Task force did more than send patients out of province

Opinion

Hey there, time traveller!
This article was published 08/02/2024 (610 days ago), so information in it may no longer be current.

In December of 2021, when the former provincial government formed the diagnostic and surgical recovery task force, they also formed a steering committee which I had the privilege of chairing. By any measure, the mission of the task force and the steering committee seemed like a near impossible one. Faced with trying to recover from the biggest health care crisis since the polio epidemic, in a system already under strain, the challenges were huge.

Although the task force was labelled as a political body, the steering committee had representation from a broad cross section of all political stripes who had the common intention of trying to serve Manitobans at a time of great need. In fact, politics never came up at any of our meetings and I believe we were left alone for the most part to try to solve issues the best way possible.

Our steering committee membership included provincial medical leads of surgery, anesthesia, diagnostic imaging and lab services. We also had on our committee a retired chief of surgery (who was also a patient representative), university professors, Doctors Manitoba representatives, nurses and Indigenous representatives.

Task forces by definition are not permanent entities, but created in a time of crisis with a finite mandate. I believe that under extremely difficult circumstances, we actually gave Manitobans some tangible successes that will benefit patients for years to come.

The DSRTF has been mainly identified in the media for out of province referral of patients for surgery, which was always intended to be a temporary measure until provincial capacity allowed increases close to home. Provincial capacity was mainly limited after COVID by severe human resources shortages (mainly nursing). Despite the common conception that out of province work was our sole mission, this only accounted for 18 per cent of our budget and three per cent of the patients that we were able to help through increases in funding.

Some of the highlights of our in-province work included :

1) Expanding orthopedic surgery capacity by opening a fifth operating room at Concordia General Hospital to enable an addition 1000 hip and knee replacements;

2) Mitigating the endoscopy wait list by expanding the use of Fecal Immunochemical Tests (FIT) as well as providing funding for additional endoscopy in the system, including rural access to endoscopy;

3) Expanded general surgical capacity at Grace and Victoria hospital, Steinbach and St Anne’s hospitals;

4) Expanding the Anesthesia Clinical Assistant Program to help address the global shortage of anesthesia providers;

5) Providing operating costs for the new Surgical Wait Information Management (SWIM) system to centralize wait lists in Manitoba and make wait list management more efficient;

6) Expanding the Spine Assessment Clinic at Health Sciences Centre to a provincial resource as well as funding for additional outpatient spine surgery at Maples surgery centre;

7) Expanding diagnostic imaging capacity Manitoba-wide through addition of staff; and expanding hours for MRI and CT scanning, and by purchasing one new mobile CT and one new mobile MRI;

8) Expanded provincial pain clinic capacity for chronic pain sufferers; and

9) Supporting the RFSA (request for supply agreement) program which funded additional cataract, endoscopy, outpatient orthopedic surgeries at Pan Am Clinic, gynecology surgeries, men’s urology, ear nose and throat cases, plastic surgery cases, echocardiography among many other procedures and diagnostic tests.

In total, the task force funded over 80,000 additional surgeries or diagnostic procedures that would have not been otherwise funded.

And many more projects existed that I don’t have the space to list.

All told, the task forces evaluated 358 proposals and had 110 projects operational.

In the end, the DSRTF eliminated 83 per cent of the identified COVID-19 backlog in Manitoba across all 36 service lines with reliable data — 90 per cent of the diagnostic backlog had been eliminated, and 69 per cent of the surgical backlog had been eliminated.

Among the criticisms were that the task force was expensive with a lack of financial oversight.

The task force was set up to be nimble and fast in implementing new funding, which meant hiring new project managers to develop and refine proposals in rapid fashion, circumventing the usual multiple bureaucratic steps and avoiding the normal protracted process. We provided detailed reporting to a ministerial working group including finances every two weeks.

While unusual, desperate times require desperate measures and we needed the ability to act fast and effectively.

Why did we not make a bigger dent in wait lists? Firstly, there is currently no accurate way of measuring wait lists for the T1 (before consultation) and T2 (between consultation and surgery) in most areas.

Post-COVID patient demands for diagnostic tests and procedures increased dramatically while patients who were postponing their health-care needs during COVID emerged from the closet and created huge post COVID demands for the system to deal with.

While we held the line on wait times, the reasons above meant that dramatic decreases in wait times did not occur. One can only imagine, though, what would have happened if the additional 85,000 procedures and tests had not been funded.

The Steering Committee and task force were not perfect, and we apologize to Manitobans for not being able to do more.

Together we worked very hard, countless hours trying to expedite care for Manitobans, overwhelmingly in Manitoba. We wish the projects we initiated and that we were overseeing, such as those listed above, will continue to a successful conclusion.

As to whether all this could have happened through the normal health-care channels, the best answer, quoting George Bernard Shaw’s Eliza Doolittle, is “not bloody likely.”

Dr. Peter MacDonald was the chair of the diagnostic and surgical recovery task force steering committee.