The Agenda with Steve Paikin (Audio) - Do Voters Still Care About Hallway Medicine?

Episode Date: February 20, 2025

In 2018, Doug Ford promised to end overcrowding in hospitals so that patients aren't relegated to hallways and other unconventional areas. Each party leader during this election has pledged considerable health care spending. Including more primary care doctors, and additional beds. But there may not be a one-size-fits-all solution. So, how does a new government tackle this complex issue that's been decades in the making? For insight, we welcome: Dr. Samir Sinha, director of health policy research at the National Institute on Ageing; Joanna Frketich, health reporter for the Hamilton Spectator; Rosalie Wynoch, associate director of research at the C.D. Howe Institute; Natalie Mehra, executive director of the Ontario Health Coalition; and Paul Woods, CEO of Southlake Health.See omnystudio.com/listener for privacy information.

Renew your 2.0 TVO with more thought-provoking documentaries, insightful current affairs coverage, and fun programs and learning experiences for kids. Regular contributions from people like you help us make a difference in the lives of Ontarians of all ages. Visit tvo.me slash 2025 donate to renew your support or make a first-time donation and continue to discover your 2.0 TBO. Doug Ford promised to end overcrowding in hospitals so that patients aren't relegated to hallways and other unconventional areas. During this election, each party leader has pledged considerable health care spending, including more primary care such as doctors, nurses, and nurse practitioners. So how does the next government tackle this complex issue that's been decades in the

making? Let's ask. In Oxford, England, Dr. Samir Sinha, Director of Health Policy Research at the National Institute on Aging. In Newmarket, Ontario, Paul Woods, CEO of Southlake Health. In Hamilton, Ontario, Joanna Frikentich, health reporter for the Hamilton Spectator. And here in studio, Rosa Lee Wanch, associate director of research at the C.D. Howe Institute.

And Natalie Mera, executive director of the Ontario Health Coalition. And as I welcome everybody, both here and in points beyond to our program, let me do the whole full disclosure thing, which I do every time we talk healthcare. My wife is a health policy consultant. She deals with some of these issues. So we put that on the record for everybody's edification.

Let's start with, Sheldon, you want to bring these graphics up and we'll just go through some numbers here to show you basically the evolution of this issue, which we have come to call hallway health care. This is from the Trillium, one of the fine digital publications at Queens Park goes back to September 2024. In 2017-18, which is the first time that data on so-called unconventional hospital spaces was tracked, it was about a thousand patients a day that were being treated that way. But by 2024 the number had doubled to 2,000. In terms of hospital beds in the province, in 1990 there were 50,000 per about 10 million people. By 1999 that number had dropped

to almost 32,000 even as the population had risen to 11.5 million. Capacity increased only slightly in 2018 to nearly 32,000 again, while the population had grown to 14 million. And today, of course, Ontario is close to 16 million. Another factor is people waiting in hospitals for alternative levels of care. In mid-2024, there were 6,100 people waiting to complete their treatment at home or waiting for a space in long term care. Alright, let's get some ideas as to why this is happening. Samir Sinha, come on in here

and tell us about what's one main reason why all these things are happening? One of the main reasons we're having a lot of hallway medicine is that we actually have a system that was designed in the 50s when the average Canadian was 27 years of age. So we designed a system for a much younger population. We focused on hospitals and we focused on physicians, but we didn't focus on enshrining long-term care services or even prescription drug coverage as part of our healthcare system. So we have a system that I like to say the patients have changed, the system hasn't. And right now, one of the reasons why we have 6,000 people

waiting in hospitals, which means that we have 2,000 people waiting in unconventional spaces, is because we don't have enough home and community care and other community-based services that would allow more people to age in their own homes longer and not end up in hospitals or be able to get out of hospitals sooner. Paul Woods, what would you add to that?

Well, I would say it's just a mismatch between inpatient capacity and demand for those services that are just driven by an aging population and a growing population. It's just a math problem. It's one of the big issues. Joanna, you've looked into this. What would you add?

