October 3rd will mark Manitoba’s first provincial election since the COVID pandemic and health care is the leading central campaign issue. In the annual Manitoba Budget survey, health care was the top priority, with tax cuts the lowest priority.
“Vote like your life depends on it” signs have been up throughout the province since the early summer, however the Manitoba Nurses Union, alongside other health care unions, have been warning Manitobans of the dire conditions in the health system for years. Among the primary sources of frustration amongst health care workers is “Manitoba’s Health System Transformation”, launched in 2017 to bolster health system coordination and decrease costs. Implementation of the health system transformation resulted in the closure of emergency rooms, the privatization of Manitoba’s air ambulance service, the cancellation of health care capital spending, and the deletion of hundreds of nursing positions, ultimately leaving health workers demoralized and with reduced bed capacity prior to the COVID pandemic.
The NDP has led the opening weeks of the provincial election campaign with health care funding announcements, and the PCs have followed with their own during weeks two and three. This analysis maps out what the two leading parties have pledged on health care, and what difference it will make in improving the system. To read more about the Manitoba Liberal health commitments, please visit their platform here.
Funding
In July, CCPA Manitoba published a “Made in Manitoba Crisis”, which found Manitoba’s inflation-adjusted, per-capita health care funding has fallen well below the Canadian average since 2017. In 2022, Manitoba had the third lowest per capita rate of spending in the country at $8,414 per person, compared to the Canadian average of $8,563 according to the Canadian Institute of Health Research. This was a marked decline from 2016, when Manitoba’s inflation-adjusted, per capita spending was in the top four among Canadian provinces.
The crisis in health care was one of the Manitoba government’s own making, starting with a wage freeze on all public sector workers. This means that health workers on the front lines of the pandemic were working with frozen wages. Some professionals received bonus pay, however, these bonuses were selective and not widespread. Many health care staff were working without new contracts throughout the pandemic, with bargaining effectively frozen. Manitoba nurses, for example, settled a new contract in 2021 with an 8 per cent wage increase spread between 2018-2023. CUPE 204 members negotiated a new contract in 2022, which included a 9.4 per cent wage increase from 2017-2023. The Manitoba Association of Allied Health Care Professionals settled at 8.35 per cent for the majority of their members. However the cost of living rose higher than these wage gains. The Consumer Price Index between January 1, 2017 and July 2023 for Manitoba increased by 29.7 per cent (MB Bureau Statistics). The Manitoba government saved money on wages for public sector workers over this time period, money that was used to pay for regressive income tax cuts, business tax cuts, and cutting the PST. These new collective agreements expire in 2024 and require a new round of bargaining with the provincial government at this time.
The new federal health funding and increases in equalization payments are bringing in more money for Manitoba, much of which had been earmarked by the federal government to revitalize provincial health care, but has not made its way into the health system. Over the past 10 years, equalization and health and social transfers to Manitoba have increased from $2,627 in 2014/15 per Manitoban to $4,135 in 2023/24. This is due to booms in the oil and gas markets of “have” provinces that are channeled via the equalization formula to “have not” provinces like Manitoba and to the new federal provincial health care deal. Although increases to health spending were announced in Budgets 2022 and 2023, these have not been commensurate with federal transfer increases. Instead, in this election, PCs have doubled-down and announced huge tax cuts with increases in federal transfers masking the true impact of lost revenue.
During this provincial election the PCs have doubled down on their tax cut agenda, with the cost of proposed income and corporate tax cuts estimated to be over $1 billion by 2027, on top of the $1.6 billion already cut during their term in office. This election, the NDP is going along with the PC fiscal plan announced in Budget 2023, which included large tax cuts, but has not followed down the path of further income or corporate tax cut proposals.
With the NDP agreeing to follow the Budget passed in Spring 2023, they will be limited to available provincial revenue to meet their election promises. The NDP have identified $200 million in the contingency fund and $500 million unallocated in the Manitoba Budget; this is the source of revenue they are using to pay for their election commitments related to health and other portfolios.
Given the large amount of equalization, health and social transfers, there is federal money available to make transformative investments in health care, but Budget 2023/24 regressive tax cuts mean a great deal of this is actually going out the door again.
