B.C. makes progress on surgery backlog—but serious challenges remain

The pandemic has impacted British Columbia’s health-care system in many ways. Like many provincial governments, the Horgan government postponed surgeries—specifically, more than 30,000 “non-urgent” scheduled surgeries between March 16 and May 7 of last year. The resulting backlog (including an additional 24,000 patients waiting for surgery referrals) was originally estimated to take two years to get through. Recent announcements suggest the Horgan government has made remarkable progress with its surgical renewal program and is far ahead of its initial forecast. However, questions remain about the sustainability of these efforts and the lessons the government can take into a post-COVID world.

It’s first important to note the ambiguity surrounding what exactly has been accomplished. Initial estimates pegged the number of surgeries that had been postponed or left on a waiting list at approximately 30,000. However, after clarifying and adjusting these initial figures in each subsequent update, the government says somewhere around 14,154 out of 15,727 postponed surgeries have been completed. On January 6, the B.C. government announced that 90 per cent of surgeries that had specifically been “postponed” had been completed, alongside a 15- to 22-month timeline for total catchup. This is, nevertheless, a remarkable achievement and our frontline health-care workers and the Horgan government deserve congratulations.

Though precise details of how this was achieved remain scant, initial data point to three factors.

First, the government mitigated the effects of B.C.’s annual “summer slowdown” and increased surgical capacity by reopening unused hospital operating rooms, increasing hours of operation and hiring additional surgical and support staff.

Second, it took the necessary and welcome step of contracting several private surgical clinics. Combined, these factors have resulted in a 3.5 per cent average increase in operating room hours between May and November of last year (though again, their relative contribution is unclear).

Third, money. The province allocated an additional $187.5 million in the first budget year to help tackle the backlog. Although we know few details of how this money was spent, in November’s progress report, the government indicated that 32 anesthesiologists and more than 500 nurses had been hired since April 2020.

The result? The previously projected two-year backlog is now estimated to cleared up in 15 to 22 months. Further, the total list of patients waiting in B.C. was actually 3.7 per cent lower in October/November of last year compared to 2019.

But here’s the bad news. While these results are commendable, further examination of the data suggest patients in B.C. will likely continue to face long wait times.

First, although the government reports that 4 per cent fewer patients were waiting in November 2020 compared to 2019, because of routine rationing of services that list still adds to up a whopping 88,401 patients waiting for treatment. Worse, the government’s reported wait list is only about half the size estimated by other independent studies.

Second, the government ran an active campaign to call patients to assess if they still needed surgery or were ready to reschedule. These efforts reduced the waiting list by about 1,691 patients who no longer wanted to pursue surgery (in addition to revealing data errors in the accounting of procedures). In fact, despite increased efforts to perform more surgeries, the government reports having completed only 218 more “scheduled and unscheduled” surgeries during October and November last year (compared to 2019), suggesting other factors may be at play.

Finally, while the efforts of our excellent medical staff should not be ignored, it’s important to remember that unplanned fiscal injections are sustaining current activity. Historical data have repeatedly indicated that simply pumping more money into the system may buy temporary reprieve but it’s not a sustainable solution. Given the rapid deterioration in government finances owing to the pandemic, continued increases in spending are not realistic. In fact, the B.C. government budget deficit will reach a projected $13.6 billion this year while debt continues to accumulate.

Obviously, COVID-19 created many challenges for B.C.’s health-care system and forced patients to postpone treatment without any alternatives. The Horgan government worked hard to address the resulting backlog and bring wait lists back in line with historical norms. However, this temporary success does not permanently address B.C.’s historical wait times crisis, and the government cannot indefinitely spend its way out of the challenges on the horizon.