December 21, 2005
(Health and Community Services)

NL on track to meet national wait time benchmarks

Health and Community Services Minister John Ottenheimer today provided an update on government’s continued efforts to improve access to heath care services in the province. The minister was joined by Susan Gillam, CEO for Western Health; George Tilley, CEO for Eastern Health; and Dr. Robert Williams, VP – Quality, Diagnostic and Medical Services, Eastern Health, where he outlined the province’s current wait times in relation to the pan-Canadian benchmarks announced December 12, 2005.

"Our government is making significant progress in reducing wait times for health care services and we welcome the recently announced national benchmarks as a significant step forward for residents of Newfoundland and Labrador," said Minister Ottenheimer. "All provinces/territories have committed to achieve meaningful reductions in priority areas by 2007. That being said, Newfoundland and Labrador is already at or near the national benchmarks in many areas and I am confident that all partners will work collaboratively to achieve these benchmarks sooner."

In keeping with government’s commitment to openness and transparency, the department will report, on a quarterly basis, on wait time progress, beginning in February 2006.

This first set of pan-Canadian benchmarks is based on available research and clinical evidence. They do not apply to emergency procedures as patients requiring emergency care will continue to be treated on a priority basis. Additional benchmarks will be developed as further research is undertaken and new clinical evidence is produced. A wait time begins with the booking of a service, when the patient and the appropriate physician agree to a service and the patient is ready to receive it. Benchmarks are not ‘care guarantees’ or legal obligations to individual patients.

Service Area

Pan-Canadian Benchmarks announced December 12, 2005 Newfoundland and Labrador Wait Times (current)
Curative Radiotherapy Within 4 weeks (28 days) of being ready to treat. 84 percent of all cases have commenced treatment in 30 days.
Cardiac (Coronary bypass surgery)    
Level 1
Level 2
Level 3
Within 2 weeks (14 days)
Within 6 weeks (42 days)
Within 26 weeks (182 days)
87 percent of all coronary artery bypass surgery cases completed in 182 days.
Data has not been collected according to these new national urgency levels.
Sight Restoration    
Cataract Within 16 weeks (112 days) for patients who are at high risk Provincial range is from 54.3 percent in Eastern to 96 percent in Central of all cases completed in 90 days.

Data has not been collected according to risk category.

Hips & Knees    
Hip Fracture Fixation within 48 hours Data collection currently underway for hip fixation.
Hip Replacement Within 26 weeks (182 days) Provincial range is from 92 percent in Western to 100 percent in Central of all cases completed in 182 days.
Knee Replacement Within 26 weeks (182 days) Provincial range is from 70 percent in Eastern to 100percent in Central of all cases completed in 182 days.
Diagnostic Services    
Mammograms Women aged 50-69 every two years. Approximately 20,900 women aged 50-69 years had at least one screening mammogram procedure in the previous two years at one of the provincial breast screening centres. Additionally, thousands of mammograms for screening purposes are performed in hospitals each year.
Cervical Screening Women, starting at age 18, every three years to age 69 after two normal pap test. In 2003, the province launched the provincial Cervical Screening Initiatives Program with a staged implementation strategy. Currently provincial guidelines recommend annual cervical screening. In 2004/05, 43 percent of women aged 18-69 years in NL had a pap test.

Minister Ottenheimer said while benchmarks will allow patients to monitor the province’s progress, other changes are needed to enhance how wait times are measured, monitored and managed. Currently there is no provincial centralized wait list since all regions manage wait times in different ways. The minister acknowledged that physicians, other health professionals, managers and policy makers are all working together to reduce wait times.

The department recently hired a provincial wait times coordinator and is completing baseline assessment of wait times in the province. Government is working in partnership with health authorities and health care professionals in identifying challenges that exist in the health care system and working toward addressing them. Through further collaboration and investment, along with increased health promotion, government will continue to advance its vision for a reformed health care system.

Minister Ottenheimer added: "Patients can also play an active role in helping to reduce wait times by becoming informed about their options, talking to their health care providers about changes that can affect the timing of their treatments, and by living an active and healthy lifestyle to prevent the need for care."

Government invested an additional $113 million in health care funding in Budget 2005, bringing the total provincial investment in healthcare to $1.75 billion, representing a seven per cent increase over last year’s budget. $23.2 million was invested to improve access to key services. Through the purchase of equipment, modernization of diagnostic and medical equipment and the expansion of select services in all of the province’s major health care centres, government has added capacity for 43,344 MRI, CT, cardiac and other key diagnostic procedures, surgeries, as well as cancer treatments.

In September 2004, first ministers committed to establish evidence-based benchmarks for medically acceptable wait times in priority areas including cancer, heart, diagnostic imaging, joint replacements, and sight restoration by December 31, 2005. Provinces and territories announced 10 common benchmarks within the five priority areas on December 12, 2005. All provinces and territories are committed to achieving these benchmarks by March 31, 2007.

Media contact: Tansy Mundon, Communications, (709) 729-1377, 685-1741


(As distributed at the Provincial/Territorial announcement on December 12, 2005)

Provinces and Territories Establish Wait Time Benchmarks

Substantial progress is being made to improve access to health care across Canada. Canadians now have more information than ever before about wait times in their communities and today governments are establishing a first set of evidence-based benchmarks for selected health services.

Provinces and territories are committed to establishing benchmarks for diagnostic imaging, such as MRI and CT scans, but there is not yet enough clinical evidence currently available. To fill this gap, provinces and territories are seeking advice from some of Canada’s leading experts. While new evidence is being produced, each jurisdiction can set its own access targets, including some for MRI and CT scans. Benchmarks for breast and cervical screening are also being established because of the important contribution they make to detecting cancer and keeping people healthy.