Well, I would say that hallway medicine is really the thing that patients see, but it is a symptom of all of the backlogs in the health care system from, you know, too few family doctors to deficits in hospitals, aging buildings, long-term care waits, inadequate home care. It's really a symptom of all of the log jams in the system. Rosalie? Well, I think I agree that it's a symptom of the problem, less the actual disease, and that it really is just that when there's no other

alternatives for Canadians, they're going to go to an emergency room, even if they know it's not an emergency. If they need care, they know that they can get it there so they end up being crowded when other parts of the system aren't available. And they'll wait 20 hours if they have to. They will if they have to. Which they often have to. Natalie, what would you add? So I agree with mostly what everyone said except for maybe that comment actually, but except for one thing, that alternate level of care patients, about half of them are waiting for another type of hospital bed.

So they're waiting for a rehab bed in a rehab hospital. They might be waiting for complex continuing care bed. So about half of them are actually waiting for hospital care. Just that's important to know. The rest are waiting for long-term care. If they can discharge you to home care, they discharge you whether or not the home care is in place, as to know. The rest are waiting for long-term care. If they can discharge you to home care, they discharge you whether or not the home care is in place, as we know.

People wait at home with no care at all. So if they can get you out, they get you out. It may be people waiting because they've had a stroke and their home has to be renovated so they can get back in it or something like that. There are some people waiting for home care, but mostly they kick them out. So to us, I mean the cuts.

Ontario has the fewest hospital beds left of any province in Canada. Per capita? Per capita, yeah, by far. And we fund our hospitals in Ontario at the lowest rate by far. It's really astonishing because we spend more than $80 billion a year on health care in the province of Ontario, which sounds like a big number. And this issue has come up during the election campaign. There was a leaders debate just the other night.

It came up again there. Let's see what some of the candidates had to say. Sheldon, if you would, let's roll it. We're going to continue to invest, invest into the doctors, over 15,000 people, over 3,500 new beds, and another 3,000 on top of that. But you can't do this without the foundation, and that's the economy. The hallway health care crisis was invented by the previous liberal government, but Doug

Ford and his government have poured gasoline all over it. We have a crisis in our province right now. He can talk about how much he's spent on health care, but the reality is, you know, talk to any Ontarian about the state of our health care crisis right now. It's terrible. By your own admission, Doug, you put 1.8 billion into your plan for health care. You put more into the spa at Ontario Place at 2.1 billion.

Yeah, you might build hospitals, but you're not recruiting doctors. You're not recruiting nurses, and you're not giving them the operating costs. If Ontario continues to be dead last in per capita healthcare spending in the entire country it would take an additional 12 billion dollars just to get us up to the average that's why you have rural hospitals closing their services that's why 2.5 million people don't have a doctor we need to make the investments that the Ford government has failed to make.

The pluses and minuses of Ontario HealthCare at the moment. Joanna, you've been covering this issue for years. Tell us whether you've seen progress at all in this issue. No, well, I've really seen the opposite. You know, I have been a health reporter for more than 25 years, and I've either covered hallway medicine or sort of the precursors to it for pretty much that entire time. And the pandemic really exacerbated a lot of these issues.

So, from what I've seen, the issue's actually gotten worse instead of better. Paul Woods, if we had better primary care, primary care reform, where everybody had a general practitioner to go to if they got in trouble, would hallway medicine dissipate? Well, I think it would dissipate, but I think it's important to understand that there's going to be a lag between the achievement of every Ontarian having a primary care physician

and getting the outcomes we need to actually keep them well and in their own homes or to catch them after hospitalization, et cetera. So it's not gonna be an overnight thing even if we could fill all of the manpower needs in terms of that primary care workforce. Natalie, you're shaking your head, how come? Well, I mean, it's not like people,

even if you had a family doctor, nurse practitioner or family health team, or community health centre, you'd still have people who have strokes. You'd still have people who get old and get cancer, people who need operations. You're going to need hospitals. For decades now, I've watched this debate, you know this, we've been part of it, and everyone will talk about everything except for improving capacity in the hospitals.

