The Paul Wells Show - Sick kids, sicker hospitals

Episode Date: November 30, 2022

Children's hospitals across North America are seeing a major surge of sick kids as a result of the "tripledemic" of COVID, RSV and the flu. And they're struggling to keep up. Alex Munter, President and CEO of CHEO, talks candidly about how the current crisis in children’s healthcare has only exacerbated problems that began long before the pandemic. 

I read the news today. Oh boy. There's a real moral distress, you know, in our emergency department when, you know, sick kids keep coming and coming and coming and coming and they just feel they can't keep up. This week, the calm at the center of the health care storm. Children's Hospital CEO Alex Munter. I'm Paul Wells. Welcome to The Paul Wells Show. My topics aren't always ripped from the latest headlines, but this week's topic sure is. Children's hospitals are in a crisis right across North America.

Unprecedented wait times. Resources stretched to the limit. That's definitely the case at CHEO, which used to stand for the Children's Hospital of Eastern Ontario, but for the last few years, it just stands for CHEO. It's Ottawa's children's hospital, and its CEO is a guy named Alex Munter. People in Ottawa know Alex well enough. He was a city councillor for a while. He even ran for mayor in 2006. And he helped lead the national fight for same-sex marriage before that. Nobody was expecting him to be at the local epicentre of a national crisis. Probably even he didn't expect that. And yet here we are. He told me about the burden on his staff from what's being called a triple-demic, the RSV respiratory illness, a nasty seasonal flu, and COVID all hitting at once. And he said

the healthcare system was already strained by years of staffing shortages and funding negligence before that. The portrait he paints of a system in crisis is stark. It's worrisome. And he's kind of short on magic solutions. To get through this mess, we're going to need the dedication of overworked professionals, the attention of distracted politicians, and a little more patience from all of us, even though we're tired of masks and public health advisories. After the break, my conversation with Alex Munter. Alex Munter, thanks for joining me. Happy to be here. What's going on this week at GEO? Well, we've had a slight dip in admissions, which is good. We are seeing, however, that flu admissions are going up while RSV admissions are trending down, although a lot of the littlest patients, and they could be quite

little. I went to one of the pods outside our ICU that's caring for critically ill patients. There were five babies there. The oldest baby was nine weeks old. And a couple of those were co-infected with RSV and flu. So it could be quite, quite ill. So but while the numbers are down slightly, we're continuing to run over capacity on our medicine units, on our critical care units. And our emergency department, which was built for 150 kids a day, is seeing 220, 240, 260 a day. So it continues to be very busy with unacceptably long wait times. So we are hoping for the best, which is that, you know, RSV will continue to trend down and that flu will peak soon. But we are planning for the worst, which is that RSV will continue to trend down and that flu will peak soon.

But we are planning for the worst, which is many more weeks of this. And part of the reason for that is that our catchment includes northeastern Ontario. And they're only a couple of weeks into the RSV surge. So you're talking about numbers like 160, 170% of capacity, if my arithmetic is good. Does that teach us that capacity was an imaginary term anyway, and you actually have more capacity than you want? Or is this a crisis? Yeah, that's not the lesson people should take.

Because what's happening is, in order to staff all these beds, we have to pull people out of their other work. And so we are cancelling clinics. We're cancelling surgeries. If you walk around, you will see surgeons and anesthetists, plastic surgeons and endocrinologists and oncologists. And last time I was in our pop-up medicine unit, there was a cardiologist there caring for viral patients. And so just to use the example of surgery, before the pandemic, 35% of kids in our catchment area, CHEO patients, children, were waiting longer than is clinically safe for surgery. Earlier this year, that had risen to 50%.

