Good morning, Mr. Chair.
I'd like to begin by thanking this committee for the privilege of attending today. My name is Erik Skarsgard. I am a pediatric surgeon in Vancouver and surgeon-in-chief at the British Columbia Children's Hospital. I am also a member of the Pediatric Surgical Chiefs of Canada. I have no conflicts of interest to declare.
I've been practising pediatric surgery in Canada for 22 years. For much of that time I've been able to deliver timely, high-quality surgical care to children and their families. That has changed. Increasingly, my surgical colleagues and I are unable to look in the eyes of parents of children who need surgery and tell them with confidence that their child will be all right. This causes anxiety for families and moral distress for our surgical teams, who feel helpless in their ability to ensure optimized health outcomes for the children they treat.
The root cause is reduced access to scheduled surgery for children due to a severe contraction of capacity. This is not a new problem. It was first revealed by the 2007 federally funded Canadian pediatric surgical wait-times project, which resulted in nationally endorsed, diagnosis-specific wait-time targets across the spectrum of children's surgery.
Delivery of surgical care within a benchmarked wait time is critical to optimizing developmental and functional outcomes, with significant delays threatening a child's vision, hearing, speech development, mobility and learning potential, with risks of avoidable pain and long-term disability.
As late as 2018, national data confirmed that only 65% of scheduled surgery in Canadian children's hospitals was performed within the window. With the arrival of the COVID-19 pandemic and the more recent respiratory viral “tridemic”, things have only gotten worse. Surgical wait-lists have essentially doubled, and the percentage of children waiting longer than their wait-time target is as high as 70% in some provinces.
What factors have caused this?
As you are aware, we are in the midst of a human health resource crisis, with a reduced pipeline of specialty-trained nurses to care for hospitalized children with increasingly complex care needs. These include nurses who work in surgical areas like the operating and recovery rooms, but also nurses who work in the emergency departments, wards, and in mental health and critical care areas. It cannot be overstated that this crisis is affecting the care of all children, not just those in need of surgery. The workforce shortage extends beyond nursing to allied health, anaesthesia and subspecialty pediatricians and surgeons, including some hard-to-recruit specialty areas such as pediatric ophthalmology and cardiac surgery.
Many children's hospitals face space shortages, particularly in terms of operating rooms, minor procedure rooms and outpatient clinic space. When surgeons are not in the operating room, they are usually seeing patients in an ambulatory clinic setting. Some specialties have very long wait-lists for new referrals, and despite innovation in referral management, including centralization and the increasing use of telehealth, there are children who are languishing on referral wait-lists with time-sensitive diagnoses. These children represent an unmeasured demand for surgery.
Fewer than a half of all operations in children 18 and younger are performed by trained pediatric surgeons in children's hospitals. Across the provinces there is poor integration between specialty services uniquely available in children's hospitals and community-based services with the capacity to deliver surgical care to some children. In our geographically vast provinces this disconnect means that families often travel to a children's hospital to receive surgical care that could be safely and effectively delivered much closer to home. The lack of coordinated funding of hub-and-spoke models of children's surgical care causes disorganized utilization of existing surgical capacity, and uniquely disadvantages families who live outside the urban areas where children's hospitals are located. It also means there is no line of sight on children waiting for surgery in adult hospitals, where they represent a tiny piece of the pie and risk being overlooked in favour of adult surgical priorities like joint replacements and cataract surgery.
What can be done?
First, our children need targeted and sustained federal and provincial funding for children's surgical services.
Second, our children need pediatric-specific HHR recruitment that will address gaps in all service areas.
Third, our provinces need coordinated, integrated health services planning that “right sizes” child health services to population need so that children have the right operation at the right time by the right surgeon as close to home as possible.
Fourth, our children need governments to encourage and fund innovation that specifically benefits child health. This should span the spectrum of discovery research, implementation science, AI, health technology assessment and regulatory approval so that we are continually improving care and health outcomes for children while introducing efficiency that will drive value in health care.
More than ever before our children need advocacy within a public health system for their unique care needs, including prioritization for surgery. Children are not small adults and are not less deserving.
Thank you for your attention.