Recent changes to procurement and delivery systems by two provincial agencies are to blame for an ongoing home-care medical supply shortage in Ontario, sources tell the Star, as patients and their caregivers continue to report they can’t get supplies when they need them.
The current shortage stems from three problems introduced when Ontario Health and Ontario Health atHome changed the way supplies reach thousands of patients receiving care at home, according to industry insiders who have knowledge of the home-care medical supplies system but who are not authorized to speak publicly.
The first, they say, is that the list of medical supplies and medications needed for home care wasn’t finalized until just before the new procurement and distribution system launched in September, which didn’t provide enough time to secure inventory before the launch.
The second is that the forecasts for quantities of supplies set by the provincial agencies were too low to meet demand.
The third is that a consolidation of supply companies resulted in fewer suppliers being responsible for larger geographic areas, which contributed to logistical and delivery delays.
The sources say that both Ontario Health, which oversees health-care delivery in the province, and Ontario Health atHome, which co-ordinates in-home and community-based care, were warned by medical supply and distribution companies that expectations in the new procurement and fulfilment contracts weren’t realistic.
“After years of struggling through the pandemic with supply issues, these provincial agencies were warned about the fragility of medical supply chains and the need to really plan this out and build in buffers and contingencies. This process provided neither of those things,” said one industry insider involved with procurement.
Since the new contracts came into effect on Sept. 24, home-care nurses and their patients have reported widespread shortages of everything from bandages, syringes and saline solution, to IV lines, antibiotics and catheters.
Doctors who offer palliative care to patients at home also say they can’t access crucial supplies, such as pain pumps, drainage bags and pain-relief medications. Some patients and their families report being told to go to their local emergency departments to ask for supplies when deliveries failed to show up.
Ontario Health atHome told the Star it launched new contracts for medical equipment and supplies because the previous contracts were expiring. This provided an opportunity, the agency said, “to provide better access to standardized high-quality products across the province.”
“We want to assure patients, their families, and health system partners that we are doing everything we can to address this situation and are continuing to look for opportunities to stabilize the delivery of these critical medical items to get patients they supplies they need on time, and as ordered,” Ontario Health atHome said in an emailed statement.
Ontario Health, which sources say issued requests-for-bids to supply vendors, did not respond to a request for comment.
A key reason for the delays, sources say, is that the ‘provincial formulary’ — a list of medical supplies and medications needed for home-care patients and their caregivers — wasn’t finalized until sometime in July, with some changes being made as late as early September, just before the new contracts launched.
This meant the companies responsible for going to market to find and purchase the anticipated supplies simply didn’t have enough time to get what was needed by the end of that month.
“The formulary just came out late,” said one source, adding that when vendors advised Ontario Health that the timeline was too tight, “there was sort of a sense of ‘that’s your problem.’ We’re going live on Sept. 24, come hell or high water.”
Ontario Health atHome said the formulary was first shared with vendors and suppliers as part of the request-for-bids process and that these industry players continued to participate in the evolution of the formulary until July 26. The agency did not address questions about changes to the formulary being made up to the first week of September.
The agency added that it is meeting with vendors, suppliers and service providers to address concerns and refine the formulary to ensure patients have supplies and equipment.
Another issue was that the quantities of supplies on the formulary were much lower than in the past and not nearly enough to service all of Ontario’s home-care patients.
The previous formulary contained some 2,000 items, many of which were duplicates to ensure supply would not be disrupted if a manufacturer went down or supply chains were disrupted, according to sources. But the new formulary had only around 700 items, meaning there was no redundancy built in.
“The idea was that you would have multiples of the same kind of product so you could have variation or so that you’re not beholden to just one manufacturer. That was eliminated,” said one industry insider.
Another source said the agencies “just didn’t have an appreciation of the time it takes” for supply chains to ramp up.
“Combined with perhaps a certain amount of arrogance, basically means they didn’t do their due diligence properly.”
The third factor, sources say, is the change in both the number of suppliers and the geographic regions they became responsible for.
Under previous contracts, local businesses, such as pharmacies and smaller medical supply companies, serviced areas that roughly lined up with the province’s 14 former Local Health Integration Networks (LHINs). The new structure now has two master service providers, Cardinal Health and Ontario Medical Supply (OMS), that procure supplies on the open market, with four companies — OMS, Bayshore Specialty Rx, Shoppers Drug Mart and Robinsons — responsible for distribution to patients.
While fewer suppliers may seem like less bureaucracy, one source said that the handful of companies that won the new contracts are now responsible for much larger geographic areas.
“To get product to patients in a short time period, you need companies that are quite close to the population bases,” the source said. If companies don’t have multiple locations, the source added, delivering supplies the same day — or four hours in emergencies — becomes difficult and contributes to delays.
The crisis has sparked calls for an auditor general investigation, while Ontario Health atHome is promising to reimburse patients and their caregivers forced to pay out of pocket for supplies due to delivery problems.
“The situation is unacceptable,” said Hannah Jensen, a spokesperson for Health Minister Sylvia Jones. “We expect everyone who needs the home delivery of medical supplies to care, for themselves or their loved ones, to receive those supplies on time and as ordered.”
Jensen said Jones has directed the chair and CEO of Ontario Health atHome to “utilize whatever means and resources necessary to resolve this situation as quickly as possible.”
The medical equipment shortages and delays are still being felt acutely by a North York resident named Kathy, who looks after her 96-year-old father. The Star is not publishing Kathy’s surname to protect the privacy of her father, who uses a permanent urinary catheter.
Before the new contracts came into effect, Kathy says, the catheter kits were delivered to her home every three to four weeks. But since early September, she says, nothing has come. Kathy says she has used two catheters already — one that she already had at home and one she and a home-care nurse were able to locate in the community.
“But if anything happens to the catheter my father is currently on, we would have to take him to the emergency room to have it changed,” she said, adding that she realizes her father is luckier than many because he lives with family.
“With some of the elderly people on their own, they can’t just go to emergency every other day or look online to find supplies,” she said.
“I don’t know what they do.”
