The province announced on Jan. 16 that it would invest $300 million this year as part of its surgical recovery strategy to help clear a backlog of surgeries and diagnostic procedures, \u201cprioritizing patients waiting longer than recommended in clinical guidelines,\u201d a news release from the Ontario government stated.<\/p>\n
Step 1 of the province\u2019s plan is to add 14,000 cataract surgeries through partnerships with centres in Kitchener-Waterloo, Windsor and Ottawa, and to allocate $18 million to existing Independent Health Facilities across Ontario for diagnostic procedures like MRI and CT scans and for a variety of surgeries, including cataract and other ophthalmic procedures, some gynecological surgeries and plastic surgeries.<\/p>\n
According to the provincial government, there are currently 206,000 people estimated to be waiting for surgeries in Ontario.<\/p>\n
There were just over 7,000 individuals waiting for an elective surgery in the Kingston region in January, according to data provided by KHSC. Approximately 4,000 of those patients have waited longer than Ontario Health\u2019s targeted wait times.<\/p>\n
\u201cThose wait times have been substantial, even before the pandemic,\u201d Pichora said. \u201cObviously they took a hit during the pandemic.\u201d<\/p>\n
Non-urgent ophthalmology and orthopedic procedures like cataract surgery and hip and knee replacements represent the largest group of patients waiting in the Kingston region.<\/p>\n
According to the province, community surgical and diagnostic centres licensed under the Independent Health Facilities Act currently perform approximately 26,000 OHIP-insured surgeries and procedures ever year.<\/p>\n
Pichora says that IHFs have been part of Ontario\u2019s health-care system for some time. He pointed out that pharmacies and physiotherapists are private facilities that work in partnership with the province\u2019s public system.<\/p>\n
\u201cIt\u2019s not like this is a new thing,\u201d Pichora said. \u201cThese IHFs have been around for a long time doing a variety of things.<\/p>\n
\u201cThis is a way of adding capacity. That\u2019s not a bad thing. From my perspective, it\u2019s more about how\u2019s it done.\u201d<\/p>\n
Pichora believes that a \u201chub and spoke\u201d model utilizing existing IHFs in an integrated fashion will be a positive for Ontario\u2019s health system as an immediate response.<\/p>\n
\u201cI think the (Ontario Hospital Association) and virtually all hospitals would agree that it would be far better to do this in an integrated partnership fashion,\u201d he said. \u201cWe work really hard to have an integrated health system. This is Ontario Health\u2019s job. This is what the future of (Ontario Health Teams) is about. The idea of setting up a completely independent parallel stream doesn\u2019t really resonate with that very well, but yet we could achieve the same goals if we do it in a more integrated manner.\u201d<\/p>\n
What Pichora doesn\u2019t want to see is patients undergoing surgical procedures at clinics that have no ties to local hospitals.<\/p>\n
\u201cWe don\u2019t want itinerant surgeons coming into town, who are here today and then gone, who don\u2019t have hospital privileges, who aren\u2019t there to provide any kind of post-operative care or deal with problems or concerns that might arise,\u201d he said.<\/p>\n
KHSC maintains existing partnerships with IHFs in the community that were in place before the pandemic, including an ongoing contract with Focus Eye Centre for cataract surgeries.<\/p>\n
That contract allows for allocating cases as hospital staff deem appropriate, stipulates that the hospital\u2019s surgeons have \u201cfirst right\u201d to working at the clinic, as well as allows doctors in training access for teaching purposes.<\/p>\n
\u201cIt\u2019s part of the hospital, essentially,\u201d he said.<\/p>\n
This kind of partnership and oversight are what Pichora hopes to communicate in his ongoing discussions with the provincial government, which has reached out for advice from hospital organizations across the province.<\/p>\n
\u201cThey\u2019re certainly seeking our advice, and others, on how to set up the policies and regulations and the application process,\u201d Pichora said. \u201cI suspect the government realizes as well that doing this in a co-ordinated, integrated fashion is better.<\/p>\n
