How To Fix The Staffing Crisis In Manitoba’s Health-Care System

On July 18, the Manitoba Government and General Employees’ Union (MGEU) released a shocking report detailing the staffing crisis across the province’s health care system. “From Crisis to Stability: Fixing the Staffing Crisis in Manitoba’s Health Care System” is as thorough as it is damning. As the report makes clear, years of fiscal austerity have pushed the system and the people who staff it to the breaking point, and only a co-ordinated plan to restore funding that puts workers first can right the ship.

The MGEU represents 7,700 health-care union members working in Prairie Mountain Health, Southern Health-Sante Sud and the Interlake-Eastern Regional Health Authority in Manitoba. These frontline workers are health-care aides, custodial and maintenance workers, staffing clerks, dietitians, respiratory therapists, speech language pathologists, and many others. As the union notes, “These members are the backbone of our healthcare system,” though their work is frequently overlooked and undervalued.

The issues outlined in the report are all the more urgent as health-care workers represented by the MGEU appear poised to reject the latest inadequate contract offer from the Prairie Mountain Health (PMH) and Interlake-Eastern (IERHA) regional health authorities.

The report makes a strong case that Manitoba’s health-care crisis stems in large part from the austerity imposed by the previous Progressive Conservative (PC) governments of Brian Pallister and Heather Stefanson. Beginning in 2016, the PCs undertook a mission to “bend the cost curve” of health care and introduced a series of “sweeping cuts,” as the MGEU describes them. The results were shuttered emergency rooms, service reductions and widespread restructuring, the consequences of which have been borne largely by frontline workers.

On a per capita basis, health-care expenditures in Manitoba fell 3.5 per cent between 2015 and 2019, during the previous PC government’s austerity budgets. Among these cost savings were “health workforce” reductions worth $34 million in 2017/18 and $36 million in 2018/19, cuts made on the recommendation of consultancy firm KPMG, who the government retained to advise its health-care “restructuring plan.”

In all, regional health authorities were compelled to rationalize services and staffing and restrict spending by tens of millions of dollars in the years leading up to the pandemic. The COVID-19 public health crisis then stretched the already thinned system to capacity, as overburdened staff managing debilitated services led to a mass exodus between 2020 and 2023.

On top of the cuts to health-care services, Bill 28, the government’s wage restraint legislation, caused further damage as salaries stagnated and frustrated workers began to leave for more promising job prospects elsewhere. As the MGEU characterizes it, “The legislation was a direct assault on the rights of workers to bargain with their employer collectively and in good faith, while also sending a strong message to public sector workers that they were in the government’s crosshairs.”

Subsequent legislation, the Health Sector Bargaining Unit Review Act, forcefully consolidated health-care union bargaining units, introducing years-long delays in negotiations, which the MGEU and other unions understood as a direct assault on workers and unions in the sector.

MGEU’s report does not mince words. Assessing the consequences of spending restraint on the health care system, it concludes: “The result is a system in chaos, with health care workers struggling to maintain a high standard of patient and client care in a very challenging environment, amid growing demands from an aging population and increasingly complex medical conditions. Health Care Aides and the Home Care Program have over 700 vacant positions that remain unfilled. The staffing crisis is leading to burnout and dissatisfaction among health care providers and threatening quality of care.”

Much like the health-care staffing crisis across the country, Manitoba’s is therefore the direct result of stagnant wages, deteriorating working conditions and a failure to recruit and retain skilled workers. Burned out by stressful work with inadequate pay, current health-care workers are simply leaving the profession and new workers aren’t taking their place.

To temporarily solve the personnel crisis, the government of Manitoba and its regional health authorities have turned to costly private staffing agencies. According to the union, in some cases nearly half of this money is spent on travel expenses rather than direct patient care. Yet paying large premiums for temporary workers is failing to address the root causes of the staffing crisis and in many ways making matters worse.

