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Health – Elective Surgery

Dr Rosalie Woodruff MP

Dr Rosalie Woodruff MP  -  Monday, 6 June 2022

Tags: Elective Surgery, Health

Dr WOODRUFF - Minister, I have a story from a Franklin constituent whose name is Stephen. He has given me permission to use his name and discuss his case. He was put on the public waiting list for ear, nose and throat elective surgery as a category two and he was told that he would be seen within three months. After three years and three booked and cancelled surgery dates, he finally received surgery over 1000 days after being put on the waiting list.

After two follow up appointments at around 12 weeks, post op, it was discovered that the biopsies and samples taken during the surgery had never been tested so no cause was available for Stephen's clinician to understand why he now had returned and had very severe symptoms. Stephen is back on the waiting list for surgery as a category three case and has been told to expect a 12 month wait. His breathing issues are now so severe, he has difficulty with simple tasks around the home and is scared every day.

Minister, the category one to be seen in 30 days' time average overdue days are 93.4; category two to be seen in 90 days are 235 days. Can you explain what work is being done to address those particular category one and two wait times and the significant blow outs and multiple cancellations that people like Stephen have been experiencing?

Mr ROCKLIFF - Thank you, Dr Woodruff. You have raised a matter regarding your constituent. I am very mindful that the data that is presented has a face behind each and every bit of it. I am pleased to see some improvement in key elective surgery performance indicators, albeit there is more to go.

We performed more elective surgeries in the first 10 months of 2021 22 than we did in the first 10 months of 2020 21, a rise of some 11 per cent. There was more elective surgery performed over these 10 months than the first 10 months of any financial year since current record keeping began in and around 2010 11, I am advised.

Over the past year, we have seen elective surgery waitlists reduced and, most importantly, there are now fewer people on the waitlist who are waiting longer than clinically recommended. At the end of April 2021 22, the elective surgery waiting list had reduced by more than 2650 patients from the peak we saw in January 2021.

Dr WOODRUFF - Minister, may I clarify? Are you talking about category one and two patients which is what I am talking about?

Mr ROCKLIFF - I am talking about all.

Dr WOODRUFF - So you are including category three.

Mr ROCKLIFF - It includes the category one and category two following the impact of the first wave of the COVID-19 pandemic, a reduction of some 22 per cent. This is also a reduction of 1739 patients compared to the end of 2019 20 or 15.3 per cent.

I am also pleased to let you know that over the 10 month period from the start of July 2021 to the end of April 2022, the number of over boundary patients on the waitlist decreased from 5616 to 4790, a reduction of 826 patients or 14.7 per cent, compared to the end of 2019-20. This is a reduction of some 1449 patients, or 23.2 per cent. I recognise that while those figures are encouraging, there is a lot more work we need to do. Those still waiting outside the clinically recommended time frames, I hope it provides a little bit of comfort that it is moving in the right direction. But I appreciate that more needs to be done well and truly, particularly when it comes to people having their elective surgery within the clinically recommended time frames. I am very pleased that the work we have been doing with clinicians has resulted in a four year elective surgery plan. We are expecting that to continue, given the investment we have committed to in the forward Estimates.

I have some figures regarding the number of over-boundary patients per hospital. The Royal Hobart Hospital, in 2020-21, was 2669 and it is now 2098. That is to April, those figures. The LGH, 1998 in 2020-21 and in April it is 1911. The North West Regional Hospital, 737, April 2022, 695. The Mersey Community Hospital for the financial year of 2020-21, 212, and so far this year, in April 2022, the Mersey Community Hospital had 86. Those figures add up to 5616 and 4790 respectively between 2020-21 as about and that is for April. It is heading in the right direction, albeit there is more to go.

I do have an updated waiting list number for this week, which is down. If you look at June 2021, we were 11 153 and we are now at -

Dr WOODRUFF - What waiting list are you talking about?

Mr ROCKLIFF - That is the elective surgery wait list. In June 2021, 11 153. It is now 9 414. I think that is where that 1739 figure came from that I just mentioned.