Commitments in the 10-Year Plan
The 10-Year Plan to Strengthen Health Care, reached by First Ministers in September 2004, commits jurisdictions to reduce wait times in priority areas, recognizing the different starting points, priorities and strategies across the country. One of the main commitments is to establish evidence-based wait time benchmarks for cancer and heart treatments, diagnostic imaging, joint replacement and sight restoration. Multi-year targets to work towards the benchmarks will be established by each jurisdiction by the end of 2007. A second commitment is for each jurisdiction to establish comparable indicators of access to health care professionals, diagnostic procedures, and medical treatments.

As described in the agreement entitled "Asymmetrical federalism that respects Quebec’s jurisdiction," which accompanies the 10-year plan, Quebec applies its own wait time reduction plan in accordance with the objectives, standards and criteria established by the relevant Quebec authorities.

What is a benchmark?
Wait time benchmarks are evidence-based goals that each province and territory will strive to meet, while balancing other priorities aimed at providing quality care to Canadians. Benchmarks express the amount of time that clinical evidence shows is appropriate to wait for a particular procedure. They are not care guarantees or legal obligations to individual patients. For provinces and territories as the managers of Canada’s health systems, benchmarks are policy tools that can help to identify pressures affecting the delivery of care, to assess priorities for improving care, and to inform decisions about how best to allocate resources. The ultimate objective is timely and appropriate care for Canadians.

Urgency levels
The benchmarks for cardiac bypass surgery reflect three urgency levels that have been well validated by clinicians. For example, a Level I patient could have been admitted to a hospital with a small to moderate heart attack and be at risk of another larger attack. A Level II patient could have been admitted for a small to moderate heart attack and have a low to moderate risk of a recurrent attack. A Level III patient could have mild to moderate symptoms that are stable.

The benchmark for cataract surgery does not apply to all patients – only those individuals who are at high risk. For example, cataracts may be impairing the ability to treat other eye diseases or significantly impairing the ability to function without assistance.

As each province and territory works towards the common benchmarks for cardiac bypass surgery and cataract surgery, they will refine criteria for the various urgency levels to reflect their own situations.

In all cases, emergency patients will continue to be seen as soon as possible.

What is a target?
While evidence-based benchmarks apply to the whole country, targets are set by each province and territory. As agreed to in the 10-year plan, they are the interim goals set over a period of time to guide jurisdictions as they work towards the benchmarks.

What is a wait time?
To establish benchmarks, measurements are needed – we need to know when the clock starts and stops.

A wait time begins with the booking of a service, when the patient and the appropriate physician agree to a service and the patient is ready to receive it. The appropriate physician is one with the authority to determine the needed service. A wait time ends with the commencement of the service.

Using benchmarks along with other steps to improve access
Benchmarks will allow Canadians to see how well their provinces are improving access to selected health services, but they are not a cure for reducing wait times. Other changes are needed to enhance how wait times are measured, monitored and managed.

Provinces and territories are working to meet these benchmarks by:

  • Using information technology to collect data on wait times and measure progress;
  • Improving the way services are delivered to make them more efficient and patient-focused;
  • Managing access using consistent ways to assess the needs of patients and how urgently they require care;
  • Clarifying how health service organizations and health providers are responsible for enhancing access to care;
  • Evaluating access to health services and health outcomes to help determine where resources should be directed for the most effective results; and
  • Communicating clear information to the public so that Canadians can track wait times for services that affect them and measure the progress that all jurisdictions are making.

Illnesses covered by the benchmarks
Some benchmarks set goals for procedures that address one illness, such as repairing hip fractures or removing cataracts. The hip and knee replacements help patients with degenerative osteoarthritis and those with inflammatory conditions, such as rheumatoid arthritis. Cardiac bypass surgery treats patients with blocked arteries that deliver oxygen to the heart. Patients with tobacco-related coronary artery disease and complications of diabetes will also benefit from the cardiac benchmarks. The single benchmark for radiation therapy applies to a long list of cancers, including breast, lung, brain, cervical, prostate, and thyroid cancer as well as leukemia. The two benchmarks for breast and cervical cancer screening acknowledge the important contribution played by early detection. Altogether, the 10 benchmarks being established today deal with illnesses that affect millions of Canadians and their families.

What is a comparable indicator?
Indicators are used to measure how well a health system is performing. Comparable indicators have the additional benefit of allowing comparisons across health systems.

Provinces and territories are establishing comparable indicators, along with the Canadian Institute for Health Information, to track how well they are improving access to care. The focus is on the health services that now have common benchmarks, such as cardiac bypass surgery, radiation therapy for cancer, and cataract surgery.

Using these indicators, each province and territory will be able to report on access to selected health services. For example, each jurisdiction will be able to identify wait times for hip and knee replacements, and the public will be able to compare results across Canada.

What does this work mean for patients?
Provinces and territories have made many of the system-wide changes required to improve access to care. Faced with the growing demand for health care services as a result of population growth, aging, new drugs, technologies and incidence of chronic diseases, governments continue to renew their health care systems to provide quality, patient-centred care. For example, Canadians are benefiting from new models of care that make providers more accessible as well as innovative initiatives designed to prevent illness and promote healthy life styles. Benchmarks will add to these achievements by giving Canadians a way to track the steady progress that each province and territory is making.

What can patients do?
Patients can become informed about their options, speak with their health providers about changes that can affect the timing of their treatment or access to health services, be prepared for surgery on short notice in case an earlier opening becomes available, and make healthy choices to prevent the need for care and improve the results of medical procedures.

2005 12 21                             11:30 a.m.

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