The status quo won’t clear the surgical backlog We must be willing to experiment

By Dr. Kevin Smith

While there is never a shortage of opinions when it comes to the cherished Canadian healthcare system, it is a nearly universally accepted belief that the status quo simply isn’t working – for patients, providers, policymakers, or funders.

With a significant surgical backlog in Ontario and other provinces and substantial health human resources (HHR) stresses and strains, we know that many citizens are waiting too long for procedures that stand to dramatically improve the quality of their lives. More than 200,000 people were estimated to be waiting for a surgical procedure last month, according to provincial figures.

Recently, Ontario Premier Doug Ford and Deputy Premier and Health Minister Sylvia Jones unveiled a threestep plan they say will improve wait times by using public money to expand the number and range of procedures. It appears they are open to receiving expressions of interest from not-forprofit as well as for-profit clinics – an idea that has caused consternation in some quarters.

Beginning with cataract operations, and later expanding to offer MRI and CT imaging, colonoscopies, endoscopies, and hip and knee replacements, the government appears to be leaning on solutions that leverage public-private partnerships.

While the provincial government has been unequivocal that all procedures will be covered for patients under the Ontario Health Insurance Plan (OHIP), the plan has raised earnest concerns about the potential privatization of our system and the fear of HHR bleeding to privately run clinics.

While much of the early reaction focused on the enhanced role of private clinics, the plan also includes non-profit surgical and diagnostics centres, with promised measures to require new facilities to give detailed staffing plans with their application and to ensure several physicians at such centres have active privileges at their local hospital. There are approximately 900 Independent Health Facilities in Ontario–about 875 of which focus on imaging and about 25 community surgical and intervention centres which currently perform 26,000 OHIP-insured procedures and surgeries each year, mostly cataract surgery and endoscopy procedures.

While the devil is always in the details, this approach has signalled a willingness in government to explore innovative ways to better serve patients. With the correct safeguards in place we can build on the success of the existing centres and leverage our scarce –and tired – healthcare workers, as well as attract extenders who will see the denominator of care expand.

As the President and CEO of University Health Network, the only public hospital deemed to be among the top 5 best in the world by Newsweek maga- zine, I am proud of how Canadians passionately defend the public system.

It is a sacrosanct principle that the money you have in the bank should not determine your health or the length and quality of your life in Canada. We must never lose that moral lodestar.

Yet if we accept that the current state of affairs is not good enough, we must also be willing to experiment with models that ensure timely care is available across the continuum of need.

I am confident that by focusing on day surgeries – low acuity procedures that can be cancelled in a hospital setting because of emergency clinical needs or staffing pressures – the system can help clear the surgical backlog, get people the procedures they need promptly, and protect universal access while easing the burden on hospitals and allowing them to focus on critical and complex procedures.

To address concerns, including the potential of upselling services at pri- vate clinics, it is imperative the government work with system partners to develop a framework to safeguard and maintain the integrity of our public system, particularly regarding staffing and quality assurance.

To ensure the plan is successful, we must begin by identifying the risks and possible unintended consequences and put in place a policy and financial framework that mitigated these risks while leaving room for true innovation. Ideally, an Expert Panel should be established to provide advice and recommend the needed guardrails on how best to improve access, enhance quality, and control costs. We can create models that, for example, negate the possibility of large numbers of nurses leaving hospital environments for these centres, exacerbating HHR challenges. If that scenario were to come to pass, and sicker patients’ care put at risk, this should rightly be viewed as a failure.

Yet it is long past time for Ontario to have the same kinds of mature conversations about public-private partnerships that have been had in British Columbia, Alberta, Quebec, and Saskatchewan. But conversations alone won’t advance access to care. We must have the ability to experiment and soon.

It could be argued that the Canadian healthcare system has not done anything truly radical since the days of Tommy Douglas. Instead, we’ve tinkered around the edges with marginal changes, even as patients who deeply value a public healthcare system demand a more patient-centred culture than we have seen in the recent past. Providers are equally demanding change that gives them the tools and the capacity to meet the needs of those we serve.

If we can agree that the status quo is no longer tolerable, let us also agree we can change with the times–if those changes mitigate unintended consequences and raise all ships. It is said that fortune favours the bold and Canadians are rightly demanding timely access to high-quality care. ■ H