For the past four years in Ontario, one in 10 children needing non-emergency surgery in Ontario have waited more than 230 days for their procedure.
During that same period — from 2020 to 2023 — around 30 per cent of non-emergency pediatric surgeries were not completed within the recommended timeframe, according to Ontario Health data The Trillium received through the freedom-of-information process.
The data outlines the number of surgeries completed each calendar year, the 90th percentile wait times — meaning 10 per cent of patients waited longer than this number — and the percentage of surgeries completed within the recommended timeframe.
The numbers generally show longer wait times and fewer surgeries performed in the years after 2019, when 52,851 surgeries were completed. That year, the first one after the Ford government took office and prior to the COVID-19 pandemic, 18 per cent of the surgeries weren’t done in the recommended target time.
There was an overall dip in the number of pediatric surgeries completed between 2019 and 2022, from 52,851 to between 32,500 and 34,600 surgeries the following three years. In 2023, the numbers picked up, with 48,595 surgeries completed, and 25,789 done within the first six months of 2024.
In 2019, 10 per cent of patients waited more than 173 days, but that wait time increased to 257 days in 2020. It stayed above 250 days in 2021 before going down to 230 days in 2022 and 2023. During the first half of 2024, that wait increased again to 245 days.
The data obtained by The Trillium included patients up to the age of 23 and didn’t include emergency surgeries — called priority level 1 cases. For the other three priority levels, Ontario Health’s website lists wait times for different categories of pediatric surgeries, such as cardiac and orthopaedic.
For each one, the priority 4 target time was listed as 182 days, while the target times for more urgent priority 2 and 3 cases varied.
When the pandemic was declared in March 2020, Ontario’s government ordered hospitals to ramp down non-urgent surgeries to make room for COVID-19 patients. Between March 16 and April 26, there were 6,097 fewer pediatric surgeries, a reduction of 93 per cent, compared to the same period the previous year, according to data included in an Ontario Health memo in June 2020.
“We have been underfunding children's health-care services across the country for decades, and we're now seeing the consequences,” said Emily Gruenwoldt, president and CEO of Children's Healthcare Canada, a national association that represents children’s hospitals and other health services organizations, including several in Ontario.
The pandemic affected access to various “essential health services,” but surgeries were “impacted quite significantly,” said Gruenwoldt, adding that the Ontario data is consistent with the delays being seen across Canada.
“No child or their family elects to wait for care 100 days, 200 days or even longer," she said.
Gruenwoldt said that when she hears about wait times like this, she's concerned about what the children are going through.
“Children can be waiting in pain, they can be missing out on attending school, they could be missing out on attending social events or extracurricular activities that are formative in their development at that particular age,” Gruenwoldt said. “When it comes to surgical procedures in kids specifically, we really do worry about the consequences of their long-term health outcomes.”
There’s also the “economic burden” of long waits, both on families and on the health-care system, she added.
Parents might have to stay home and not work while their child is waiting for a surgery, or they might face additional costs while waiting such as for caregiving, rehabilitation or physiotherapy, Gruenwoldt said.
Costs to the health-care system “also increase significantly when we look at what it takes to care for a child who's even sicker, 200 days later than they would be if they had received that care within the medically defined window,” she said.
What Adil Shamji, the provincial Liberals’ health critic and an emergency room doctor, said he found “most damning” about the data is that surgeries completed within the target “plummeted since 2019 despite the fact that the number of surgeries getting performed has also gone down.”
The 90th percentile wait times were also a concern for Shamji.
“The children who are waiting the longest for their surgeries, are waiting dramatically longer than ever before … at least two months longer than they did four years ago,” said Shamji, referring to the difference between the 2019 and 2023 numbers.
Like Gruenwoldt, Shamji said these waits mean children are in pain and not able to go to school, often spending more time in emergency departments — further increasing wait times and costs within the health-care system.
“But above all, it's having a profound impact on the dignity of our children, who really should be focused on learning, going to school and making connections with their friends and family,” he said, adding that he’s heard from constituents whose children are waiting for surgeries and are turning to other countries to try to get them done sooner.
Shamji blamed the Ford government for what he called “mismanagement of wait times in our province.”
“The numbers genuinely speak for themselves, they continue to fall behind where they were in 2019, we continue to see hospitals scrambling for funds, struggling to meet their bottom lines,” he said.
For its part, the provincial government pointed to its announcement last summer that it would add $330 million each year for children's health services.
“Through this investment, partners like CHEO have provided care for an extra 30,000 children, improving access to diagnostic imaging and outpatient services," said Hannah Jensen, a spokesperson for Health Minister Sylvia Jones, in an email. She noted that Holland Bloorview also expanded its inpatient capacity, with the hospital noting it was also able to see 60 per cent more patients in its day patient unit.
“London Health Sciences Centre has reduced its surgical waitlist by 25 per cent through new ambulatory clinics and partnerships with community clinics. McMaster Children’s Hospital has cared for an additional 4,000 children and increased their surgeries by 27 per cent. SickKids has also reduced their surgical waitlist to below December 2022 levels and treated an extra 1,300 children in the Emergency Department this year,” she said.
Jensen said the government would “continue to take bold and innovative steps” to connect people with needed care.
In a press release last month, London Health Sciences Centre (LHSC) said its children’s hospital used provincial funding to boost operating room capacity, leading to an additional 500 surgeries being completed in the last fiscal year.
The hospital was also able to move more procedures to its “Minor Procedure Room,” freeing up the operating room for complex cases.
Gruenwoldt called the investment “outstanding" and said she hopes other provinces follow suit, but that more is still needed.
“Is it enough to solve the problem? No. Is it a silver bullet that's going to address some of the workforce shortages that we face, or the infrastructure challenges that we face? No. But it's a really meaningful and important investment to say kids are important, we're falling behind, and we need to do something differently if we're ever going to tackle these wait lists,” she said.
Gruenwoldt said the current workforce with specialized training to perform pediatric surgeries is small and that future workforce planning needs to include a specific plan for those who deliver care to children.
“The surgeons who are trained to care for and undertake surgeries in our adult population, they're not interchangeable with surgeons in the pediatric space,” she said, adding that other steps include centralized waitlists.
Editor's Note: This article was updated after publication following a request from Holland Bloorview Kids Rehabilitation Hospital to correct the statement provided by the health minister's office to clarify that provincial funding allowed the hospital to see 60 per cent more patients in its day patient unit, not 60 per cent more inpatients.