The NDP led their provincial election campaign with health care announcements to boost the public health care system, committing to reopen four ERs (Victoria, Concordia, Seven Oaks and Eriksdale) with new capital and staff funding. They committed to restore the cardiac care program at St. Boniface, including improving surgical access and wait times, with a focus on prevention. The NDP would turn Concordia Hospital into a Centre of Excellence for complex joint surgeries and pledged more hip and knee surgeries (CBC). The Manitoba government had announced a new fifth operating room at Concordia last June. The NDP would increase surgical capacity at the Grace Hospital, and add 12 beds to reduce wait times. The Manitoba government also announced 20 more beds for the Grace hospital last April, an effort to reverse previous cuts to ICU beds. The NDP criticized the government for cutting 14 percent of the ICU beds in Winnipeg prior to the pandemic. Demand for ICU beds continues to be high (Winnipeg Sun).
Privatization
While in government, the PCs increased reliance on private agencies to deliver health care services and supply health care staff. As a result, health care workers frustrated with the conditions of work in the public sector are attracted to the private sector. The Winnipeg Free Press reported that the province spent $60 million on contracted out agency nurses in the 2022-23 fiscal year.
During the pandemic, the province began relying on privately owned facilities to provide publicly funded care: Maples Surgical Centre, Western Surgical Centre, Winnipeg Clinic and Manitoba Clinic. Patients are being shipped out of province to the U.S. for surgeries as well. For now, these are offered at no cost to Manitobans, but critics have said this is the “thin edge of the wedge” toward two-tired, private health care in Manitoba.
The province created a “Surgical and Diagnostic Task Force” in 2021 to deal with backlogs in areas like hip, knee and cataract surgeries made worse during the pandemic. The task force was criticized for becoming another layer of bureaucracy and for not dealing with the backlogs as wait times actually got longer after the Task Force was created (WFP). The task force has accelerated privatization in Manitoba. The Winnipeg Free Press found it spent $24 million on out-of-province surgeries, 18 per cent of its budget, for only 0.01 per cent of all surgeries performed in Manitoba. The Manitoba Health Coalition has consistently criticized this approach and called for a stronger investment in Manitoba’s public system to address the surgical backlog.
This election, the PCs have pledged $10 million to privately owned, First-Nations-operated Quest Health toward the construction of a 12-week, 180-bed addictions treatment and recovery centre (CBC).
The NDP pledged financial support to establish five neighbourhood-based “team-based” medical centres owned and operated by doctors and connected with emergency rooms in an effort to reduce wait times at ERs and attract more ER doctors (CBC). The party also announced $25 million for doctors to add other health professionals to their clinics. Previously while in government, the NDP had backed access centres, publicly owned and operated health and social service centres with doctors on salary (Global, 2019). The physician model, whereby providers are paid per service rather than on salary, is widely used in the Canadian health system, but it is critiqued for incentivizing high volumes compared to publicly owned community health centres (CBC and CBC). The team-based care model proposed by the NDP this election is advanced by Doctors Manitoba and the Canadian Medical Association.
Given the massive pressures on the health care system, it is clear that Manitoba must do more to increase access to health care. Expanding capacity and funding for the public system, and reducing pressures on the health care system by opening more long-term care beds, must be the priority for the new provincial government.
Staffing
The Association of Regulated Nurses of Manitoba called out a provincewide nurse vacancy rate of 21.4 per cent this year (WFP). The NDP promised $500 million in new dollars over five years dedicated to health care funding; hiring 300 nurses in two years in Winnipeg, and an equivalent commitment for hiring northern and rural Manitoba nurses within the first term in government. The NDP is promising 400 physicians in five years, more rural Manitoba paramedics and home care staff (CBC). The NDP also pledged to accelerate newcomer credentialing for internationally educated health care professionals.
While in government, the PCs pledged to add 2,000 health care workers, a plan critiqued for not identifying where the workers will be attracted from, for not including allied health care workers, such as paramedics and health care aids and for not including targets and timelines. During the election, the PCs have promised to spend more on health care recruitment ($30 million per year) (WFP).
Notably, neither party has talked about expanding the scope of practice for nurse practitioners, an evidence-based practice that can take pressure off the health care system. The PCs did announce they would increase the scope of care for pharmacists, and the NDP responded that they would look into this as well (WFP).
The PC government’s treatment of health care workers with the wage freeze, health transformation, and cuts to public health care resulted in health professionals leaving the public system for retirement, career changes or to the private system. The new provincial government will need a strong, comprehensive approach to train, attract and retain health care workers of all types in Manitoba.
