up together.
There is much work to do. Let’s get started.