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Kailey Vokes: We need to get creative to clear the post-COVID surgical backlog

Commentary

Well before the COVID-19 pandemic, Ontario’s healthcare system was under strain.

Even then, it took an unacceptably long time for hip replacements, non-evasive procedures, or even just an open hospital bed. The costs and consequences in economic and human terms were significant. In response, the current Ontario government started to pursue administrative reforms to address these wait times and improve the province’s health-care system.

Then the pandemic hit.

Responding to the exigencies of the pandemic superseded these broader reforms. Attention and resources have instead been dedicated to treating the influx of Ontarians affected by the virus. Although these policy and operational choices were of course necessary, they have contributed to a severe surgical and diagnostic backlog in a system that was already under strain.

Now that Ontario appears poised to begin its recovery from COVID-19, what does that backlog really mean for those waiting for care?

For many, it means waiting months on end in pain and discomfort, with limited mobility, unable to work, relying on government benefits for income, and even developing potential mental health challenges as a result. This problem is not just about the number surgeries and procedures to be performed, it is about the quality of life of our loved ones.

If Ontario wants to see its economy recover, it will need its people to recover. This will require a dedicated plan to eliminate the surgical and diagnostic backlog in large part by getting back to the reform agenda that the government was pursuing prior to the pandemic.

Ontario’s Financial Accountability Officer’s (FAO) recent report on the Ministry of Health’s spending plan estimates that the province’s surgery backlog will reach 419,000 elective procedures and 2.5 million diagnostic procedures by the end of September 2021. The FAO projected that even assuming that hospitals operate at 11 per cent above pre-pandemic volumes for all surgeries and 18 per cent above pre-pandemic volumes for non-emergent diagnostic procedures, it will take 3.5 years to clear the surgery backlog and over 3 years to clear the diagnostics backlog.

The Ontario government has acknowledged the problem of the pandemic-induced backlog. Its 2021 budget included incremental funding of $610 million to keep operating rooms open later and to create a centralized provincial surgical waitlist program to help reduce delays in scheduling and match patients to surgeons with shorter wait times.

Ensuring patients who can be treated outside of a hospital setting are treated in the community is key.

While this incremental funding is much-needed and will increase capacity on the margins, it’s not enough. More ambitious policy solutions will be needed to reduce the backlog and ultimately address the long-term challenges facing Ontario’s health-care system.

A big part of such an agenda must be to move ahead more rapidly on the pre-pandemic reforms to community-focused care through Ontario Health Teams. The basic idea here is to create regionalized and localized teams of health-care providers and organizations (including, but not limited to, physicians, secondary care providers, community support services, and mental health services) that can coordinate patient care across a full continuum of health services. Province-wide implementation of this new model was paused during the pandemic. The government should soon resume the process. Reaching province-wide implementation of Ontario Health Teams will help get patients out of hospitals sooner and keep patients out of hospitals in the first place.

To support this implementation, the government should continue to invest in expanding hospital capacity, provide more access to home care, and deliver more healthcare services in the community. Ensuring patients who can be treated outside of a hospital setting are treated in the community is the key to providing much needed relief to hospitals.

But, to have a workforce to provide that capacity and care, creative solutions are needed to put the right incentives in place for people to choose to pursue and remain in health-care roles in Ontario.

Health-care workers are exhausted and burnt out from fighting the pandemic on the frontlines, and not all of them feel appreciated for their work. Targeting funding to create new positions will not work if existing workers are vacating their posts and potential workers do not see the value in pursuing the profession.

The first part, keeping workers in the sector in Ontario, may require that the government take a hard look at pay and working conditions, which will be complicated and expensive. It might take reconsidering the measures in Bill 124 (which mandated wage growth for Ontario’s broader public service) regarding wages for health care professionals or creating a new retention fund for those in the health-care sector.

Labour relations are challenging for every government, but it is imperative that the Ontario government get this right so that we keep our qualified workers in the province and focused on reducing the surgical and diagnostic backlogs.

To ensure a consistent supply of new workers, the government may also need to leverage the work it has done in other sectors for post-secondary education and training. It can, for instance, provide incentives to encourage individuals to become health-care workers in Ontario such as increased OSAP eligibility or bonus payments for those who work in remote or underserviced regions.

Performing more procedures outside of hospitals will also provide significant relief. The government has already started to see success through the licensing of Independent Health Facilities for the provision of cataract surgeries. This is a start and provides a useful model.

