By Emily Gruenwoldt

What has historically set child and youth healthcare apart from the adult sector is the ability to come together as a national collective to identify common system challenges and codesign solutions to implement in unique environments. There has never been a time where this community spirit was needed more.

Canadian healthcare systems are in crisis, and this includes systems that serve children, youth, and families. If the diagnosis is overstretched, underfunded systems serving children and youth, the symptoms include challenges accessing primary care, long waits for community-based children’s rehabilitation services, emergency services, surgical interventions and diagnostics, an understaffed and burnt-out workforce, government apathy and public belief that “the kids are alright.”

While the pandemic very publicly highlighted how fragile children’s healthcare systems are, the truth is Canada’s kids have been a low priority for decision-makers for years. In 2020, UNICEF Canada reported that Canada now ranks 30th out of 38 OECD countries regarding children’s health and well-being outcomes – an alarming standing that should be of great concern to elected officials at every level of government, parents, and youth alike. While organizations like Children’s Healthcare Canada have been ringing alarm bells for years, very little action has transpired to change the course of children’s health outcomes.

The current situation: Children’s Healthcare Systems Stretched Thin

Canada is home to 16 tertiary/quaternary children’s hospitals, many of whom are seeing a sustained surge in referrals for specialized care, visits to emergency departments (ED) and associated admissions. There is both a lack of inpatient beds and healthcare professionals available to facilitate care – further exacerbating already lengthy ED wait times. Some centres are reporting that children are waiting between 24-48 hours before such a bed is available – waits described as unprecedented in children’s healthcare in Canada. Very recently, a children’s hospital in Quebec closed their emergency department to non-urgent care based on high volumes of patients requiring hospitalization or critical care. Long delays result in sub-optimal care and outcomes for sick children and their families and create moral distress for children’s healthcare providers unable to deliver care in a timely fashion.

In addition to ED delays, some children in Canada are waiting longer for essential healthcare services than adults. In Spring 2022, Children’s Health Coalition in Ontario reported that at CHEO, in Ottawa, children wait three times longer for an MRI than do adults (18+). At Sick Kids, in Toronto, 61% of children are waiting longer than is recommended for surgeries, affecting the time they may wait in severe pain, and resulting in developmental and other health impacts that may last a lifetime. For some children, this could mean lifelong disability, being dependent on technology to survive, or experiencing chronic pain into adulthood – all untenable outcomes with long-term health and economic impacts.

More publicly reported, children and youth in Canada are waiting far too long for mental health services in community and hospital settings – in some instances, wait lists are as long as eighteen months for community based mental health services. According to UNICEF Canada Report Card 16, suicide was a leading cause of death among young people in Canada and one of the indicators in which Canada ranked most poorly prior to the pandemic. Since COVID hit, Canada’s children’s hospitals and regional community hospitals have experienced a sustained increase in mental health related visits, referrals, and admissions for children and youth. It has been reported that across 13 children’s hospitals, admissions for eating disorders have nearly tripled, visits for depressional anxiety (especially among equity deserving populations and children with disabilities) nearly doubled.

Beyond the children’s hospitals, many of Canada’s regional community hospitals serve children and their families through emergency departments, neonatal intensive care units, pediatric in-patient units, and outpatient services. To meet the needs of the sick adult population throughout COVID, many of these hospitals made significant changes, which included closing pediatric departments or redeploying specialised pediatric healthcare professionals. For some community hospitals, these wards remain closed (or significantly downsized), and staff have yet to be repatriated, resulting in reduced access to local, specialized healthcare services for children and families.

Children’s homecare and respite care providers across the country are experiencing similar staffing challenges as their acute care colleagues, as the result of the pandemic. A shortage of specialized nurses and personal support workers to care for kids impacts families of children with medical complexity who require support at home, including respite, rendering parents and caregivers equally exhausted.

Routine healthcare for children has also been disrupted. The pandemic contributed to decreases in primary care access for children under 17 (Saunders et al., 2021 – CMAJ), but even prior, Statistics Canada estimated that 15% of Canadian youth did not have a primary care provider. Primary care is a cornerstone for healthy growth and development for millions of Canadian children delivering programs and services such as well-baby care, the delivery of routine childhood vaccinations, and assessments and referrals to services for child development assessments, diagnosis, and rehabilitation.

Canada’s 8 million children might be small in stature, but the challenges facing children’s healthcare systems are daunting, and the stakes are high. The path forward is complex, and there is no single solution or magic bullet that will “cure” decades of underfunding. Pressures in one part of the children’s healthcare system inevitably create ripples across the broader system. Long-term thinking and planning, sustained investments across the continuum of care, and an openness to new collaborations – across sectors, across all levels and portfolios within government (including across jurisdictions), with patients and their families, and across civil-service organizations is required.

In 2020, over 1,500 youth, parents, researchers, educators, advocates, policymakers, service providers, community and business leaders, and others came together to co-create a roadmap to measurably improve children’s health and wellbeing, called Inspiring Healthy Futures. Five interlinked priorities for action lay a foundation for leaders, organizations, and governments to create a healthier, stronger future for children, youth, and families in Canada. The path forward is clear, now is the time to put the plan into action.

Emily Gruenwoldt is President & CEO, Children’s Healthcare Canada.