And now because we're canceling all kinds of surgeries, it's going to rise even further. So the only silver lining for me in all of this is that we're having this conversation. You and I are having it right now, but there's lots of other people having the conversation too. And there's a recognition that we need to right size the pediatric healthcare system,

the child and youth health system in hospital and outside of hospital. And, you know, I think that penny is dropping. And so I'm feeling hopeful as we look beyond the surge that that will start to happen. And in fact, we've been successful after, you know, many years, but we've finally been successful in having the Ministry of Health here increase permanently our critical care capacity that is positive in the long term, because for many, many years, you know, our

seven funded beds, which were the only level three, so highest level of intensive care beds between Montreal and Toronto, you know, we're just not enough. And in very busy viral seasons, we would often send kids to other communities. So we'll be able to keep kids here. And we will be able to right size our capacity in critical care. And we need to do that as well in other parts of the organization. The situation that you're describing, longer waits, people pulled off of care that may be less urgent, but that is often very important. To what extent is this life all medically necessary? And the consequences of delay for children are the same as they are for adults,

so longer suffering, but much more significant in the sense they can have developmental impacts. You know, a child that can't get dental surgery, that can affect language acquisition. A child who can't sleep because of, you know, they need a tonsillectomy and they're in pain, that will affect their education. And of course, a sick child affects a family and a family's productivity, ability to work, all those things. Let's step back a bit. Tell me about CHEO. Everyone in Ottawa thinks they know CHEO. A lot of our listeners across the country will be less familiar with it. How does it fit into the Ottawa health system and how does it fit into the

network of children's hospitals in the country? So CHEO is almost 50 years old, opened in 1974, really because of young moms. Young moms started a campaign, teamed up with pediatricians and then, you know, a smart politician who was Don Reed, running for mayor of Ottawa, did what smart politicians do, which is he saw a parade, and so he rushed to the front of it and promised a children's hospital and got elected, so kind of had to deliver. So really opened as what you would think of as a kind of traditional acute care hospital. And of course, we're still at in terms of an emergency department, the regional pediatric trauma center. But over those 50 years, it's also grown into an integrated child and youth health system. So many programs in the community, in schools, in homes,

everything from development, rehabilitation, behavioral programs, autism, other diagnoses, mental health, outpatient clinics, home care, research, obviously, as well as home to a number of provincial programs, most notably the newborn screening. So when your child is born here in Ontario, the little pinprick in the heel, that blood spot, wherever that child is born in Ontario, that blood spot comes here. And Nunavut as well, we're the children's hospital for Nunavut. So that's the evolution. In the most recent few years, we've created with about 60 organizations and many hundreds of physicians, something called the Kids Come First Health Team, which really, again, seeks to work across that continuum of care in the community, in homes, primary care.

And that's been really super helpful to us during the pandemic. For example, we've been able to stand up two urgent care clinics, one at CHEO and one in Orleans, really that are led by primary care physicians, community pediatricians, and staffed by CHEO staff. And that has been instrumental in helping us with the emergency department pressure by giving families other options. So that's who we were and who we've become. And, you know, there's 13 children's hospitals across the country. And so it is a very tight network. And all children's hospitals right now are experiencing the kind of pressures that we're experiencing here at CHEO in Ottawa. How would you rate that pressure on the children's hospital network compared to a normal tough autumn? Is this another in a series of hard years or is this something unprecedented?

No, this is, you know, talking to people who've been here 20, 30, 40 years, they've never seen anything like it. We've never had to open a second ICU or pop-up medicine units or any of those kinds of things. We have had viral surges. They've tended to be a few weeks, maybe a couple of months, typically in the dead of winter. The surge here in emergency started in May. So May, June, July, September, and October, the busiest May, June, July, September, and October in the history, nearly 50 years of CHEO. And then the surge on inpatient started in September. And so we're kind of into the third month of that, and it's certainly going to continue on for another month. So, you know, nobody's here ever seen that.

And, you know, talking to counterparts across the country, they would say the same thing about their organizations. One last piece of our puzzle. Tell me how you came to run CHEO. It's now more than a decade since you ran for mayor. I bet you're still getting asked questions. What are you doing running a children's hospital? But that's closer to your career path than the other thing. Yeah, well, 16 years since I ran for mayor in the city of Ottawa. That was coming out of a local government where I'd been responsible on the council for health and social services.

And leaving there, I ran two organizations before coming to CHEO. One was the Youth Services Bureau, which is a child and youth mental health agency here in Ottawa, about 20 locations across the city. And then the Champlain LHIN, which has since been reorganized, but there used to be 14 local health integration networks, they were called, which were provincial crown corporation that funded and coordinated health care. So kind of, you know, the child and youth mental health plus the delivery arm or the funding coordination arm of health care, I was approached about the opportunity to lead CHEO and that led to my appointment 11 years ago, which now makes me and Margaret Fullerton, who leads the Children's Hospital in Calgary, the Alberta Children's Hospital, we both of us appointed at the same time. She and I are like now the godfather and the godmother of the Children's Hospital CEOs.

