At a time when Hamilton hospitals are already struggling with overcrowding and year-over-year deficits, Ontario’s financial watchdog is warning of potential cuts to nurses, beds and more due to health system underfunding. The Financial Accountability Office of Ontario (FAO) provided a stark picture of the Progressive Conservative government’s estimate that health spending will go up by just 0.7 per cent annually for a three-year stretch that ends March 31, 2028. Growth that slow is projected by the FAO to result in provincially funded health care losing 2,457 hospital beds, 7,263 nurses and 1,784 personal support workers over those three years. In addition, increases to the number of beds in long-term care during that time will not come close to meeting demand. The number of beds will drop to 56 per 1,000 Ontarians aged 75 and over, compared to 60 as of March 31, 2025. “In order for hospitals and other providers to live within that kind of budget envelope, some pretty significant trade-off decisions would have to be implemented,” said Anthony Dale, president and CEO of the Ontario Hospital Association (OHA). “Everywhere you look, there’s nothing but tough decisions.”
Hamilton hospitals
The FAO estimates it will take an increase in spending of four per cent growth a year — more than quadruple the province’s estimate — just to maintain current services. As a result, “efficiencies” will have to be found if growth is kept to 0.7 per cent a year, flags the FAO. But Ontario’s hospitals are already among the most efficient in the country. The majority — including Hamilton’s hospitals — have been finding efficiencies in the face of shortfalls going back years. For Hamilton Health Sciences (HHS), it’s the fifth fiscal year in a row the hospital network has projected a deficit. Michael Heenan, president and CEO of St. Joseph’s Health System, said hospitals across Ontario are under pressure. St. Joseph’s Health System Meanwhile, St. Joseph’s Healthcare was called one of the most efficient hospitals in the province by its leadership — and it is still planning to cut $9.1 million from its budget this fiscal year. “We are constantly looking for new ways to deliver care while being efficient,” said Michael Heenan, president and CEO of St. Joseph’s Health System. Heenan said finding efficiencies gets “harder every year.” Cuts is the word the Ontario Health Coalition uses instead. The advocacy group’s executive director, Natalie Mehra, says hospitals have talked about “cuts as though they are efficiencies for a long time.” “We need hospital leadership to be brave and speak up and tell the public about what’s really going on,” Mehra said. “But if they won’t, we will and the public should be rightfully angry about this.” Health Minister Sylvia Jones said through a spokesperson that patient care and access to services at hospitals won’t be affected. But Hamilton’s hospitals are already struggling financially, projecting deficits of $177 million this fiscal year and cutting jobs. Dale says a “significant majority” of Ontario hospitals are also facing shortfalls. At HHS alone, the deficit is projected to be $152 million on its roughly $1.6-billion budget for the fiscal year that ends March 31, 2026. Last fiscal year, HHS brought the deficit down to $24 million from a projected $112 million. But the hospital network has been vague about what it has been cutting to combat the year-over-year deficits that have accumulated to an overall shortfall of nearly $277 million from April 1, 2021, to March 31, 2025. HHS has also refused to provide any information about how many jobs have been eliminated during that time, as well as how many more are being cut as the hospital projects a deficit for the fifth straight year. “It’s the endless downsizing of Ontario’s public hospitals,” Mehra said. “They’re not growing to meet population growth, and they’re not able to maintain safe staffing levels. The impact on patients is very clear. It means that there are stretchers in hallways … and inadequate number of services.”Hospital overcrowding
Losing hospital beds in Ontario is particularly troubling for Hamilton, where having more patients than funded beds has been a near-daily occurrence for years.
Ontario Health Coalition executive director Natalie Mehra said hospitals are underserved, overcrowded, understaffed and underfunded.
Metroland file photo
On Dec. 2, HHS had 85 patients receiving care in beds that were not funded by the province — and could be in unconventional spaces like sunrooms, staff rooms, closets and hallways — while St. Joseph’s had 20.
The FAO report, on Oct. 23, estimates the number of hospital beds will go down even further to 203 per 100,000 Ontarians by March 31, 2028, compared to 220 as of March 31, 2025.
Ontario already had the second-lowest number of hospital beds per capita in the country when the rate was at 230 per 100,000 Ontarians in 2022 — the latest interprovincial comparison available.
“The single largest financial pressure facing hospitals today … is actually unfunded beds,” Dale said. “These are beds that hospitals have opened and kept open in order to meet local patient care needs and they’re not being covered, at least historically, by the province directly. That factor has always existed, but we’re seeing significant prevalence of it.”
Fewer long-term-care beds per capita could also be hard on Hamilton’s hospitals, which have so many patients stuck waiting for care in the community that they had to open a satellite health facility in a former hotel to care for them.
There are 180 beds run by HHS and St. Joseph’s Healthcare at the former Crowne Plaza Hotel at 150 King St. E. for patients who can’t be discharged because they are waiting for long-term care, home care, rehabilitation, complex continuing care and mental-health care.
There are so many of these alternate level of care (ALC) patients that the satellite health facility usually can’t come close to taking all of them, so some are stuck at the hospitals.
In fact, the province is spending more than $16 million to build a 57-bed health centre on several unused floors at St. Joseph’s Villa in Dundas to get patients out of Hamilton hospitals while they wait for other types of care.
