Ministry of Health

Surgical and Diagnostic

Recovery
Foundational Overview
Provincial Programs Branch
Hospitals and Capital Division
 Key Messages

• The goal of the Surgical Recovery Strategy is to address wait times, significantly reducing the number of
patients being seen outside of target wait times (“long waiters”) and improve access to care.

• Throughout the pandemic, access to urgent and emergent surgeries has been preserved. 99.3% of the
most urgent and semi-urgent patients have received their surgeries. Wait times for cancer surgery and cardiac
surgery remained stable.

• However, wait times and the total number of people waiting for non-urgent procedures has increased due
to three Directives issued to ramp-down non-urgent care.

• As of April 2022, Ontario hospitals are making progress on overall system wait times and waitlists after
peaking in March 2022, while also working to end hallway health care.

• $300M has been announced for Surgical Recovery in 2022/23 and this was communicated to the hospital
sector in May. The sector is now awaiting further information to support their planning for this fiscal year.

• The approved surgical recovery funding is one-time and must be spent in the 2022/23 fiscal year.

Several key actions are required by Ontario Health and the Ministry over the summer to ensure the
successful implementation of the Surgical and Diagnostic Recovery strategy (see slide 9).

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COVID Disruptions Along The Patient Journey
• During the pandemic, normal patterns of care were disrupted at multiple steps along a patient’s surgical journey.

Pre-hospital (Prevention and Screening Hospital Post- Hospital

Primary 12.5% decrease in Primary Care Visits in spring 2021

Care compared to pre-pandemic, over half delivered virtually

Referrals ~10% decrease in general surgery consults

for Surgery during first 2 years of pandemic

Home Home Care capacity is not keeping up with

rising demand driven by surgical recovery,
Care aging population, and reduced LTC capacity.
Screening, ~23% reduction in cancer screening
Diagnostic Imaging, volumes in February 2022 vs. pre-pandemic
Lab Tests

Hospitals ramped down non-urgent care 3 times in

Surgical
the pandemic and are currently only achieving 80% of
Volumes
pre-pandemic activity

As part of the Surgical Recovery Strategy, the Ministry of Health has developed strategies to support
all parts of the surgical pathway to get patients the care that they require.

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 Current State – Across the Continuum of Care
Cancer Screening
• Cancer screening volumes have rebounded and have been at, or greater than, pre-pandemic output for several months.

Diagnostic Imaging
• Prior to the Omicron wave, hospitals had been able to increase their CT output to 122% and MRI output to 112% and
Ontario achieved the lowest diagnostic imaging wait times among all provinces in Canada.
• Diagnostic imaging output was directed to ramp down during the Omicron wave but has once again rebounded.

Surgical Services
• Key metrics are moving in a positive direction including:
• Overall system wait times
• Overall number of patients waiting for surgery
• Number of patients outside of wait time targets

Home Care Services

• Service volumes are higher than pre-pandemic, but are not keeping up with the rising demand.
• Service delivery costs (fuel prices are up 60%) are rising and remain a barrier.

Currently, HHR challenges across the continuum of care remain a key challenge in surgical recovery
• Shortages of specially trained hospital staff (OR nurses, diagnostic imaging technicians, oncology RNs).
• Wage disparities are also causing HHR shortages in home care (up to 36% RN wage gap, 37% PSW wage gap).

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 Current State – Focus on Long Waiters for Surgery
Approximately 250,000 patients are waiting for surgery. This is 25% (50,000) higher than the pre-pandemic
waitlists.

Of patients waiting, 105,000 or 43% are long-waiters compared to 23% pre-pandemic. Long-waiters are
defined as patients waiting outside the maximum clinical guidelines for their procedure.

The Ministry’s surgical recovery programs are targeted at reducing the number of long-waiter patients from
current levels ~110K to pre-pandemic normal of less than 50K.

5 Data Source: Ontario Health

 Current State – Focus on Cancer Services
• Cancer surgeries and therapies have been largely preserved throughout the pandemic.
• As of May 2022, Cancer surgeries only accounted for 6,650, or 3% of the overall waitlist – and only 2,942, or
2.6% of the number of ‘long waiters’.

Wait times for Cancer surgeries

have remained stable

As of December 2021:
• 77% of cancer surgeries were completed within target wait-times, compared to 87% pre-pandemic.
• 83% of Acute Myeloid Leukemia patients received transplant within target timelines, which marks an improvement
from the previous quarter (74%), indicating increasing stability in the system.