We're the longest serving of that group. Another thing I was reminded as I was reading your bio was that in 2004, 2005, you were national co-chair for Canadians for Equal Marriage, which is, it was at the time just an epic battle. And it now seems almost hard to believe that that took as much work as it did. Is it? Do you pay attention to American politics? No, I suppose that's true. I would pay $8 a month to like have a Twitter feed that has zero American politics on it, if you're listening, Elon. But, you know, I think there's a backlash and you can see it building in the

United States and starting to trickle into Canada. But yeah, I mean, that's almost 20 years ago. And like all social change, you know, when I was chair of the health committee at the city of Ottawa, we brought in the first big city smoking ban in Canada and workplaces and public places. and workplaces and public places. And it was hugely controversial at the time. And, you know, I got death threats, the medical officer of health had to have security protect him at meetings. And it all seems so quaint now, right? Like, who out there is arguing for bringing tobacco smoke back into public spaces. So times change and people change. We're in a moment in time in our culture where we somehow believe that people never change when, you know, all evidence to the contrary, right?

And if I may, I get the impression that one of the lessons you have taken with you from those earlier fights is an understanding that public advocacy is part of public administration, that working through channels sometimes doesn't cut it, and that you have to make your case to the broader society. Yes, and you got to do both. So I would say this organization, CHEO, You know, you got to do both. So I would say, you know, this organization, CHEO, was created by this community. You know, I think of those young moms, then young moms, this was the 60s, right?

And I've known some of them. They became volunteers. And this organization has grown and thrived because of the remarkable, enduring support of our community. And so I think we have an obligation to explain what's happening and to be transparent with our community and also to advocate on behalf of children in our community. Now, advocacy for somebody like me is different

than if you're leading an advocacy organization an advocacy organization this is not an advocacy organization it's a service delivery organization and we do work through channels and i have personally in this organization we've had great working relationships uh with government when i was elected there was a conservative federal government a liberal provincial government it's the opposite it's the other way around now and we've worked really well with all those, you know, many ministers of health and different administrations. And that's part of the obligation we have. So advocacy for us is not picketing, condemning, flaming elected officials. For us, it's finding the way to work with them and in a principled and clear way making the case,

not for us, but for the kids and families that are depending on us. But you've written quite a number of op-eds. That's part of the job too. Yeah. Again, both in the spirit of explaining what's going on and helping people like you, uh, people who follow public policy, public servants, elected officials kind of understand from our perspective, what some of the priorities should

be. Yeah. I mean, cards on table, I wish there were more people like you. You know, some people say the opposite. So, you know, take your poison. But it's funny, as channels for getting message out multiply, sometimes it feels like the sense of a public square erodes, almost paradoxically. Yeah.

And that's one of the reasons I'm doing this podcast. It's, we need to get together and talk about what we're talking about sometimes. Yeah. And the other thing I, you know, I know that we had the, we had Minister Jones here, the health minister in Ontario a few days ago. And so, you know, I did what I always do. I thanked her for coming, posted some pictures of her visit. And, you know, there's a barrage of abuse. Most of it aimed at her, much of it quite misogynistic. And some of it aimed at me.

I should be ashamed of myself for inviting the Minister of Health to a public hospital, which, you know, is an interesting perspective. That didn't happen 10 years ago. This idea of platforming, how dare you give voice to the person I disagree with, is very strong. It is very strong. But it's also, if you think about it, take two minutes to think. It takes you seconds to think about it. It's nuts.