The truth is we've cut beyond all rhyme and reason, beyond any evidence we need. And I think what Joanna said off the top is absolutely right. The hallway medicine is a symptom of the lack of capacity across the whole spectrum, including hospitals, including long-term care, home care, primary care, all of them. And these cuts have just gone on for too long and we can't sustain another four years of this. Sameer Sinha, can I get you to speak to the issue of if everybody had a family doctor in Ontario, would this problem go away?

It's not going to go away exactly. I think if everybody had a primary care provider, you know, that's a great way to make sure that we can do more preventative health measures, but also really deal with issues that don't need to be dealt with in our emergency departments. But one of the bigger issues is just how we're spending our money. Yes, we're spending $80 billion. This government and previous governments can say we're spending more than ever before, but I don't think we're prioritizing our funding in the right areas. Because for example, when a person is waiting for long-term care or other forms of care in a hospital, that's about $1,000 a day. When they're waiting, if they're living in a long-term care home in Ontario, it's about $200 a day. Home care for a long-term care

eligible individual is about $100 a day. So we know that investing in home and community care, in primary care, these are the cheaper parts of the system where you get a lot of bang for your buck. Because right now, 15% of our hospital beds in Ontario are occupied by people who don't need to be in those spaces, but we're ending up paying a lot of money because we have a system where we haven't prioritized in the other areas. Rosely, why are we doing things this way if the numbers are so obvious, as Dr. Sin has just told us? Well, I think coordination within the system

can be a challenge, certainly. And I'd actually like to back up and maybe put some of this in context, because yes, Canada and Ontario have declining hospital beds per capita. That is an OECD trend across the developed world because we actually want fewer people to be staying in hospital and have them stay for shorter times. I'd just like to point out and give credit where credit's due that Canada is a world

leader in outpatient and day surgery rates. We've actually already done quite a lot of work to get what was previously hospital care either just shorter or someone doesn't even have to stay overnight in the bed. And so I would say a lot of progress has been made. Despite that, the problem has been getting worse. So I think there is no one simple solution to it. And from what the politicians are talking about, yes, more primary care would certainly help alleviate some of this.

But if you don't get to the more fundamental systemic issues on coordination that led us to this place, you can just kind of throw money at the problem and kick that can down the road, but it won't address those sort of fundamental, more underlying complicated changes that are harder to make. Paul Woods, can I just do a fact check with you on that? Is what Rosalie says true,

that we're among the best in the world at getting people out of hospital healthier and faster? Because you don't hear that, I'll tell you that much. Yeah, I think that it's important to bring forward things like that. While we do have one lowest hospital supply per 1,000 population, that our hospitalization rate is best in class and our length of stay,

at least within Canada, Ontario actually has tied for the lowest length of stay. So it isn't a matter of sort of mismanagement or that kind of thing. Sameer Singh, you know, we've heard this expression, people get released from hospital quicker and sicker nowadays, true or false? It depends, right?

I think, again, in some areas where we're doing really good work, like in day surgeries or other things, and there's a lot more care we can deliver in the community and doing that well. That's great. But, you know, I think as Natalie was mentioning right now, you know, we have situations, I think at Paul's hospital a few years ago, I remember hearing that there were people, you know, waiting at South Lake who could not go to their own homes of government funded home care for up to 12 days because that was the level of shortage of home care services. And when people are in hospital longer and just waiting around, you can acquire infections, you know, you can have more functional decline. And that's how you can end up, you know, in a worse state and then to a point where people say, we can't even send you home, let's just wait for you now to go to a nursing home. So there are, again, I think what we're talking about

are symptoms of a system that doesn't have the right level of coordination and isn't right sized with the right things in the right place. Because again, remember 15% of our current hospital beds in Ontario, the precious few that we have are occupied by people who don't need to be in those spaces because we don't have the right amount of home care, long-term care services,