Where we are now

Despite the increase in hospitalizations and hospital staff absences during the 6th wave, hospitals were still
able to achieve 91% of their normal cancer surgery volume output in April.

6 Data Source: Ontario Health

 22/23 Surgical Recovery Strategy
In collaboration with partners and stakeholders, including the Ontario Health and OH Regions, the OHA, the OMA and
hospitals, the following programs were developed:

Volume-Based Investments Capacity and Efficiency Investments

Directly paying for increases in activity Supporting hospitals with the building blocks to increase output

Premium Pricing and Targeted funding for Additional MRI/CT Surgical Pathway Surgical & DI Innovation Centralized Waitlist
additional surgical Pediatric and Private operating hours Training Program and Efficiency Initiative Management (CWM)
volumes ($220M) Hospitals ($15M) ($40M) ($12M) ($13M) *18M previous year investment

• Expand OR hours to • Support time- • Transform the delivery • Advance centralized,

evenings & weekends sensitive growth and • Expand diagnostic • Support training of surgical care, digital intake of
development imaging operations programs for OR improving efficiency referrals to specialists
• Perform additional surgeries into evenings & staff (nurses, techs) and enabling higher
volumes of prioritized weekends and diagnostic output through targeted • Improve load-
(‘long-wait’) surgeries • Increase publicly- imaging staff projects balancing of surgical
funded surgeries at cases through a
Shouldice and provincial real-time
Clearpoint hospitals data tool

Community Investments: ~$18M in one-time incremental volumes at existing

Independent Health Facilities (IHFs) for surgery and diagnostic imaging, pending
Minister approval.

• 2022/23 marks the third year of the Ministry’s work to address pandemic impacts on surgery and diagnostic imaging.
• To date, funding has supported over 250,000 surgeries and hospital-based procedures, as well as over 370,000 additional MRI and
CT imaging hours.
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Independent Health Facilities (IHFs) and Private Hospitals
• In Ontario, 97% of surgeries are done in hospitals. There are relatively few community outpatient providers in Ontario
(compared to other provinces) due to legislative requirements.

• However, as part of the Surgical Recovery Strategy, community-based IHFs or Private Hospitals are being leveraged to
help increase capacity of routine, low-risk, publicly funded surgical and diagnostic imaging procedures/services (e.g.,
cataracts, hernia repair, plastics, MRI/CT).

• A Call for Applications to expand IHF capacity and license new IHFs for cataract surgery was launched on January 15,
2021. To date, no IHF licenses have been issued.

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Independent Health Facilities Private Hospitals

• Invested $18.5M across 17 IHFs over the past 2 years to
achieve over 4,000 additional surgeries/procedures,
~60K MRI / CT hours.
• For 2022/23, up to $18.4M in one-time incremental
volumes will be allocated to IHFs (pending MO approval).
• Invested $8M across 2 private hospitals over the past
2 years to achieve over 3,300 additional surgeries.
• For 2022/23, $5M in funding has been allocated to
support ~2100 procedures.

The Ministry is committed to continuing to leverage all available capacity to reduce wait times.
 Bed Investments to Support Surgical Capacity
• Many complex surgeries require a post-surgical inpatient and/or critical care unit admission to ensure safe patient
recovery.
• The Ministry has added over 3,100 beds to the hospital system that are supporting pandemic response, including
hospitals’ capacity to do more surgeries.

PROVINCIAL BEDDED CAPACITY ALLOCATION

Complex Critical Care
Acute – Acute - Transitional/ Critical Care Total Bed
Region Continuing Rehab (Adult &
Med/Surg Other Care Post-Acute (NICU) Count
Paediatric)
Toronto 296 57 0 220 28 100 14 715

Central 382 21 0 262 0 63 3 731

East 233 48 28 598 10 98 3 1,018

West 436 46 14 462 0 58 10 1,026

North 36 4 0 376 0 2 0 418

Provincial 1,383 176 42 1,918 38 321 30 3,908

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 Next Steps
Ontario Health and the Ministry will need to communicate to the hospitals over the summer in order to allow
hospitals to plan for increased activity and to be responsive to the capacity and efficiency investment
opportunities (calls for applications).

Upcoming Actions Required:

✓ By end of June: OH to release eligibility criteria to the sector for proposal based programs.
✓ By July 15th: MO review and approval of a memo that sets out premium pricing policies for 2022/23.
✓ By end of August: Final decision-making on proposals and informing hospitals of funding decisions.
✓ By early September: List of prioritized surgeries and prices for incremental funding set through a
Minister funding package.