The Minister of Health of the province of Ontario, of course, I'd like her to be here as much as possible. It's an opportunity for her to see our organization. I'm grateful she came. And she's the primary, her ministry is the primary funder of this organization. We are accountable for our outcomes to her ministry. You know, but it always happens, right? So, you know, Justin Trudeau was here last year, got the same, you know, different people, but got the same barrage of abuse. And then the premier was here in October. It's just so interesting to me

because it didn't happen when I started 10 years ago. I mean, everybody kind of understood, of course, elected officials go to public institutions, and that's a good thing. And now it's so hypercharged. It struck me as astonishing that anybody would think it's a bad thing for the Minister of Health to go to a public hospital. We'll come back to my conversation with Alex Munter in a minute. I want to take a moment to thank all of our partners, the University of Toronto's Munk School of Global Affairs and Public Policy, the National Arts Centre, our founding sponsor, TELUS,

our title sponsor, Compass Rose, and our publishing partners, the Toronto Star and iPolitics. Let's get back to healthcare. Yes. One of the points that you have made on Twitter is that CHEO, the health network in Ontario, were already in a substantially less than ideal state before COVID happened.

That in the fall of 2019, people were ringing alarm bells about acute care, intensive care, and the hospital system in general in Ontario. Tell us about that. Yeah, that's true. So the Ontario Hospital Association, and disclosure, I'm on the board of the OHA, the Ontario Hospital Association put out a report, an analysis in, actually it was December of 2019, that showed that Ontario on a per capita basis had the lowest proportion, it was last in the number of acute care hospital beds,

tied for last, I should say, with Mexico. And so, you know, that was a big reason for the lockdowns that came in, you know, three months later in 2020 was policymakers looked around the world. They saw places like Italy and France and their hospital systems collapsing. New York City. Those are places that have 50, 60, 70% more beds on a per capita basis than we did. So we're talking here about hospitals, but you could say the same thing about long-term care and other services. And, you know, CHEO is a microcosm of that. CHEO, when it opened, had 300 beds. And today we have fewer than half that.

I was amazed by that statistic. And some of it is trends that are healthy and easy to understand. So I would say most of it is a good news story, right? So, you know, when Chio opened, 80% of patients, for surgical patients, were admitted. Like, I grew up in, I still have my tonsils, but I grew up in Ottawa. And I remember being jealous as a kid, my classmates that would get to go to CHEO to get their tonsils out, because it honestly sounded like a spa, right? Like, they'd get like most of a week off. They ate nothing but ice cream.

They didn't have to go to school. So like, my view of CHEO as an eight or nine-year-old would have been, it would have been like a kid version of, you know, a Nordic spa at the time. But now, you know, 80% of surgery is day surgery. That's good. Kids shouldn't be in the hospital for days, right? We've got, you know, much better prenatal care for women,

healthier babies, public health measures like helmets and seatbelt laws that have really reduced neurosurgery, for example, lots of pharmacological interventions now that prevent even needing to see a doctor, let alone hospitalization. So most of it really positive trend. But then what happened was that for the last 20 years, and really especially for the last 10 years, 10, 11 years, was a period of restraint and reduction of the hospital system. A view that we were overbedded was the language. And for us in the children's world, that came at the same time as, first of all, population growth. You know, population of children is growing quickly, nine times more quickly in Ottawa than in Ontario as a whole. Whole new diseases.

COVID's the most recent, but H1N1 before that. Dramatic increases in mental health and addiction, eating disorders. mental health and addiction, eating disorders. And so I mean, to use eating disorders as an example, we had a in CHEO in 2000, probably three or four, about 20 years ago, a six bed eating disorder unit was open, it was still six beds, when the pandemic started. And at one point, we had 30 eating disorder patients and eating disorder patients, because they are so medically compromised, right, their heart rate or tube fed, or need to be tube fed, have to be admitted, right. And so, you know, we now have had a right sizing of our eating disorder unit, and created a whole new program there, which is more reflective of the population demand that we now have. So,

you know, that reduction in acute care capacity, much of which, you know, certainly for kids is a good news story. Then it's not that it went too far. It's just that once the benefits of that ran out and the population grew and demand increased. We didn't have the commensurate increase in investment in hospital and in community-based services. It's a mistake to think, you know, we need to go back to 300 beds. We don't. A lot of the investment should happen in community-based services and, for example, child and youth

community mental health agencies so that we can keep kids out of hospital. But that investment needs to happen in capacity. And that, again, I hope is what people are taking out of what's the moral of the story of what's happening in children's hospitals across the country right now. What would that community-based service look like? Drop-in centers, things like that? Things like that, but really outpatient clinics primarily. So here in Ottawa, we've created something through our Kids Come First health team called One Call, One Click, which is a good name for it.