and we have a primary care system that's under pressure right now too. Well, we are in the middle of a rip period. Actually, not the middle. We're almost near the end of this election campaign. So with apologies to all of you, we got to talk a little politics here today. And Joanna, I'll start with you on that. As you look at what all the parties have on offer, does anything jump off the page at you and say,

yeah, these guys have got the right ideas? Well, I mean, really the family doctor shortage has become the focus of the election. And I think that is because family doctors are really the foundation of the system and their patients need them to guide them through the system and to navigate the system and get to other parts of the system. So I think you're really seeing that. You see patients lining up, well, community members lining up in the thousands if a family doctor has an opening. So this has really become a pain point and that has been the focus of the election.

And, you know, I think we're really seeing that the parties are really focusing on that instead of some of these, you know, larger issues and providing a solution for that. But I mean, that itself is also a hard problem to fix. Natalie, who's had what to say that you think that's a step in the right direction? Well, there's lots of promises and all of them actually are along the right lines. I mean, I think we'd rather see a lot more emphasis on teams, you know, community health centers like nonprofit, you know, connected to the community teams. We would not, I'm sure,

have seen the thousands of patients orphaned that we've seen over the last few years, were they served by community health centers and not sort of private doctors groups. You're referring to the situation where a family doc leaves town or retires, and then suddenly you've got a roster of 10,000 people who've got no doctor anymore.

That's right. We saw it in Sault Ste. Marie. We saw it in Kingston, etc. And you know that just does not happen where you have community health centers. So with some nuance, you know the ideas around primary care are good. However, we need the teams. We need the social workers, we need the nurse practitioners, we need the whole team, not just the docs. The docs are crucial, but not the only players that are important there. But I think another burning issue out there,

not so much in Toronto, but you see it across the province, is the hospital closures. I mean, today in Thessalon, there's going to be several hundred people on the Trans-Canada Highway demanding that they reopen the inpatient beds in that hospital and stop the closures of the emergency departments up there and those hospitals are an hour away from each other. No primary care is going to replace the inpatient beds in Thessalon. People want a palliative care bed close

to their home where their loved ones can die if they need to. You know those things are not unreasonable and every service, I should say, that they move out of hospitals is privatized and that is part of the drive here to endlessly close hospitals and move services elsewhere. And if you look now, sorry. I was just gonna, I want to pick up on that first issue because we got a guy here who actually runs a hospital. So Paul Woods, I want to ask you, we've seen this a lot over the past number of years, very recent years actually,

where hospital emergency departments, for example, will close down in the evening or on a weekend, oftentimes in cottage country, bad things happen in cottage country over the summer, accidents, whatever, there's nowhere to take somebody to the ER. Can you explain to us as a guy who runs a hospital, how does that happen? Well I think probably the biggest driver of that is healthcare HR around

physician staffing and I think most of those closures are actually due to that. I can't comment whether there may actually be other drivers as well but that's one of the biggest issues has been the physician workforce. And some of those closures could be offset with, you know, virtual ED type stuff. But to somebody's point, if somebody's having a heart attack or has a fish hook stuck in their hand,

that can't be dealt with virtually. So it's complicated, but I would say a physician workforce is the biggest issue. Yeah. Sameer Sinha, can you help us with that as well? It just seems unreal that in 2025, we should be having emergency departments closing all weekend long, all evening long, basically working

9 to 5, that kind of thing. How does that happen? Part of the reason it happened was, again, under previous governments, we actually saw cuts in medical school enrollments. We saw a number of, you know, beds being closed in hospitals and nurses losing their jobs. So we went through a real period of contraction where people just left the system altogether. COVID also did a wallop on the system because a lot of doctors started to retire, a lot of long-standing nurses, they started to retire.

And so an emergency department closes, it's not just about the physicians, it's the entire healthcare team, especially the nurses, where if we just don't have sufficient staffing to deliver safe care, it's better just to not deliver any care at all in those dire situations. But this is the challenge, we have an HHR shortage, but we don't have a provincial health human resources plan.