Temporary agency workers lack the site- and client-specific knowledge of full-time, permanent staff and can at times undermine the quality of care, the union warns in its report. In addition, relying on for-profit staffing agencies introduces perverse incentives into the health care system and may encourage staffing agencies to take advantage of lax regulation and staff-desperate health-care employers. Most importantly, drawing funds away from the hiring and retention of permanent workers to temporarily fill gaps is counterproductive.

In recent contract negotiations with nurses, agency staffing was a contentious issue. Although the Manitoba Nurses Union was able to secure modestly improved base wages, the government largely relied on various forms of incentive pay in an effort to attract more full-time nurses. The contract was narrowly ratified in most regions, but was initially voted down at Shared Health before an improved package was ratified in early July.

The staffing crisis is exemplified by often startlingly high job vacancy rates across a range of health-care positions represented by the MGEU. The vacancy rate for Health Care Aides at Prairie Mountain Health, for example, stands at 30.74 per cent. To put this in perspective, in May, the job vacancy rate across the entire Manitoba economy was 3.2 per cent, with health care and social assistance sitting at 4.8 per cent nationwide.

Similarly, in Manitoba’s Home Care Program, which allows many clients to stay in their own homes longer while receiving publicly provided care, short staffing is a persistent issue. Across regional health authorities job vacancies remain elevated. Staffing vacancies at this level translate into patients receiving far less care and time with staff than they require.

Understaffing is also leading to unsafe workplaces. Health care is now the most dangerous sector in Manitoba, according to the provincial Workers Compensation Board. Based on reported physical and psychological injuries alone, health-care workers face more harms than workers in any other industry. Six in 10 health-care workers have been injured on the job at least once and four in 10 have taken at least a week off because of a work-related mental or physical injury.

The structural problems imposed on the health care system by fiscally austere governments is compounded by the growing health needs of an aging population. Health care and home care needs are set to grow along with the population’s average age. An aging population also means an aging workforce, which the MGEU notes is especially true in the broad health-care sector. Without a long-term staffing plan that centres on attracting and retaining qualified and younger staff, retirements will only exacerbate the snowballing staffing crisis.

According to MGEU, in northern and rural areas of the province, offered wage rates for new positions such as bank tellers and cashiers are often higher than those for the most urgently needed health-care workers. To address the staffing crisis in competitive local labour markets, this has to change. Only adequate living wages will attract the necessary staff.

As the report aptly summarizes: “Years of underfunding left our public health care system vulnerable to the dangerous impacts of the COVID-19 pandemic. The pre-pandemic staffing problems were magnified and deepened after 2020, leading to gaps in service quality, which were compounded as more staffing resources were outsourced to for-profit staffing agencies during the pandemic.”

The MGEU’s report recommends a mix of short- and long-term solutions to address the staffing crisis and invest in quality public health care.

First, the union advises the province to develop a comprehensive health-care labour force retention strategy, which encompasses all members of the health-care workforce. This would involve improving wages and working conditions and making health care a more appealing career, particularly in rural communities.

Supplying the funds to attract and retain staff necessitates ending the current reliance on for-profit staffing agencies, which are draining public revenues and failing to fix the underlying problem.

Next, the union recommends increasing training opportunities and tuition rebates, particularly for high-vacancy positions. As well, there is a need to expand the number of full-time positions.

Echoing a growing demand across jurisdictions, the MGEU calls on the government to implement staff-to-patient ratios to align with the provincial goal of 4.1 hours of care per day for residents in personal care homes.

The union is also seeking improved health and safety on the job through prevention programs that meet the standards set out by SAFE Work Manitoba. Improving staffing levels in itself would go a long way toward improving overall health and safety.

As well, the MGEU calls on both the federal and provincial government to forge a funding model that meets the needs of patients and the broader public. In the Manitoba government’s case, this must involve ending wasteful tax cuts that the previous government handed out to the richest in the province. Along with ending system-wide restructuring that contributed to the staffing crisis in the first place, adequate and sustained resourcing can help fully fund and staff Manitoba’s health care system.

As the report concludes, “By prioritizing and supporting the health care workforce, the Manitoba Government and health care employers can ensure that all patients, residents, and clients have access to the high-quality and reliable health care services they deserve.”

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