\u201cIt\u2019s not about saying \u2018no.\u2019 It\u2019s about saying, \u2018How?\u2019\u201d<\/p>\n
The government\u2019s announcement in mid-January has incited mixed responses from medical organizations, many of which believe investing in the public system is a better approach to a long-term fix for staffing shortages and wait times<\/p>\n
The Registered Nurses\u2019 Association of Ontario believes the provincial government should help bolster hospitals with underutilized resources, such as operating rooms that are closed during evenings and on weekends, The Canadian Press reported in January.<\/p>\n
\u201cThe premier needs to open the operating rooms, the operating theatres, the recovery rooms in our public hospitals 24-7 like many other countries do,\u201d Doris Grinspun, the association\u2019s CEO, told The Canadian Press.<\/p>\n
The OHA is concerned that private clinics will steal staff from public hospitals, where staffing shortages are already a problem.<\/p>\n
\u201cWe certainly aren\u2019t interested in seeing members of the hospital teams being poached by other employers,\u201d Anthony Dale, the president of the OHA, told The Canadian Press.<\/p>\n
In a news release responding to the province\u2019s announcement on Jan. 16, the Canadian Union of Public Employees (CUPE) said for-profit clinics, long-term care homes and nursing agencies have worsened staffing shortages in Ontario\u2019s public health system.<\/p>\n
\u201cThis move runs counter to the principles of our public health-care system,\u201d Naureen Rizvi, Unifor Ontario regional director, said in the CUPE release. \u201cDoug Ford is allowing private clinics to profit by performing these essential health procedures, which is not a solution to our health-care crisis. It will simply make this crisis worse by exacerbating the staffing shortages in our public system and diverting funding away from public hospitals and clinics.\u201d<\/p>\n
Ross Sutherland, with the Kingston arm of the Ontario Health Coalition, echoed concerns about investing in private clinics instead of the public system.<\/p>\n
\u201cIt\u2019s a matter of resources,\u201d Sutherland told the Whig-Standard in an interview. \u201cIn a way, it\u2019s no more complicated than that.\u201d<\/p>\n
Investing in private clinics will likely make a difference to Ontario\u2019s surgical wait list, he admitted, but at a cost to taxpayers and to the public health system\u2019s future success.<\/p>\n
\u201cIt\u2019s just going to cost us more, it\u2019s going to fragment the system and it\u2019s going to cost patients more,\u201d he said. \u201cSo why wouldn\u2019t we build a strong public health-care system? That\u2019s what I don\u2019t understand, when you get right down to it.<\/p>\n
\u201cWhere these resources go will determine what we\u2019re going to see 10 years down the road from now.\u201d<\/p>\n
Pichora agreed that while IHFs are \u201cone way to do it,\u201d investing in Ontario\u2019s public hospitals is a needed solution.<\/p>\n
\u201cIf hospitals had the funding and the staff available, we would be able to run our operating rooms on Saturdays, some in the evenings, and expand capacity with existing resources,\u201d he said. \u201cLooking at the number of (functioning IHFs) today, it\u2019s a very small number. If we were to start building a bunch of new IHFs, why wouldn\u2019t we first extend hours at hospitals that are able to work already?\u201d<\/p>\n
Pichora pointed out that locally, while hospitals have returned to full operating room capacity \u2014 in fact, running more operating rooms than KHSC did pre-pandemic \u2014 there is room to utilize local existing infrastructure more effectively. Hotel Dieu Hospital\u2019s operating rooms do not run in the evenings or on weekends.<\/p>\n
\u201cThere\u2019s a potential for expansion there without building anything new,\u201d he said. \u201cIt\u2019s just a matter of staffing it so that we can run it.\u201d<\/p>\n
Pichora encouraged people who are concerned about the province\u2019s current trajectory with private clinic partnerships to focus on encouraging an integrated model.<\/p>\n
\u201cFrom my perspective, what they should be concerned about is getting improved access to the system, where they know that they\u2019re going to be able to get access to the same quality of care no matter where they go, and that where they\u2019re getting their care is part of the system one way or another,\u201d he said.<\/p>\n