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Ontario expanding private clinics while hospital ORs sit idle, health care advocates say

Posted: February 6, 2023

(February 6, 2023)

By: Jeff Gray, The Globe and Mail

Health care advocates and the Opposition NDP say the pivot to private clinics makes little sense when Ontario hospitals have ORs that are underused because of funding or staffing shortages. CHRIS YOUNG/THE CANADIAN PRESS

Ontario’s existing public hospitals are not all running their operating rooms at full capacity, critics say, even as Premier Doug Ford is planning to allow more surgeries in private health clinics to shorten swollen waitlists.

The government announced plans last month to increase the role of private-sector, for-profit health clinics across the province, saying it was needed to help tackle a backlog of more 200,000 people waiting for outpatient surgeries exacerbated during the COVID-19 pandemic.

Starting right away, the plan will allow private-sector eye clinics to do thousands more cataract surgeries this year. Draft legislation due within weeks would allow new or expanded independent clinics, most of which are now for-profit, to do more diagnostic procedures. Starting in 2023, the changes would allow more knee and hip replacements to be done outside hospitals – all covered by public-health insurance.

Mr. Ford said hospital surgeons have told him they could do more procedures but need more operating rooms. But health care advocates and the Opposition NDP say the pivot to private clinics makes little sense when Ontario hospitals have ORs that are underused because of funding or staffing shortages.

The Ontario Health Coalition, an umbrella group of activist groups backed by major health care worker unions, points to a December, 2021, report from Auditor-General Bonnie Lysyk that says more than a third of Ontario hospitals in 2019-2020 failed to hit a benchmark of using their operating rooms for 90 per cent of their available time because of a lack of funding or qualified staff. The coalition also points to an internal government document from last summer showing that surgeons were only completing about 80 per cent of the non-urgent procedures they did before COVID-19.

“Instead of using their operating rooms, that we paid for, they want to rebuild them in private clinics,” the Ontario Health Coalition’s executive director, Natalie Mehra, said in an interview. “All over Ontario, there is all kinds of hospital capacity if we chose to open it.”

Asked about this issue, Health Minister Sylvia Jones’s office points to the fact the government has funnelled $880-million in the past three years to hospitals to do more surgeries and reduce waitlists. The government is also already funding extra surgeries in existing private clinics and hospitals, but they are currently a small part of the system. (About 97 per cent of outpatient surgeries in Ontario are typically done in a public hospital.)

Ms. Mehra says empty ORs are a long-standing issue: Many hospital operating rooms still close at 3 p.m. on weekdays and are used after that only for emergencies. And while temporary extra funding has allowed ORs to open on evenings and weekends, some hospitals still have entire operating rooms that sit idle for long stretches – a situation more common in places outside Toronto.

France Gélinas, health critic for the NDP, said the province could easily increase the number of surgeries it funds within public hospitals instead of resorting to the private sector: “You can phone any hospital in any part of our province: They all have idle times in their ORs. All of them do.”

Dominic Giroux, chief executive of Health Sciences North Hospital in Sudbury, said in an e-mailed statement that because of a lack of bed capacity and staff, his hospital typically operates only 14 of its 17 operating rooms. However, he said HSN was doing more surgeries than it did before the pandemic. He also said with wait times worse in Southern Ontario, he expects the new clinics to be concentrated there.

Leigh Duncan, a spokeswoman for the Scarborough Health Network in east Toronto, says her institution’s 24 ORs are running at what she said was 100-per-cent capacity, with extended hours to catch up on the surgical backlog from 7:45 a.m. to 5 p.m. She said there were two more spaces that the hospital intends to convert into ORs in future redevelopment plans.

Kevin Smith, the president and CEO of the University Health Network, which operates Toronto General, Toronto Western and Princess Margaret hospitals, says his ORs are also at capacity, but still don’t all run at all hours. While he said any hospital could do more operations with more money, funding has not been an issue during the pandemic. But he said running ORs around the clock is expensive because of overtime costs and that elective surgery done at odd hours can have worse outcomes for patients.

The province’s new private surgical centres, whether for-profit or not-for-profit, Dr. Smith said, could take the easiest cases out of hospital, freeing up capacity and allowing hospitals to focus on riskier and emergency procedures. UHN, he said, will likely seek to open its own version of one of these new clinics, he added.

But for the plan to work, he said, the new clinics must have agreements with existing hospitals to ensure that hospital medical advisory committees, which monitor surgeons and their care, are charged with holding the new clinics to the same standards as the hospital. They must also have arrangements to ensure nurses are shared, not poached, Dr. Smith said, adding that the new clinics could also make use of less-expensive non-nursing staff for certain tasks nurses end up doing in hospitals.

“If this resulted in an exodus of nurses from hospitals, it’s a failure. Period, the end,” he said.

The government has said the new clinics will need to work with hospitals and provide “staffing plans” in their funding applications but has not provided further details. Hannah Jensen, a spokeswoman for the Health Minister, said the government is still working out what relationships the clinics will be required to have with hospitals and the way they will be regulated.

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