Women
Notably the only party to include health-related announcements for women is the NDP. They have pledged to reopen the mature women’s centre at the Victoria Hospital, which was closed by the Manitoba government in 2017 (WFP). This centre would provide services like menopause transition, hysterectomy alternatives and other gynecological services. In March, the NDP pledged universal free coverage for prescription birth control (CBC).
The NDP also announced funding for the equivalent of seven full-time forensic nurses in Manitoba and the creation of a sexual assault strategy (CBC). The NDP also announced they would offer birthing services in northern Manitoba, in Pimicikamak Cree Nation and Norway House. In 2018, the Manitoba government closed down obstetrics care in Flin Flon, and then in The Pas in 2021 due to a shortage of nurses and no new nurses were recruited. The NDP has not announced a restoration of these services.
With anti-abortion legislation in North Dakota, more American women are seeking abortions in Manitoba. Access to abortion is limited, with procedures currently only available in Winnipeg and Brandon. The Women’s Health Clinic requires additional funding to meet current demand as they turn away 500 women per year for abortions. No party has pledged to increase access to abortion, or to compensate travel and associated costs for women seeking access from rural and northern communities.
Home care
The NDP commits to hire 100 home care workers and would commit $5 million towards mileage increases and hiring incentives for those workers (Global). The provincial 2016 Future of Home Care Services report recommended hiring 80-100 new home care workers annually to respond to the demand for services. As few new workers have been added since 2016, CCPA Manitoba research recommends hiring 800 more health care aids and home support workers to reduce wait times and ensure quality care to deal with current demand, at a cost of $52.8 million (Harney, 2023). The NDP has pledged to increase the mileage rate for home care workers. CCPA MB recommended providing a fleet of vehicles for home care workers to aid in recruitment and absorb the cost of travel to provide home care services.
The PCs have yet to make any announcements related to home care.
Long-term Care
Back in 2016, the Manitoba government promised to build 1,200 new personal care home beds, however, the total number of beds had fallen by 200 by 2022. This includes the 260 bed Parkview Place that was closed down during the pandemic. The tragic deaths of residents during the early phases of the COVID pandemic, particularly in privately run facilities, spurred calls for the province to make these facilities public. In Saskatchewan, the government bought out Extendicare and transitioned 1,300 private long-term care spaces over to the public system in 2022. Currently in Manitoba, CUPE 204 workers at nine privately owned Extendicare personal care homes voted 99 per cent in favour of a strike. Extendicare has profited $84 million dollars since the pandemic while starving workers wages and under-staffing facilities. It is time for Mantitoa to follow Saskatchewan’s lead and end privately-run long-term care in Manitoba.
In Manitoba, there are at least 200 people on the wait list for personal care home beds in Winnipeg and a shortage of beds means they wait in hospitals. Advocates have called for an increase in the per bed funding from $133,000 to $200,000 for new construction. The Manitoba government had once announced it would build 670 beds at six new facilities (Arburg, Lac du Bonnet, Oakbank, Stonewall, Winnipeg (Bridgwater and Portage Ave) and committed funding for the planning phase. The PCs have touted the “Niverville model” of privately run long-term care expansion.
The Manitoba NDP have yet to make an announcement on long-term care.
Mental health and harm reduction
In addition to the privately run Quest addictions centre, the PCs have pledged to build 1,600 new addictions treatment spaces over two years, with $8.7 million public dollars. This is at a rate of $5,437.50 per bed and will require private sector financing as the construction cost per bed is in excess of $32,000 per bed. The PCs’ election pledge assumes private market donations to make up the funding gap for the ambitious proposal. It did not include any provincial funding for operations of the promised beds, therefore, they would be fee-for-service for those who can afford treatment, leaving those without resources unable to access the provincially funded beds.
While in government, the PCs introduced Bill 33, the Addictions Services Act, requiring provincial licensing of addictions services. Community organizations like Sunshine House spoke out against the bill as they argued it would be used to shutter the organization’s mobile drug overdose prevention site (MHC). The NDP delayed the bill, as part of the five bills they can delay each house sitting (WFP).
The NDP has supported harm reduction approaches and the creation of at least one supervised consumption site (CTV).
The Manitoba government’s own Virgo Report calls for a harm-reduction approach to problematic substance use. The Manitoba government has dragged its heels on this as the poisoned drug supply grows and the number of people dying from overdoses has doubled in just the past two years. Clearly, more is needed in order to stop the poisoned drug supply and help those most vulnerable to problematic substance use, including supervised consumption sites, as part of a continuum of care. This oped, “Time for Treatment” by Thomas Linner at the Manitoba Health Coalition, calls on voters to look at where parties stand on supervised consumption sites this election.