It's very illustrative. It's through One Call or One Click, you can access 24 child and youth mental health agencies because there's agencies for younger kids and older kids in English and French and addictions and mental health. So one way in, and then rooting to the right place, case coordination, case management of the kids that need more intensive service. There's a daily huddle of all the organizations. They use a common technology platform. There's nurses in schools, all referrals from school now at the eight school boards across our region go in through one call, one click. And that got stood up thanks to Royal Bank of Canada through RBC, through philanthropy. And we kind of cobbled together funding for it.

But it's that kind of program that needs to be put on stable footing. Because, you know, at CHEO, and, you know, I think it's the same elsewhere, one quarter of the kids in our emergency department in mental health crisis, one quarter, are back in six months. And so that's an indicator that they're not getting what they need in the community. They're not getting ongoing support in the community. And if they do, then they don't need to come to the emergency department, right, which, again, is a win for them, most importantly, but also is a way of addressing the pressures that we're seeing.

Okay. So the end of 2019, you've got an institution that's part of a system that is built for... Built for the early 2000s, frankly. Yeah. That's probably the best way to think of it. And built for a much lower incidence of bed stay than the system we all grew up with. What happens to that system through 2020?

How did COVID affect Chio? And how has the more complex landscape since then pointed up weaknesses in the system? Right. By the way, when you say we all grew up with, you mean we all, people of a certain age. Yeah, us old folks. Yeah, yeah, yeah. Because the young nurses were hiring kind of, they were an age where they would have grown up with this system.

Because it's been a generation, really. they would have grown up with this system. But because it's been a generation, really. You know, the last time there was a significant investment in capacity was Prime Minister Martin and the agreement with the provincial governments in kind of 2004. So, well, so the pandemic came for us in the initial instance. Of course, activity plunged, right? People were locked down. Public health measures were in effect, and that reduced certainly viral illness, but also reduced injury. In that first wave,

we actually sent 60 staff from here into long-term care. The principal nursing home we were in, there were two staff that had died, right? We forget now just how scary that first phase was. But what was building through 2020 was that the access problem that existed already, that too many kids waited too long for care, and those waits were getting longer and longer and longer. And so, you know, through successive waves, those weights continued to get worse. In the third wave, we started admitting adults to our ICU, which is most children's hospitals in Canada also did that. And so, you know, at this point now, two and a half years in on the child and youth side, we're in fact, in Ontario, for most types of care in most parts of the province, kids are waiting longer than adults. And as we look beyond the surge, that is the fundamental problem. And that's just not okay.

For the system as a whole, and the issue in general hospitals, of course, is the proportion of their beds that are occupied by people who don't actually need to be there. They're not acutely ill any longer. That's been a problem for a long time, and it's gotten worse for a variety of, again, it's a great example of capacity outside hospital being the solution to problems within hospital. And so there's a lot of work happening there, a lot of expansion of long-term care underway, probably more expansion of home care needed. You don't build all those long-term care units overnight. And so the general hospitals are also dealing with the need for increased capacity. And they're dealing with whole new, they're also dealing with all kinds of new pressure. So for example, the other day, I don't know what it is today, but the other day, the Ottawa

Hospital had 80, eight zero COVID patients admitted. Well, you know, that's a disease that didn't exist in 2019. That's 80 people who wouldn't have been in the hospital in 2019, right? And that's also displacing other activity. And certainly here in Ontario, there has been a significant investment in increased capacity, some 3,500 beds across the continuum. That's been really important. And I don't actually know.

