The Canadian province of Ontario is thousands of miles away, but the problems facing its health care system all seem remarkably similar to the situation in England:
- Chronic underfunding of public health care (while Canada spends more on health than the average for OECD high income countries, Ontario spends the least per head of any province);
- Millions being pumped in to expand private provision of diagnostics and simple elective surgery, while spending on public hospitals is constrained;
- Stubbornly high waiting times in emergency departments, with problems discharging frail older patients after treatment.
One significant Ontario problem that has not (at least so far) been reported in England has been that patients referred to private providers are being persuaded to stump up payments in addition to the fee paid on their behalf by Ontario Health. Campaigners argue this is illegal.
A report from the Ontario Health Coalition found that although Ontario’s Premier Doug Ford promised that residents would never have to pay with their credit card at private clinics, and everything needed for cataract surgery should be covered by the government-run Ontario Health Insurance Plan:
“patients have been deliberately upsold on unnecessary procedures during privately operated cataract surgeries – sometimes walking away with bills as high as $8,000. People shouldn’t be put in a position where they’re being manipulated into paying thousands of dollars because they think that their surgery will have poorer outcomes if they don’t, or because they’re just plain lied to.”
Other problems are strikingly similar. As in England, the geographical distribution of the new private clinics and MRI scanning in Ontario is profoundly unequal: much of the population to the north of the province lacks any private provision, leaving people to wait longer for under-funded public services.
Private clinics are also paid more ($605) per cataract operation, and a private hospital more than twice as much ($1,264), compared with the $500 paid to public sector providers. So for the cost of every five private clinic cases the public sector could provide six, and for every six cases sent to the Don Mills Surgical Unit the public sector could deliver 15.
This is one of the reasons why researchers have found that the expansion of new private providers has brought virtually no change to waiting times for cataract treatment (up one day to 68 days) while delays for MRI scans went up by 35%, to 47 days.
A study by progressive think tank Canadian Centre for Policy Alternatives found that as more services were outsourced, median waiting times for eight out of 12 priority procedures increased between 2017 and 2025.
The delays are increased by the lack of funding to keep the main public hospitals going – leaving deficits rising and publicly funded scanners and Operating Rooms under-used – while resources have instead been devoted to establishing additional private units, run for profit.
Natalie Mehra, executive director of the Ontario Health Coalition, revealing the results of a new survey on utilisation of resources, said:
“We made formal information requests of the hospitals across Ontario and found that the majority of Ontario’s public hospitals have operating rooms that are closed the majority of the time.
“We also found significant unused MRI capacity in every single region – that is hours that the MRIs are not used to do scans for patients.”
As of June 2026, the wait for non-urgent CT in Ontario averaged 79 days (target 28 days) and non-urgent MRI averaged 101 days (against a 28 day target). Only 20 per cent of MRIs were delivered within target – while ten percent waited over 214 days.
Waiting times for elective surgery in Ontario, averaging 19.2 weeks, are currently the best of the Canadian provinces, and not so different from England.
But the province’s waiting times for emergency care and admission are disastrously long – and far worse than the figures we complain about here.
It was bad enough in 2020-21, when one in ten emergency admissions waited over 29 hours for a bed. But by 2024-25 that had jumped to 44 hours.
In May Niagara Health indignantly refuted allegations that patients were waiting 3 days or more in the ER. They insisted on putting the real figures:
“Our most recent data shows that 90 percent of patients are assessed, treated and, where needed, a decision to admit is made in 15.3 hours or less.
“For those who do require admission, the total average time to move to an inpatient bed is 56.4 hours.”
The long delays are, like the A&E delays here, a result of hospitals being unable to discharge frail, older patients for lack of adequate care at home or in community or care home settings.
England’s population of older people (65+) is estimated at 11.2m – 18.9%: Ontario’s proportion of 65+ people is just slightly lower, at 18.6% (3 million).
The long delays in ERs bring another grimly familiar problem: what we call ‘corridor care’ is branded ‘Hallway medicine” in Canada, with huge numbers of patients parked for hours or days on end in hallways, closets and other inappropriate areas. Ontario is the most populous province in Canada, with a population of just over 16 million. This is less than double the population of London: but Ontario at peak times has almost the same number of corridor cases as the whole of England – with a population of 59 million.
In May this year the first official NHS figures for corridor care were published, showing a daily average of 2,242 patients stuck on trolleys, waiting for a bed. Ontario’s hospitals racked up an average of over 2,000 patients enduring “hallway medicine” in the first two months of 2025, and averaged close to 2000 for January 2026.
The financial squeeze is growing tighter: in May more than 70 per cent of Ontario hospitals were forecasting deficits – and Health Minister Sylvia Jones told them to come up with three-year plans to balance their budgets. Ontario trails all other provinces in total health care spending per capita.
In October 2025 the Financial Accountability Office of Ontario (FAO) warned that the 2025 budget spending plan was below expected costs by $3.4 billion in 2025-26, by $6.4 billion in 2026-27 and by $9.6 billion in 2027-28. Even before Trump’s pointless war on Iran had forced up fuel prices and given another boost to global inflation this meant:
“the Province will need to implement health sector efficiencies (i.e., provide the same level of services with less resources) and/or commit additional funding to the health sector to maintain 2024-25 service levels.”
The cutbacks take a familiar form – closing beds, reducing numbers of qualified staff, and seeking to replace them with cheaper, less qualified staff.
The FAO Spending Plan Review in September warns that, based on the 2026 budget health sector spending plan, the funding constraints would call for a reduction of 2,407 in funded acute hospital beds in the province (almost 7%) by 2028-9, even though Ontario already has the lowest provision of beds per head of the Canadian provinces.
However the growing elderly population means an extra 6,196 (7.5%) long-term care beds would be needed, and even that would lag behind the rising numbers.
And while the FAO warns that there would only be sufficient funding for 2,522 fewer provincially funded nurses in acute hospitals, the long stay beds would require an additional 3,455 Personal Support Workers (PSWs).
The financial pressures have already forced hospitals across the province to make cutbacks in staff numbers – piling added pressure on the staff left behind.
In early September the Ontario Nurses’ Association (ONA) was tracking staff cuts across 14 major health-care facilities.
The ONA has demanded answers from the Ford government and Health Minister Sylvia Jones following the announcement that St. Joseph’s Health Care (in London Ontario) is cutting more than 120 registered nurses. This is part of an escalation of staffing cuts across the province – including hundreds of RN cuts at London Health Sciences Centre – hurting whole communities.
Hospitals in Hamilton-Niagara have cut at least 617 hospital jobs since the end of last year, plus another 140 jobs cuts through the closure of long term care beds.
Charting the decline of staffing levels and services across the province has been made much more difficult by a bill passed earlier this year which limits the scope of freedom-of-information requests. The legislation (which is retroactive to 1988!) prevents future requests and also kills off many requests that were already being processed.
However at the end of October the ONA had received official notification of more than 1,900 registered nurse and health-care professional position cuts since January 2025: that totals 3.1 million hours annually of lost care across the province.
The ONA is calling for the implementation of mandatory nurse-to-patient ratios and demanding that the Ford government impose an immediate moratorium on registered nurse (RN) and health-care position cuts. Perhaps it’s time for a similar fight in England.
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