TORONTO -- On any given day, at least 1,000 people are being treated in Ontario hospital hallways, according to the special adviser on health care, who says "tough decisions" will be required to fix the problem.

The first report from Dr. Rueben Devlin and the premier's council on improving health care says hallway medicine is a significant problem in Ontario.

The next report is set to contain a series of recommendations, but some themes identified in the first document include a greater need for innovation and efficiency to decrease hospital overcrowding.

"Tough decisions will be required to address the challenges facing our health-care system, while we continue to champion the health-care professionals already leading great work in our communities," Devlin writes in the report.

Ontario's health-care system can be characterized as decentralized, large and siloed, noting there are 21 health-related government agencies supporting the design and delivery of health care in the province, the report says. Recent media reports have indicated the government is considering shutting down those agencies and folding them into one super agency.

The 21 agencies are not always well-aligned "and there is limited strategic oversight to ensure the efficient and co-ordinated use of resources," the report says.

Eliminating hallway health care will require dealing with other areas where people get treatment, which could prevent some of the admissions to hospital, Devlin said.

"Hallway medicine is not a hospital issue, it's a systems issue," he said in an interview. "We know that we need to improve on primary care, we need to improve on access to long-term care, better home care and a real focus on mental health and addictions."

A government health-care survey found that 41 per cent of people who went to the emergency department could have been treated by their primary care doctor, and just one-third of hospital patients are admitted to an in-patient bed from the ER within the eight-hour target.

"Overcrowding of the emergency department means Ontarians whose care can only be provided in an emergency department are waiting longer to access the health care they need, and are sometimes waiting in unconventional locations -- like hallways," the report says.

The report defines hallway beds as those in hallways, emergency department stretchers or other unconventional spaces such as alcoves. Those spaces are not properly equipped to treat patients, Devlin said.

"Patients want to be treated with dignity and if you're in the hallway for two days, it's not a great place to be," he said.

One way of measuring use of space is looking at how many people are waiting for care in another setting, and in October, almost 16 per cent of days spent in hospital were by patients waiting for care elsewhere.

The largest proportion of that is people waiting to be transferred to long-term care, the report says, where the average wait time to access a bed is 146 days.

Natalie Mehra of the Ontario Health Coalition said claiming that those patients waiting for other spaces are blocking beds is a partial one, at best, and Ontario needs more hospital beds.

"What happens in Ontario's overcrowded hospitals is that all the beds in the wards are full because so many beds have been closed down," she said in a statement.

Another area in which it the report identifies problems is mental health. About one in three adults who went to the emergency department for mental health or addictions care hadn't previously seen a doctor for their mental illness, the report says.

Even though most mental health issues are best treated in the community, long wait times for that treatment sometimes mean that a patient's condition worsens while they wait and they have no other option than to go to the emergency department, the report says.

Health Minister Christine Elliott thanked the council for the report and said in a statement that the government is committed to creating a health-care system that works for Ontarians.

The Ontario Hospital Association welcomed the report and said system transformation is essential to ending hallway medicine.