Provincial plan to tackle surgical backlog includes hospitals operating at up to 115 per cent capacity

The provincial government's plan to tackle the surgical and procedural backlog and an anticipated influx of patients requiring care includes increasing hospital operating capacity up to 115 per cent of pre-pandemic levels.

The government said it is addressing access to surgeries, procedures and diagnostic imaging, which was negatively impacted during the pandemic, through an investment of $324 million, which includes $216 million to increase surgical volumes.

Surgeries and other care like cancer screening have been hit hard during the pandemic, with the chief medical officer of health twice — once when the pandemic first hit and then again in April this year — directing hospitals to pause non-urgent surgeries and procedures in order to create hospital capacity amid a rise in COVID-19 cases.

Health Minister Christine Elliott said 76 per cent of patients on the surgical waitlist between March 1, 2020 and March 1, 2021 have had their surgeries, while 99.3 per cent of those requiring urgent surgeries have received them.

"This progress is a testament to the hard work and dedication of our health-care system, and we are in a much better situation than was expected near months ago," said Elliott, adding that as public health measures are lifted, she expects more Ontarians to "seek the care they need."

"That is why our government is investing up to $324 million as part of a comprehensive surgical recovery plan to address wait times, improve access to care and support our government's commitment to end hallway health care," said Elliott.

She said the plan would support increased capacity at hospitals and through community providers.

"Hospitals will be able to perform up to 67,000 additional surgeries on top of the typical volume of 650,000 scheduled surgeries per year, including plans for evenings and weekends," Elliott said. The government is also looking to add up to 75,000 hours of MRI scanning and more than 60,000 additional hours of CT scanning, which Elliott said amounts to a 12 per cent increase in each form of imaging.

A provincial official speaking on background said that after nearly a year-and-a-half of working during a pandemic, health-care workers are facing exhaustion and burnout. Given that hospitals are looking to provide some respite over the summer, the goal would be to have hospitals return to at least 100 per cent of their pre-COVID-19 operations by the fall and then increase that to up to 115 per cent as needed.

The funding announced on Wednesday includes the $300 million for 2021-22 that the government promised in its most recent budget, with the government outlining on Wednesday how it plans to spend the money:

• $216 million for increasing surgical volumes by 10 per cent by extending hospital operating room hours during evenings and weekends. This could account for up to 33,000 more cataract surgeries, 4,300 more orthopedic surgeries and 9,000 more pediatric surgeries.
• $35 million for 135,000 additional hours, or a 12 per cent increase, in MRI and CT imaging, on top of the nearly 1.13 million hours of imaging that typically happen each year.
• $18 million for the "centralized surgical waitlist management" program, which would include increasing the use of electronic referrals and making the tracking of surgical information more efficient.
• $1 million for "surgical smoothing coaching," where a team of expert surgeons and administrators would support high-volume hospitals to "optimize the use of operating rooms" and share best practices.
• $30 million for the previously announced "Surgical Innovation Fund," which would enable hospitals to apply for funding for solutions to address barriers to surgical output such as new technology or training nurses. Funding approvals will be shared this fall.
• $24 million for independent health facilities, which are private facilities, to boost volumes of "low-risk, publicly funded surgical and diagnostic services" such as MRI and CT scans and cataract and insured plastic surgeries (up to $14 million), and support licensing of new facilities (up to $10 million).

Other investments beyond the $324 million, but that are being funded through existing programs, include $1.2 million for more outreach to patients on cancer screening through reminder letters and updated guidance to primary care providers and funding for post-hospital care.

Matthew Anderson, president and CEO of Ontario Health, said there are currently about 200,000 people on surgical waitlists across the province. But he noted that this number would have likely been similar even pre-pandemic. This is because even with fewer surgeries being performed during the pandemic, there were also fewer referrals being made, he said.

Anderson said the "resumption of the health-care system will almost certainly lead to an increase in referrals and impact our waitlist." He added that the province would monitor volumes and waitlists and adjust its plans if needed.

Elliott said the anticipated increase in required care is partly due to the fact that during the pandemic, some people didn't want to go to hospitals for care or weren't getting other preventative tests done.

"So we want people to go back to receive those diagnostic procedures, mammograms, pap smears, other preventative tests, and making sure that if they need to have a CT scan or an MRI scan that they go to receive those scans," she said. "So we know that there are going to be some people that will come forward that just haven't been diagnosed yet, but that's why we're building up our capacity so that we can deal with the people that we still have on the list, and people that we anticipate will be coming forward."

Elliott said because there are people who will come forward and be diagnosed, it's difficult to provide a timeline on how long it might take to clear the backlog.

Earlier this year, the province's Financial Accountability Office estimated a cost of $1.3 billion and a few years to complete delayed surgeries and procedures.

Asked about the FAO's projections, Elliott said the government's plan is looking at "actual volumes of surgeries that may need to be done rather than the modelled numbers."

While the government wants to see a ramp up in capacity, the Registered Nurses' Association of Ontario has raised concerns about a a potential exodus of nurses due to exhaustion and competition south of the border.

Elliott acknowledged workers' efforts during the pandemic and the need for them to get a break, noting that the government is providing supports such as through nursing students who can help in hospitals.

Other initiatives include developing training programs to allow nurses to "upskill and to support surgical ramp up."

Meanwhile, Anderson said he's hopeful a possible fourth wave of COVID-19 will not affect the province's plan.

"COVID is still here and we still need to have the resources to manage it," he said. "With the success of our vaccine strategy and the other tools that we've been using right now COVID is at a manageable level, we hope that it will stay that way through the fall and into the winter."

Anderson said no one wants to go back the situation the province found itself in during previous waves where non-urgent surgeries were paused.