I've asked OHA for the latest data on where we stand now in that. If you were to update that 2019 report in terms of being last in the Western world, is that still our place or have these increases in capacity, you know, improved our standing? The challenge now is finding the people to staff the beds, because without nurses and doctors and respiratory therapists and social workers and all the folks you need, cleaners and clerks, a bed's just a piece of furniture, right? So that now, you know, is a central preoccupation of policymakers and hospital leadership. The OHA does an annual survey of hospital CEOs in Ontario and asks, you know, what are your top three issues? For the longest time, it was money. And now the last couple of years, the top issue has been people, has been the health human resource challenge, which boils down really to two things. One is

keeping the people we've got while the pipeline to bring on board new people and to staff new capacity, while that pipeline gets made bigger and produces new health professionals, which, again, you know, it takes years. And, you know, I always worry every time there's one of these waves, I always worry about what the attrition will be after. Because, you know, I was just up on the NICU, you know, talking to a nurse. She's not number one, I think she's number two or number three on the seniority list. She's been here since the mid-70s. She could retire. She's certainly eligible for retirement. She hasn't. And in the middle of a surge like this,

people aren't going to quit now. Their team needs them. The babies need them. These are unbelievably committed people to their vocation. But after it ends, the surge ends, I mean, it's harder to convince folks like that to stay, right? They've done their time. They've really made a contribution. So as soon as they get a few minutes to breathe, they say, look, I gave it the office. It's time to move on sort of thing. Yeah, some proportion of them will. Our turnover rate in nursing has doubled since the start of the pandemic.

And it's happening at both ends, right? So it's happening, like for us, obviously, an aging population is not a concern from a care delivery perspective, but it is a concern in terms of the workforce. And it really is happening. And it's happening in all organizations this way. So it's longer tenure staff deciding that's it. They've done their bit. They've helped through a pandemic.

And that includes, by the way, all the people who unretired in 2020. But like in our organization, every organization would call back retirees and people answered the call. But the other problem is the new nurses and the new health professionals who quit after two, three, four, five years because it's not what they expected or wanted. And so we have to worry about the working conditions,

the support for staff, because if we're losing at both ends, we're recruiting and losing the new people we're recruiting and we're losing the retirees. That I think is the most significant issue in the system now. Obviously, stable, secure funding is part of the solution, but that's the thing that we worry about most. I've got a chance here, which I don't often have, to road test a common boomer critique of millennials. I know people who, when they hear that newcomers to the system don't last two or three years, they throw up their hands and they say, well, young people today don't have any resilience. They don't know what it's like to stick to a hard task.

Is that playing in the situation you described? No, I think that the environment is harder. So imagine you, you know, you got through your nursing consolidation, you started in 2019, 2019, by the way, here, many other places too. Imagine you got through your nursing consolidation. You started in 2019. 2019, by the way, here, many other places too, but here was our previous record of busy. And then you into the pen. What was making things so busy in 2019? Well, we had a viral surge in 2019.

It was shorter. But I remember doing a town hall with staff in probably September of 2019. It was shorter. But I remember doing a town hall with staff in probably September of 2019. And we had brought a family whose heart surgery had been cancelled. Their baby needed heart surgery, been cancelled three times because we didn't have enough beds. I mean, it's the bed capacity issue, right? And so we were trying to mobilize staff to think about new ways to organize our resources. But you know, if you join joined then and you've been in a period of kind of constant crisis and churn and surge, you know, that's not something that people experienced when they joined in 1974, 1984.

So it's not really kind of an apples to apples. And by the way, the millennials, I mean, we're now into Gen Z recruits, right? The millennials are all becoming managers. So that'll be interesting too, right? So Alex Munter, let's fix this staffing crunch. What levels of government need to do what for things to get better? Well, both provincial and federal levels of government need to work together on the solutions. Part of the reason we're in the fix

we're in is that hospitals, but also long-term care, home care, really surged up and down over the years, thanks to a large pool of part-time and casual staff. That part-time casual pool is disappearing. There are more permanent full-time jobs, which is good. But provincial governments don't have the kind of fiscal capacity to do that on their own. And, you know, we saw that over the last two and a half years, there was a significant infusion of federal money that made it possible to open those thousands of new beds, for example, here in the province of Ontario, and the dozens of new beds here at CHEO. So we do need kind of stable funding in order that organizations like ours can create these positions, onboard people, keep them, and have enough staffing so that the working conditions

are feasible, are plausible for people. And also recognize that, you know, frankly, we're in a different kind of labor market now as employers. And if there's not enough supply of anything, the cost will go up. And so, you know, through the 2010s, through that decade, we constrained healthcare costs by limiting wages of providers. And, you know, that's just not going to work anymore. And so, you know, the combination of, you know, ensuring the funding for the number of positions for adequate compensation, to be able to keep our health professionals at the bedside is important. And then on the supply side, you know, there's a mystery to it. And there are initiatives underway, we need to train more. We need to license more quickly those who have the skills, but are not not working. We have to attract people back who may have left. We have to streamline and fast track licensing processes.