And again, this is where we have to start thinking about, really thinking about how we use these $80 billion in the most appropriate places, as opposed to just throwing more good money after bad. Rosalie, I presume the C.D. Howe Institute keeps a bit of a close eye on the Ontario election campaign, the platforms of the various parties, what they've had to say about health care. What do you like on what you hear? Well I'd say other than the amount of funding that they've attached to it, it's kind of

a distinction without a difference where everyone is discussing primary care. That's one of the big issues. It matters to Canadians. But so far I don't have details. And it's all in the details. Sort of like Samir was saying, how you spend the money is more important than the amount you're putting in. And I think the same would be true about primary care where, yes, everyone has this goal of getting better attachment to primary care, but it's all about the how. And so far I haven't seen any bold differences or anything that

looks all that much different than the current, the system we currently have today. We're just growing what we have. Let me pick up on that. Joanna, you know, basically all the four major parties are saying, we'll get you a family doctor, speaking to the two and a half million Ontarians who currently don't have one, we'll get it done within the next four years. They're all saying that. Is that doable?

Well, again, the family doctor shortage is very complicated. It's not something that you can just, you know, wave a magic wand. And it also isn't just training more doctors. I, we have a problem in our system that when we train doctors, more and more of them don't want to be in primary care. In fact, McMaster had to take on more foreign trained doctors than ever before to fill its family doctor residency spots in

2024, because it just couldn't attract enough Canadian trained physicians. So this is an issue that has to do with how we practice family medicine and perhaps bringing in other types of healthcare workers as Natalie talked about. A lot of family doctors want to work in teams.

So I think there needs to be a lot of reform to help make that a reality. Paul, let me just ask you directly, what have you guys done at your hospital to try to improve the hallway medicine situation? You know, we've invested a lot of time and resources into access and flow strategies. We have teams that work on it, well really 24 hours a day to make sure that we're trying to move patients between the best site of care, whether it's been within the hospital

or for instance, having rounds with our South Lake at home team in the morning to try to find ways to get resources for people in order to be able to go home. We've also launched a new strategic plan that focuses on sort of a system of care that sits between hospital care and primary care called Extensivism.

And something we're pretty excited about. I think it's definitely a comprehensive program that as we start to see it unfold will help with the entire phenomenon of hallway healthcare. Are these solutions working? You know the access and flow stuff which I think every hospital in the province is definitely working on. I think that we do a better job with it than many if not most. I definitely won't say all all, but we have a really good team and really very

focused on it. So it helps, but you know, we still have people in our hallways in the emergency department or on the wards and that sort of thing. We're, like I said just previously, we're pretty excited to see extensivism's potential realized in the coming years. I know everybody wants more money for health care. I know everybody wants more money for healthcare. I know everybody wants more money for healthcare. Natalie, I'll bring you in on this. I've yet to meet a person who said, if we went from 80 billion a year to 160 billion a year,

in other words, doubling the budget, we'd have a system that's twice as good. I never hear anybody say that. So is more money really the answer? Well, it's both. I mean, is more money and also a plan, like an actual plan, to provide the health care that people need. We don't have that at all.

In fact, we haven't had hospital capacity planning since, you'll remember this, since probably 1996, 96, 97 with the Health Care the healthcare restructuring commission. During the Mike Harris years. That's right. That's the last time anyone actually measured and tried to meet population need for hospital beds. In terms of other parts of the healthcare system, there is no plan at all.

It's ridiculous. I mean, the first job of a public healthcare system is to measure and meet population need for healthcare. But the problem is that Ontario is very technocratic. job of a public health care system is to measure and meet population need for health care. But the problem is that Ontario is very technocratic. It's very, it follows trends without sort of just rhyme or reason. I mean, obviously we've cut the hospitals too far. You can't continue to tell people we're going to have more and more tax cuts and better and better services and more and more services that's got to come from somewhere. You know, we have to be real here. There has to be more funding and

the funding actually has to go to care. And those things are fundamental. Care as opposed to what? As opposed to profit, as opposed to technology. Well, hospitals don't turn to profit. So what's that a reference to? Well, to the privatization of, you know, across the entire health system. Now we're spending more than a billion dollars a year on for-profit staffing agencies, for example. We're paying double in Ontario to for-profit hospitals to provide surgeries.

