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Home » Statement to Ontario’s Standing Committee on Finance and Economic Affairs regarding Bill 180

Statement to Ontario’s Standing Committee on Finance and Economic Affairs regarding Bill 180

[Note: Yesterday, we appeared before the Standing Committee on Finance and Economic Affairs regarding Bill 180. Here is our statement in full. We will add the video and Hansard transcript text once they become available]

Good afternoon,

Thank you for selecting our group, Minden Paper, to appear before the Standing Committee on Finance and Economic Affairs. As volunteers, patients, and residents, we appreciate the chance to provide feedback on Bill 180, Building a Better Ontario Act (Budget Measures), 2024.

My name is Jeff Nicholls. I’m a member of Minden Paper, and our feedback today comes from our year-long, 10,000-hour research, analysis, and advocacy effort on the permanent closure of Minden ER and the financial health of Ontario Hospitals. 

I want to take a moment to acknowledge the incredible work effort of my fellow team members, past and present – with special thanks to Adria, Aurora, Tracy, and Luis.

Our feedback today addresses Schedule 1 of Bill 180, as it sets out the framework for the Building Ontario Fund, formerly known as the Ontario Infrastructure Bank.

I’ll speak to Schedule 1 in the context of healthcare planning and provision with recommendations meant to ensure financial management, governance, and community engagement are embodied in this legislation.

On financial management

After we analyzed the decision-making processes before, during, and after the closure of Minden ER, our team audited the audited financial statements of every hospital in Ontario and released the data publicly.

Focusing on FY22 and FY23, we systematically calculated each hospital’s year-end position and total funding, parsing revenue streams where possible, and included year-over-year comparisons.

  • For FY22, 25% of Ontario hospitals posted a deficit: that’s 33 hospitals.
  • Their average deficit was $545,000, and their total deficit was $17.9 million.
  • For FY23, 75% of Ontario Hospitals posted a deficit: That’s 102 hospitals (a 209% increase)
  • Their average deficit was $5.9 million (a 992% increase), and their total deficit was $610 million (a 3300% increase).

One healthcare system – Mackenzie Health – posted a $93 million surplus, greater than the other 29 hospitals with a surplus combined and 564% higher than the $14 million surplus of second hospital. Mackenzie Health’s surplus could have covered the deficits of 67 hospitals in FY23.

Additionally, Mackenzie Health had a $32 million surplus the previous year and experienced a 24% increase in total funding year-over-year, despite the average increase in total funding for hospitals being around 4%. In FY23, our local healthcare system posted a 4.2 million dollar deficit and permanently closed our local ER amid a -4% year-over-year total funding trend.

The funding allocation inequities suggest disparities and necessitate a review of funding processes to ensure fair distribution and a transparent, data-driven approach to meeting each hospital community’s needs and concerns while maintaining system integrity.

As far as we can tell, five (5) hospitals have publicly stated what they project for year-end FY24 (which was March 31, 2024). Their combined stats are as follows:

  • FY22: 15.5 million dollar surplus
  • FY22: 38.3 million dollar deficit (347% increase)
  • FY24: 145.8 million dollar deficit (280% increase)

The picture we paint herein is not reflected in Ontario’s 2024 budget. Four factors have led Ontario’s healthcare system into financial ruin — yet they are not adequately addressed: 

  1. Chronic year-over-year underfunding (insufficient structural base funding); 
  2. Due to insufficient structural base funding, hospitals became dependent on one-time funding, which has now been removed.
  3. Bill 124 incapacitated hospitals’ ability to recruit & retain staff
  4. Bill 124 led to private nurse agency dependence, forcing hospitals to spend 3x (+) on labour.

Our audit process included printing every financial statement, reviewing every page, every Note, and every Schedule – in many cases, multiple times. Despite extreme variance in financial reporting, team member Tracy Klompmaker determined consistent, comparative groupings based on single-line vs. multiple-line revenue (as a starting point).

Note that:

  • Hospital funding, similar to B124 expense reporting, was not shown consistently on financial statements.
  • Some hospitals showed a single line of revenue from the Ministry of Health at the top of the Income Statement. Some referenced a Note or a Schedule to support what was included in that line item; some did not.
  • Some showed a separate Note on Covid or Pandemic funding with or without reference to that Note on the Income Statement.
  • Some hospitals showed many separate line items of revenue from the Ministry of Health on their income statements, and again, some had, and some did not have Note references.

Our recommendations:

  • Introduce emergency funding provisions in Bill 180 to address our healthcare system’s financial constraints.
  • Develop a funding formula that considers the social and commercial determinants of health relative to each localized region.
  • Establish mandatory financial health assessments for each Hospital in Ontario, led by an external organization instead of the Ministry of Health and/or each healthcare board.
  • Mandate public reporting with committee-established, dedicated Key Performance Indicators (KPIs) and/or OKRs (Objectives and Key Results) for all hospitals receiving provincial funding.

On governance

We audited our local healthcare system’s board minutes, bylaws, MSAAs, HSAAs and other relevant documents. We also documented, ranked, and categorized over 320 editions of the local newspaper “The Highlander.” We then examined a considerable number of other healthcare systems’ board meeting minutes and found that:

  • There is a significant lack of consistency in how each healthcare board conducts, records, and reports on their board meetings.
  • 42% of healthcare boards don’t post their minutes online
  • Most board minutes are extremely out-of-date.

Our recommendations:

  • Implement universal standards for transparency and accountability that all healthcare boards must meet. We’re concerned that ONCA, ECFAA, the Canada Hospital Act and other critical legislation are not being followed or enforced – they exist for a reason. 
  • Introduce rigorous oversight mechanisms within Bill 180 that require boards to report information in a timely, relevant manner.
  • Mandate specific qualifications and training for board members to ensure they are adequately prepared to oversee complex healthcare environments. This training should include elements of financial management, ethical decision-making, and patient-care quality standards.

The Ministry should regularly review healthcare institutions’ governance practices to ensure adherence to these standards. This should include establishing clear compliance checkpoints, conducting regular external audits, and publishing audit outcomes to ensure all stakeholders are informed and engaged in healthcare institutions’ governance.

On community engagement

Our findings highlight a communication gap between healthcare systems, the provincial government, and the communities they serve. The permanent closure of Minden ER —conducted without consulting Doctors, Nurses, EMS, patients or the public — illustrates a systemic disregard for community input in healthcare decisions.

The closure of Minden ER serves as a microcosm for the challenges and threats facing every hospital in Ontario, save a few, along with public healthcare at large.

Our recommendations

  • Move away from large, ambiguous funding announcements and towards clear, detailed communication that reaches and involves community members directly. This will help with accountability.
  • Mandate mechanisms for regular community feedback and involvement in healthcare planning and provision. The process must reflect the demographic and socio-economic composition of the areas served.
  • Enhance the visibility of how community feedback influences decisions. Detailed reports should be published following any major decision, outlining the rationale and community input.
  • Implement initiatives to educate the public on healthcare planning and provision, including financial management and governance, to foster a well-informed community that can advocate effectively for its needs.

These steps are essential to rebuilding trust. They represent realistic, actionable steps that can be embedded within the framework of Bill 180, fostering an effective, representative, and accountable healthcare system for the people it serves.

Conclusion

Thank you for the opportunity to share our findings and recommendations. We look forward to seeing these critical issues addressed in the final version of the bill.