The government will need to cooperate with the hospital sector and community providers to identify other publicly-funded procedures that could be done outside of hospitals, while ensuring the highest standards of care are maintained.

The government will face challenges on all of these fronts. Labour negotiations will be tough. Investments and programs for workforce education and training will take time to see results.

Opponents of expanding the scope of practice for community providers will cry foul about the “privatization of healthcare.” But, the truth is, this is a necessary evolution of our public health-care system. With courage and cooperation, this transformation can be done in a way that’s hugely beneficial to the patients who need these services by reducing wait times and providing local access to care.

Better yet, with these types of policy changes, Ontario can start putting a real dent in the COVID-induced backlog.

Ginny Roth: Don’t dismiss intersectionality, but save it from the nihilists

Commentary

Our practical politics is undergoing a realignment. The elite consensus is fracturing and parties on the left and right are grappling with populist influences as they attempt to remake their voting coalitions.

While this practical realignment works itself out, a cultural realignment is also emerging. It is easy to dismiss this version of the realignment as a performative culture war, and when it comes to Twitter, we probably should. But we should not ignore the real version of this debate emerging over dinner tables and in virtual office chats.

After all, these are the spaces we live in. Unfortunately, Canadians tend to talk past one another in these conversations just as they would online, deepening social divides and causing us to lose touch with one another.

Conservatives, in particular, tend to dismiss our progressive friends and family when they seek to engage with us on major cultural questions. We rage at cancel culture and scoff at microaggressions. Despite this, most conservatives believe that our society remains unequal and unjust in many ways.

It is time for conservatives to stop being defensive, let go of the status quo and articulate our own understanding of what a better, more just society would look like. Just as the left takes its inspiration from post-modern philosophy, we on the right should look to communitarian critiques of modernity and articulate a conservative, pluralist vision for society.

Progressives, on Twitter and in real life, do not come up with their buzzwords out of thin air. They take inspiration from a rich (if wrong) post-modern philosophical tradition. Intersectionality, critical race theory, post-colonialism, third-wave feminism and other left-wing critiques of modernity all begin with a few key thinkers who took serious issue with enlightenment-era notions of justice, freedom and equality.

Conservatives reject the communism and nihilism that emerged from this tradition, but we should not be so quick to dismiss its core insight. People are not the blank slates John Rawls and other liberal individualist thinkers wants them to be, so our ethics, our justice system and our public policy cannot and should not assume we were all born on third base.

A pluralist conservatism might require questioning free trade when Canadian workers could lose jobs.

The original conservatives, just like the post-modernists, understood that individuals are the complicated products of their environment. Income, hometown, parental education, social class, intelligence, birth order and even race, gender, sexuality and religion all play a role in shaping who we are. So why do we get our backs up when our friends and family tell us to check our privilege?

No one wants a society of vigilante cancellers and de-platformers. But conservatives are far more culturally compelling when we step out of our defensive posture. If we believe that the identity politics of the elite focuses too often on gender and race at the expense of income and class, then why not call for a more intersectional conception of justice? We all know that a poor man with an intellectual disability is more likely to have a problem navigating our courts system than a wealthy woman with a high IQ. If you doubt that, watch Making a Murderer on Netflix and you will not doubt it any longer.

A pluralist conservatism would call on our leaders to develop social policy for all of those who need it, not just those with the fastest access to elite gatekeepers. That might mean questioning free trade when Canadian workers could lose jobs, or it could mean cultivating an education system better suited to young boys who we know are more likely to struggle in traditional classroom settings.

Conservatives have our own philosophical tradition we can draw on for more inspiration. From Edmund Burke to 20th century American and Catholic communitarians, our intellectual forebearers did not call it intersectionality but they did have a vision for the common good over excessive individualism.

More recently, our ideological partners in the United Kingdom, the United States, and Australia have been experimenting with building public policy around this view and in some cases have built real political movements that speak to multi-ethnic working-class voters previously assumed to be inaccessible to conservative parties and leaders.

The progressive left’s approach to identity politics — from the toxicity of cancel culture to the empty symbolism of virtue signalling — is not contributing to a more just society. But the knee jerk response of the of the right (I’m not a racist!) is not up to the task of grappling with the big, serious problems of inequality we face. 

Cultural flashpoints of the past couple years, from the killing of George Floyd at the hands of the police to the recent discoveries of more unmarked graves of indigenous children, demand more than what conventional equality-of-opportunity views of justice have to offer.

If those of us who find identity politics to be flawed want to play a role in the cultural realignment, we must articulate an alternative that is up to today’s challenges.