You should be coming tomorrow night. We're going to talk about this tomorrow night. Yeah. The second part on this. I mean, we're wasting a lot of money on that, but also on technocracy, you know, bean counting, as opposed to actually getting the money into the front lines of care. Let me get some airs in on this, because I hear frequently people say we're cutting back on healthcare spending, and yet I heard the Premier at the debate the other night say

we're spending more on healthcare than any government in Ontario history. Now both those things can be true, but what I wanna know is, are we actually cutting back, or are we just not cutting according to the population increase, rate of inflation increase, et cetera? Which is it? Yeah, so number one is we are spending more today than ever before. So every government, year over year,

the budget continues to increase. And so every government can say, we continue to increase spending. The key issue is, is that when you look at where we're actually putting that spending, when you actually don't increase the home and community, when you keep the home and community care sector increasing at 1% or just barely at the rate of inflation,

but other sectors at a higher level, you are effectively cutting spending increasing it 1% or just barely at the rate of inflation, but other sectors at a higher level, you are effectively cutting spending in certain areas as well. And this is why, again, I say that, remember, a day of government-funded nursing home care, long-term care, is about $200 a day. A day of home and community care

for a long-term care eligible person is actually half that amount. If we actually put more money into areas like primary care and home and community care, if you took a billion dollars more and you put it in those places versus putting it in the hospital, you're gonna get much more bang for your buck.

And so, yes, every government has been spending more and more money, but I don't think they've been prioritizing it with a plan, as we've been talking about, with coordination in the right areas to meet the needs of our aging population. And if we do that, we won't keep having the Gong Show that we have every four years,

where we're just saying more and more and more, but what are we actually doing with it? You know, the Gong Show, which I remember watching in the 70s, was pretty entertaining. So you may have to come up with a different analogy, because this is not entertaining. This is serious stuff. But let me do a follow-up.

If it's so obvious that we shouldn't be doing it the way we're doing it, and we can do it a different way, why are we not? This is what I struggle with. When I had the privilege of being the senior's lead for Ontario, I made this case. I made this case to government and it was amazing. We actually had our hospitals on side where they said,

look, we will not take significant increases in our funding because we're gonna support large increases in home and community care funding. And we saw over a six year period, what happened was we had tens of thousands of more people who were eligible for nursing homes being able to be supported in their own homes because we had so poorly funded home care prior to that.

So we actually have evidence that when we actually start putting money in the right places, we're actually getting the bang for our buck. But as is politics, you know, we then have a government saying, that government never spent money for six years on building any new beds.

Exactly, because that's what I told them not to do, because we actually got 40,000 more people able to stay in their own homes in that way. So again, there's a lot of politics at play here, but we actually have the evidence and we know what we need to be doing. I just wish that we wouldn't be planning our healthcare system on four-year political cycles.

Joanna, you obviously cover these issues for a long time. You have people giving you advice all the time on what ought to be happening. Share some of that advice with us. What do you think needs to happen? Well, I mean, this is a problem that requires a lot of restructuring of the healthcare system, which is why I think you don't see a lot of movement in it.

To give you an idea of the scope of this problem, Hamilton Health Sciences is facing its fourth deficit in a row, it has buildings that are up to 100 years old. And the hospitals in Hamilton actually turned a hotel into a healthcare facility just to house people who should be discharged from hospitals, so people who would be in hallways otherwise. And that still only holds about half of the patients that they have in hospital ready to be discharged and they still have significant patients in

hallways. Hallway medicine has become a daily occurrence at Hamilton's hospitals. So in, but the problem is in order to fix that, you that, you really have to look at primary care, you have to look at long-term care, you have to look at home care, you have to look at surgery wait times and how hospitals are funded and how hospitals are staffed. So I mean, it's just a problem that requires a lot of planning, something we've talked about here and some significant restructuring and funding. Rosalie, we saw those numbers off the top. They're getting worse.