Social Determinants of Health
Social conditions influence health outcomes. Reducing inequities provides people to have the best chance for health and well-being. This is also a central tenant of the Canada Health Act, which is “to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers”. But too often Manitoba’s poverty reduction initiatives and provincial healthcare systems fail to work in tandem, leading to disproportionate and negative health outcomes for low income Manitobans. Properly addressing socioeconomic status as a social determinant of health is not only necessary to usher in a Manitoba without poverty, but by eliminating the burden of systemic inequality on the provincial healthcare system, it is also cost effective.
Poverty and income inequality are a major driving cost for health systems. Winnipeg-based studies estimate that 15 per cent of total health care expenditures could have been avoided if all Winnipegers experienced health outcomes comparable to the top 20 per cent of income earners in the city (Roos et al., 2004).
Make Poverty History Manitoba’s 10 Demands for Action outline evidence-based measures to improve health and well-being while saving the health system money.
Most obvious is to institute 10 paid sick days per year. This past year, the federal government instituted this in federally regulated industries. The NDP did speak in favour of 10 paid sick days during the COVID pandemic in 2021.
Increased income through increasing the minimum wage to a living wage is needed to ensure workers have enough money to buy essentials like healthy food. Back in 2019, NDP Leader Wab Kinew announced the NDP would increase the Manitoba minimum wage to $15 an hour. At the time, the minimum wage was $11.35 per hour. Since then, COVID and inflation have eroded workers’ wages. The Manitoba minimum wage is currently $14.15 per hour and, while in government, PCs announced the minimum wage would be raised to $15.30 on October 1st. However, the living wage, based on the actual cost of goods, increased to $18.34 per hour in 2022. CCPA Manitoba will be releasing the 2023 living wage this November. There have been no new promises on the minimum wage this provincial election.
Food bank use in Manitoba has doubled since 2019 and most of those users are on social assistance. The 70,000 Manitobans on Employment and Income Assistance receive only $4 per day for food. The Winnipeg Regional Health Authority says that a nutritious food basket in Manitoba actually costs $12-$17 per day. The Bare Necessities Campaign highlighted this massive discrepancy and the health impacts on Saturday September 23rd in front of the Canadian Museum for Human Rights. Make Poverty History Manitoba has called for a Basic Needs Benefit that increases the amount those on assistance receive to the poverty line and follows them if they gain work, breaking down the welfare wall. To date, neither the PCs or the NDP have pledged to improve or reform EIA.
The Right to Housing Coalition has released a comprehensive community housing plan with five pillars to improve access to rent-geared-to-income housing in Manitoba. Adequate housing is necessary for good health. The NDP has promised to end visible homelessness in Manitoba, more is needed to move upstream from the problems of homelessness using a public, comprehensive, community-based approach. It pledged to start with children and pregnant mothers as a way to prevent sexually transmitted diseases in newborns.
The NDP has promised to do more to support children by doubling the prenatal benefit to help increase birth weights, to ensure working smoke detectors in every home, including on reserves, and to ask Manitoba Public Insurance to work on keeping children from being injured in ATV accidents (Winnipeg Sun). The NDP has also pledged to support a universal child nutrition program in 690 schools by the end of 2023/24 (CBC). However, children are hungry on the weekends and holidays as well. Much more is needed to move the needle on child and family poverty—starting with improved income transfers and social housing.
The PC party has pledged to support “parental rights” this Manitoba election, but it does not commit to details unless they form government, when they would do a consultation to “update” related laws and programs (CBC). This has been critiqued as a tactic to bring in right-wing extremist rhetoric to Manitoba and distract from important issues at hand, like funding for public education.
In Conclusion
Manitobans will need to assess the promises made by the two leading provincial parties as they go to the polls. Given the track record of the Manitoba government’s response to COVID, cuts and health care privatization, and their massive tax cut promises, Manitobans could expect even longer wait times and a further development of a two-tired private health system. The NDP is promising to boost the current public system, however, it will be hamstrung by their fiscal commitments to Budget 2023/24. Both parties are relying on continued high federal equalization payments, which could shrink dramatically with a change in government in Ottawa. We must remain vigilant to ensure all Manitobans have access to quality public health care promised under the Canada Health Act.