Finally, we've got to change models of care. And this is the part that's hard because historically, changing the skill mix was seen as a way to cut costs. And so there's a reflexive opposition to it. Whereas now changing the skill mix is required because we just don't have the people. I'll give you an example. With that expansion I was talking about in terms of our eating disorder program. So eating disorders is a very multidisciplinary program. There's psychiatrists,

psychologists, social workers, occupational therapists, dieticians, nurses, of course. But it's very hard these days to find hospital-based psychologists. And here in Ottawa, it's going to get even harder because the federal government, which great as an employer, what a great employer, is giving every federal employee, which great as an employer, what a great employer is giving every federal employee through the benefits plan $5,000 for mental health counseling, which will be hundreds of millions of dollars chasing psychology, right? That's going to explode demand for a constrained supply. Yeah, for a constrained supply. And frankly, it's not for everybody to work in a hospital where you have to do call,

where you see the sickest patients. Some people are going to opt to do private practice work instead. So all that to say, that was my long-winded way of getting to this point, which was in eating disorders, we couldn't continue with the model we had. We had to change the work.

So the work that psychologists used to do, can we have social workers do more of that? Can we have child and youth counselors do some of the work that psychologists used to do, can we have social workers do more of that? Can we have child and youth counselors do some of the work social workers used to do? Change the work that people do, still within the scope of their practice, but really to the top of their scope. And, you know, changing the mix of providers, you know, can be challenging because it's generally perceived as being about saving money. It's not about saving money anymore. It's about, you know, using the resources you have to serve the kids who need the care with the disciplines that you have while you're, while you're training and recruiting more, right? Let's begin to sum up. You've got a situation where parents are afraid to take their children

into emergency because they've heard what a, what a long wait they're going to have and what a mess emergency rooms are. So if you're that parent, you need to come to the emergency department. And one of the things that happens in the emergency department is very, very experienced triage nurses will assess your child. And if your child is seriously ill and requiring immediate attention, they will not wait. And so I think it's important for people, if they think their child needs to go to the emergency department, they need to err on the side of taking your child to the emergency department. If you have a long wait, if you have a long wait, it's because those experienced triage nurses and nurse practitioners and physician assistants have determined that the child is well enough to be able to wait a few hours.

Okay. So that's important. Yeah, that's important. I'm not underselling that. I mean, these are not acceptable wait times, and it's so demoralizing, of course, for families, also for our staff. You know, CHEO had the best wait times back in like 2018, 2017, 18. We had the best wait times, shortest wait times in this region, and like the fifth best or something like that in the whole province of Ontario. And now we're near the bottom of the province. So it's extremely demoralizing. We are actively trying to recruit more people.

And we're trying to work outside of our walls, so that families have alternatives for low acuity needs to go places other than CHEO. trying to work outside of our walls so that families have alternatives for low acuity, needs to go places other than CHEO. Okay, so you've gone from a laudable record only a few years ago to what feels like a never-ending crisis that has to do with viruses that we weren't expecting, but also has to do with real strain on the system independent of those viruses. So it's a perfect storm. In that context, a couple of weeks ago, federal and provincial health ministers met in Vancouver for the first time in years to discuss funding the system.

And the meeting ended in acrimony. The federal minister says, I want to talk about digital health data and comparable health indicators. And all these guys want to talk about is money. How do you respond when you see the people who need to make the big decisions for the system unable to conclude a meeting? I'm not overly panicked about it. Maybe that's a function of growing up in Ottawa and having seen this movie before. So this is the beginning of the dance, right? This is the negotiation. It's always been this way. If we're still at this point, five, six months from now, then we can

start to get panicked about it. But, you know, this is how the conversation in federal provincial territorial relations always starts. And the fact is, they're both right. The provincial governments are right that the erosion of the federal share of health spending over time is part of what's got us into this situation. And, you know, we've just run an experiment on that, which is the federal government upping its share through the pandemic. And we've seen that that was essential to the response. So, you know, certainly, you know, again, you know, channeling the Ontario Hospital Association, which is, you know, very strongly supports the 35% federal contribution compared to the 21, 22 cents that it is now. On the other hand, you know, I think