Nurse shortages
Since the pandemic, local hospitals have also struggled to recruit and retain enough staff to care for all of the patients. Two investigations by The Spectator revealed that some Hamilton nurses were working so much overtime during unprecedented staff shortages from roughly 2021 to 2023 that they made more than double a full-time salary — and that the longest shift was 24 hours straight. In addition, Hamilton hospitals were paying private companies millions of dollars from roughly 2022 to 2024 to provide them with temporary staff. Yet, the FAO report suggests the number of provincially funded nurses will drop to 883 per 100,000 population by March 31, 2028, compared to 936 as of March 31, 2025. For personal support workers, the rate would go down to 719 from 737. “You can’t cut dozens of positions … without affecting services,” Mehra said. “What we see on the ground is hospitals that are woefully underserved, that are overcrowded, understaffed, underfunded.”Health-care cuts
The staff reductions in Hamilton have already begun. The Canadian Union of Public Employees (CUPE) and the Ontario Nurses’ Association (ONA) raised the alarm last year that HHS was cutting jobs to reduce its budget shortfall. The Spectator has repeatedly asked HHS to provide the number of jobs it has eliminated. Instead, the hospital network told The Spectator to file a freedom-of-information request, which is a process that can be lengthy and costly — and doesn’t guarantee any information will be released. In contrast, St. Joseph’s has been transparent about cutting 38 jobs and 24 vacant positions this fiscal year as the hospital network faces a deficit of $25 million on its roughly $800-million budget. The hope is that many of the employees affected will move to other positions that are currently vacant. In addition, other staff are being offered early retirement options. The job losses are part of a cost-cutting plan St. Joseph’s is putting in place to save $9.1 million that its CEO and president says won’t impact the hospital network’s ability to deliver care. Last fiscal year, St. Joseph’s brought a projected deficit of $24.3 million to a surplus of $2.6 million. “Hospitals across Ontario are under pressure,” Heenan said. “I think what makes this year different is the inflationary increases, the collective bargaining wages that have been agreed to centrally in Ontario and the cost of providing care have gone up.” Premier Doug Ford was asked about the job losses at Hamilton hospitals during question period Dec. 2 by Sandy Shaw, MPP for Hamilton West—Ancaster—Dundas. “Hospital job losses hit … patients who are already waiting too long in the ER, waiting for a treatment, waiting for a bed,” said Shaw, who is NDP. “With flu season here, this is a disaster for the people of Hamilton and the staff who work so hard.” Ford said in his response that Ontario spends $91 billion on health care — more than any other province. However, when the numbers are broken down per capita, the FAO report found Ontario had the second-lowest total provincial health sector funding in Canada in 2022. “Call any CEO of any hospital and ask him, is it better now,” Ford said about his time as premier.Hospital funding
Ford’s government has asked all hospitals in Ontario to provide scenarios of how they would balance their books over the next three years if funding went up by two per cent during that time. It’s a significant drop from four per cent annually that hospitals have received for the last three years that still left HHS with annual deficits. “HHS, like many hospitals across Ontario, is actively working to address financial pressures in collaboration with the Ministry of Health,” the hospital network said in a statement. “Our primary goal is to safeguard the core services that our patients and community rely on. To achieve this, we are focusing on reducing non-staff expenses through cost-effective purchasing, freezing discretionary spending, and minimizing administrative vacancies wherever possible.” The minister’s spokesperson, Jackson Jacobs, said the province is modernizing and strengthening the delivery of hospital care. “We need certainty from hospitals that they are able to plan for long-term stability,” Jacobs said. “We continue to work closely with hospital partners — including the OHA, Hamilton Health Sciences and St. Joseph’s Healthcare Hamilton — to ensure all hospitals have the resources and support they need to continue delivering high-quality care to patients.” But the FAO, which provides independent financial and economic analysis to the Legislative Assembly of Ontario, flags in the report that the province spends the least amount per capita on hospitals compared to the other provinces. The Ontario Health Coalition points out that an increasing amount of money is now going to private clinics as Ontario pushes some medical care outside of hospitals to relieve wait times. The Star reported on Dec. 8 that four private clinics — two in Toronto, one in Ottawa and one in Windsor — were the first to be approved for licences to do OHIP-covered hip and knee replacements. The Ford government has already moved more MRIs, CT scans and colonoscopies to private clinics. “They are pouring money into private clinics,” Mehra said. “At the same time, the operational funding for public hospitals is not meeting the rate of inflation and population growth, so they have no choice but to cut.” The FAO says the estimated 0.7 per cent growth in annual health spending is “a significantly slower pace” than the 6.6 per cent average annual growth over the previous three years. For context, it would be the slowest three-year growth rate since the fiscal year that started April 1, 1993. It comes at a time when Ontario’s economy has “very serious challenges on our horizon,” said the OHA, adding that the province’s hospitals are willing to do their part. “We understand really well that the province’s finances are in a real difficult situation,” Dale said. “Hospitals know that they have to lean into this problem and provide leadership and try to implement a reasonable path through all of this.” But hospitals also face their own challenges, including a growing and aging population, the cost of installing and running new information systems and inadequate reimbursement for some procedures that have been paid out at the same rate for over a decade. “We’ve recommended to the government that they consider giving us multiyear notional planning allocations so that hospitals can properly plan for and prioritize their way through this challenging situation,” Dale said. But the Ontario Health Coalition says the government can afford to give more money to hospitals. As an example, the coalition points to the auditor general’s report that found the province’s $2.5-billion Skills Development Fund handed out payments that were “not fair, transparent or accountable,” with low-scoring applications receiving funding. “There is money that is going elsewhere,” Mehra said. “While our public hospitals, which I would say are a priority for people in Ontario, are being cut.”Source link
