‘It makes your head spin’: Tackling Ontario’s surgical backlog

TVO.org speaks with Anthony Dale, president of the Ontario Hospital Association, about the pandemic’s long-term effects on the province’s health-care system
By Daniel Kitts - Published on May 19, 2021
Anthony Dale, president and CEO of the Ontario Hospital Association. (Courtesy of Anthony Dale)

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COVID-19 case counts are falling across most of the province, but the hospital system is still under stress — and will be for some time. 

A recent report released by Ontario’s Financial Accountability Officer, Peter Weltman, says that the hospital system will face a backlog of 419,000 elective surgeries and 2.5 million diagnostic tests by September. The report predicts it will take more than three years to eliminate the backlogs and cost $1.3 billion — more than double what the province has budgeted thus far. Although David Williams, Ontario's chief medical officer of health, has rescinded Directive 2, allowing Ontario hospitals to resume "non-urgent" care, a statement from Health Minister Christine Elliott's office indicates that this "does not mean that surgeries or procedures will resume at this time." 

TVO.org speaks with Anthony Dale, president and CEO of the Ontario Hospital Association, about how hospitals will handle the challenge.

TVO.org: How are you doing?

Anthony Dale: Well, we are still fighting this pandemic. We think we’ve seen the worst of the third wave, and we're watching hospitalization and ICU occupancy trends slowly decline. We're all relieved to see that, although it's come at quite a cost, both in terms of human life disrupted and lives even lost because of COVID-19. But also because of the many thousands of patients with other health conditions who have been unable to access the care they need throughout the last year-and-a-half.

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TVO.org: And how are you doing personally? 

Dale: Well, I'm managing. I'm not on the front line of clinical care. It's our job at the OHA to support the front line — our hospitals and the fantastic clinicians and other staff who work in them. But we're all very, very weary. And we're hopeful that we're in the final stage of this pandemic. None of us want to live like this. And if we keep up our aggressive vaccination strategy as a province — that's what's giving us a lot of hope.

TVO.org: The Financial Accountability Office recently released a report into the procedure backlog facing Ontario’s hospitals. What was your reaction to it?

Dale: Well, it's horrifying. The estimates are so big, it makes your head spin. It does take us out to September, in terms of the measurement of the backlog, both for surgery and diagnostic imaging. With any luck, we won't reach that absolutely gigantic kind of backlog. But no matter how you look at it, the challenge to deal with it is on par with the challenge of fighting this pandemic. 

chart showing surgical backlogs

TVO.org: The report estimates it will take more than three years to clear both the surgical and diagnostic backlogs. Does that seem correct?

Dale: I think we have to step back here for a minute and look at the big picture, because I'm not sure what assumptions have gone into all of those conclusions. The hospital sector is part of a wider health system, and it's deeply interdependent. One in five patients in hospitals are actually ready for discharge to a more appropriate setting. The setting where most of those patients are typically supposed to be headed for is a long-term-care home. And of course, that's simply not possible at the moment. 

The home-care sector’s ability to address the volume of need is clearly at some kind of limit right now. Very large numbers of requests for care are not being met, and the last budget essentially provided no new investment. So, getting back to the question of surgical and diagnostic wait times, we can go as fast as we can go in hospitals. But dealing with this backlog is predicated on addressing wider and deeper — really dysfunctional — problems that have existed for many years in our healthcare system.

TVO.org: The estimates in the report depend on the hospitals operating at 11 per cent above pre-pandemic volumes for all surgeries and at 18 per cent above pre-pandemic volumes for diagnostic procedures. How realistic is that?

Dale: I was speaking to some remarkable health system leaders yesterday. And their message is that we have to resist the urge to want to return to a state of normalcy. We have to become very uncomfortable with the scale of the challenge ahead of us just like we're very uncomfortable with what hospitals had to do to fight COVID. And we're going to have to think in the same very dramatic, very innovative way to tackle that backlog. 

There's also a deeper problem, however, because when you talk about a backlog, it's almost as though you can imagine a long list of patients with their names and what they need. Certainly, there are pre-existing waitlists for areas such as cancer care and cardiac care. But we have a huge number of patients out there who don't even know that they need care or are about to become sick. We've lost track of a significant number of patients. So, we need to be aggressively proactive, and seek out those patients in the short time ahead. I think this is an area that people are largely unaware of, that there is this gap in knowing even who many of these patients actually are. And that is a huge tragedy.

chart showing health-care spending

TVO.org: What are hospitals doing to prepare to tackle the backlog?

Dale: There are preparations underway at every single planning table in hospitals. But what the pandemic has underscored and taught us is that we can't look at this organization by organization, we have to look at the needs of patients from a system point of view. Once wave one of the pandemic started to recede, the hospital sector was asked to deal with surgical backlogs on a regional basis. And I fully expect that will have to continue: Looking at where capacity exists, anywhere in a given region, or even beyond.

TVO.org: So if I understand what that means, while in the past people may have just waited for a spot to open up at their local hospital for a particular type of surgery, now they might travel to places that have surgical capacity?

Dale: It wouldn't be the first choice. But that's a good example of what I mean about we're all going to have to be looking at uncomfortable approaches for quite some time. Because at the end of the day, what matters the most is getting the person access to care they need in a timely manner.

Agenda With Steve Paikin panel, May 17, 2021: Accounting for Ontario health-care funding

TVO.org: On Monday’s episode of The Agenda, Financial Accountability Officer Peter Weltman spoke about the stress on the healthcare system. He said: “It's not machines so much that you worry about, it’s people. It's the staff. It's the doctors and the nurses.” How are hospital workers going to be able to handle dealing with a surgery backlog after all they've been through?

Dale: I think at times during this pandemic, the risks to the healthcare system have not been fully acknowledged, or they’ve only been acknowledged too late. There are more than 200,000 employees in the hospital sector in Ontario. There's thousands and thousands of physicians in addition to that, and they are absolutely exhausted. But they're also incredibly passionate, incredibly dedicated to what they do. 

But we're going to have to ask ourselves as a health care system, and as a province, what more we can do to ease the burden on hospitals. That means reducing unnecessary pressure on them, and, above all, that means getting patients who need to be in long-term care or who need to be in home care into the right setting.

We really need to ask ourselves as a province, were we on the right path before the pandemic? I don't think anybody is going to answer yes. So, let’s learn from this crisis. Let’s be bold, and let’s be courageous in in tackling not only that surgical backlog, but in many systemic changes that are needed to make sure that people get the right care in the right place at the right time.

This interview has been condensed and edited for length and clarity

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