federal government is, you know, it's a reasonable position to say, okay, we're going to invest that kind of money, we want to make sure that it has outcomes that make a difference for Canadians. And certainly in, you know, in the children's world, Children's Healthcare Canada, which is the National Association of Children's Hospitals and other child health organizations, is making the case for a children's carve-out and some outcomes with respect to children's health. So, and if you think back to 2004 and the agreement between the federal and provincial governments at the time, there were outcome measures. They were built on wait times and access. So I think there's a bit of a template. They're going to have to find the sweet spot.

And I'm glad they've started the conversation because as you pointed out, it's the first such conversation in a very long time. I want to ask how these last couple months have been for you. Obviously, it's hardest on the families, hardest on the kids, a real grind on frontline practitioners, but what's the job been like for the guy who runs the hospital? Yeah, well, nobody should worry about me, but thank you for asking. It's, you know, it's hard. It's hard because, you know, I've been here 11 years, so I

know most of the people here. And I know that for them, it's not a job. You know, they are so committed to doing everything they can to help kids. And there's a real moral distress, you know, in our emergency department when, you know, sick kids keep coming and coming and coming and coming, and they just feel they can't keep up. Or when a surgeon is cancelling appointments, kids have been waiting a long time for surgery, and then going into the emergency department and taking care of, you know, kids that have flu or COVID or RSV. You know, this is usually a very joyful place, in part, because it's important to help kids when they have to be in hospital to make it as joyful as possible and as kid-like as possible. And, you know, it hasn't felt that way in the last couple of months. And that's hard. So, you know, I'm worried about the people.

And I'm worried, of course, I'm worried that something's going to go wrong. I'm worried with this kind of volume, with pop-up ICUs and medicine units and stretched staff that, you know, that's not the optimal formula for the highest quality care. So, you know, I worry about that. And so, you know, that's one of the reasons why, you know, children's hospitals have been saying, please wear a mask, please get vaccinated, please do the things that can help bring this viral surge to an end. You know, because we're, we're, we're here at the epicenter of all those sick babies and kids. That was going to be my next question. How can I help? And how can the people listening help?

Well, for sure, you know, and this is certainly in Ontario, this is the public health advice. And that is to wear masks in crowded indoor places, including schools and childcare. And, you know, masking works as a universal measure for source control most effectively, right? And we know that, you know, it's always interesting to listen to the debate about masking, masking doesn't work. And masking is to blame for the viral surge, because it contained the viruses for two and a half years. It's kind of funny. But, you know, vaccination, you know, flu still climbing. So if you haven't got your flu vaccine, it's a good match this year, get your flu vaccine helps prevent you from getting sick, but also prevents other people from getting sick.

COVID vaccine, the same. Like, I understand the deep desire to go back to quote unquote normal. It's a bit like when I see a TV show or movie set in New York City in the 90s. It's like, I feel nostalgic, you know, the time before 9-11 but 9-11 happened and a lot of things changed and you know the pandemic has happened it's still happening and it has changed things and you know I get it I feel nostalgic for you know not having to think about viruses all the time either but you, you know, we've learned some things, and we should apply those learnings. And, you know, when you walk through that unit where the oldest patient is nine weeks old, too young to be vaccinated, how could you not do what it takes to keep little babies out of hospital?

That's probably the best place to leave the conversation. Thanks so much for helping my listeners understand what's going on. Best of luck as you keep battling this strange crisis. Thanks for the opportunity. Thanks for listening to The Paul Wells Show. The Paul Wells Show is produced by Antica in partnership with the National Arts Centre and the University of Toronto's Munk School of Global Affairs and Public Policy. It's published by the Toronto Star and iPolitics. Thanks to our founding sponsor, TELUS, and our title sponsor, Compass Rose. Our senior producer is Kevin Sexton. Our associate

producer is Hayley Choi. Our executive producer is Lisa Gabriel. Stuart Cox is the president of Antica. If you're enjoying this show, spread the word. We'll be back next Wednesday. Thank you. you