They're not getting better. I mean, people, certainly everybody I talk to feel somewhat hopeless about any party having anything to say constructive that can improve this situation. Do we, I mean, should we be pessimistic about the way things are? Well, I mean, economics is the dismal science, so I tend to lean into the cynicism because I, yes, the challenges of the pandemic and obviously that strained our resources, But there was also this magical part at the beginning that made me rather naively hopeful that we could actually achieve change. And so I'll just use the example of when we're trying to get people to not go to the hospital and not go to the emergency room, we got public coverage of virtual care, and within a month

we got to 70% of ambulatory visits being virtual. And we had debated that for years. Everyone talked about it being a good idea. It was great. It was a great idea. Yes, we did it quickly. So there's probably some iteration and some tweaks that need to be done. But we did it for a short period during the pandemic.

So there's my proof it can be done. We've already done it. But can we do it in a long-term, strategic, fiscally sustainable way that also, in defense of the bean counters, health care is already the biggest program spend area. And for years prior to the pandemic, it was kind of crowding out other areas like education, justice. It was almost half the budget.

And so all of these things work together. And if people are struggling in other areas of their life, they're also more likely to have negative health outcomes. So we also need to look at the social determinants. And since it's already such a big part of the budget, the health minister is not going to be the popular person in the budget discussion if they ask for a huge infusion of more money. And so I think a realistic approach isn't about how much money you're going to spend.

It's about what are you actually going to achieve. And that has to be a heck of a lot more creative and bolder than you'll all get rostered with a family doctor. But there's no actual guarantee that you'll get an appointment within 24 hours. Well, let me get Paul on this. Paul, if people are pessimistic and somewhat skeptical about any of the promises being made during this writ period, can you tell us why we ought to be optimistic, if we should, about our ability to solve this problem?

You know, I think Rosalie brought up a good point, which was a demonstration that in a crisis situation, we are able to innovate and we're able to translate science into action instead of in 17 years in a few months. So I think there is a proof point there in terms of the ability to innovate effectively. There's a lot of good innovation that is happening within the province, so both within the hospital sector but in other sectors as well. So we should take some encouragement that there's really good things being done in the province. The biggest challenge is scaling those things and spreading those things. So, Ontario does great with pilots, has a lot of trouble turning that into sort of policy

and system, systemic responses and systemic programs. So, I think that's a challenge in front of us. So, I'm optimistic that's why I'm here. So, Mears, same time, down to my last minute. If whoever forms the next government of Ontario, one, two, three, here are the things they need to do right away. Make a proper plan, invest truly in a functioning

primary care system that's team-based, and double the home care budget. Are you hearing that from any of the parties on offer? I think they're all kind of biting around the edges and talking about primary care, but I haven't heard really about a clear plan, and I haven't heard as much as I want to about home and community care.

Natalie, last 30 to you on that. I think two things are true here. We're talking about hallway medicine. One is the hospitals have been downsized too far. Two is we spend too little. The third is that every group in my career that wants a change that benefits themselves or their own pet project creates a crisis to do it. You know, we can't afford it so therefore we have to radically retool and privatize for those interest groups that want to privatize. You know, those people who want home care want to create a crisis so that all the money has to go into home care.

I think from the very top, I agree with what Joanna says. Across the board, we have capacity problems from primary care to long-term care to home care to hospitals. The underfunding, the inadequate resourcing, the lack of planning has hit all of healthcare across the spectrum. Of course it can be fixed. I mean we built a world-class health system in Ontario and in Canada it still is world-class. Of course it can be fixed. It's ludicrous to think not. That's our time everybody. I want to thank all five of you for sharing your wisdom with us on TVO tonight and

as I say we'll do a second part on this issue tomorrow night. So tell your friends and family, stay tuned. Thanks all. Thank you.