Dr WOODRUFF - The latest health dash board update shows 1157 category 1 patients in the elective surgery waiting list. Category 1, for people who are listening, are for urgent patients. We have gone back over the records of the health dashboard and previous data sources and we cannot find a time that the category 1 waiting list has been higher. How do you explain this? It is obvious that things are not improving for elective surgeries for people in the urgent category, as we understand it.

Mr ROCKLIFF - Are you talking about category 1?

Dr WOODRUFF - Category 1, urgent patients.

Mr ROCKLIFF - On the dashboard 1157, category 1. March 2022, 1145.

Dr WOODRUFF - As far we can see that is the highest it has ever been.

Mr ROCKLIFF - The figures that I have seen in front of me is April 2021, which is 1000. Yes, it is the highest in 13 months.

Dr WOODRUFF - Something that clinicians warned early on when the Government announced the plan for elective surgeries was that the Government would inevitably focus attention on the cheaper and easier surgeries and not on the patients who need the help the most. This health dashboard seems to identify that while the number of urgent patients waiting has gone up, the number of non-urgent patients has dropped by 25 per cent, or around 1500 patients. We looked at all the previous health dashboards, it's not just the last year, and the elective surgery category 1 is the highest it has ever been. So, isn't it the case that the elective surgery plan is more about a political solution than a genuine solution for the people who are in the highest risk category?

Mr ROCKLIFF - No, that is not true.

Dr WOODRUFF - What is the evidence that it is improving for people who are most urgent?

Mr ROCKLIFF - The evidence is there in terms of all the categories.

Dr WOODRUFF - That's the point my question makes.

Mr ROCKLIFF - I have to disagree with you, with respect to that matter. This has been a clinician-led, patient-focused plan.

Dr WOODRUFF - When are the category 1's going to go down?

Mr ROCKLIFF - I accept we need to have further improvements but the average overdue days waiting statewide for category 1 is coming down. In April 2021, with 107 average days waiting; it is now down to 86 days. The lowest it has been is 83 and the highest it has been is 108, back in May 2021.

Dr WOODRUFF - It is still the highest it has ever been, so we're not having cut through on the urgent category.

Mr ROCKLIFF - I am advised that clinicians determine the surgeries that are allocated.

Ms MORGAN-WICKS - Yes. The four-year elective surgery plan was developed and approved by the statewide surgical and perioperative committee, which is currently chaired by Marcus Skinner of the Royal Hobart Hospital. In terms of the allocation of surgeries, that is a matter for the surgical and perioperative departments within the hospitals.

Mr ROCKLIFF - I've met with them twice -

Dr WOODRUFF - They are always going to give recommendations within the frame of what they're capable of recommending, aren't they?

Ms MORGAN-WICKS - In terms of the very hardworking teams that are working in the surgical departments, they are making very complex decisions on a daily basis as to patients that are available for surgeries.

Dr WOODRUFF - I am sure they are.

Ms MORGAN-WICKS - I do need to speak in favour of them.

Dr WOODRUFF - I wasn't speaking against them. I was only making the point that they can only work within the framework of what they've got. It's a resourcing, capacity and flow issue which is out of their hands.

Ms MORGAN-WICKS - They have received a significant injection under the four-year plan to uplift resources and to open more operating theatres, in which additional surgery is being undertaken this year.

Mr ROCKLIFF - That is all aimed at getting that waiting list down to that sustainable level of which I believe I have said publicly before, according to clinicians and the clinical statewide surgical and perioperative committee, is that’s around 5400 at that sustainable level.

Dr WOODRUFF - Minister, at the state election last year your Government promised to tackle the elective surgery crisis and a media release said on 5 April: 'We will prioritise 2021 22 providing an extra 8300 surgeries statewide.' The extra would be on the back of the department's annual report figures for 2020 21 which were 18 192 patients. So, we'd be expecting in the order of 26 500. The dashboard so far this year shows that only 16 300 patients have had elective surgeries and even if we have heroically high numbers in May and June for the rest of the year, that is still going to leave us something like 6000 surgeries short of your election promises. Aren't these figures even more evidence that the election promise was never achievable and it was just a dishonest attempt to get voters to think you had something to offer in health that you could deliver?

Mr ROCKLIFF - The commitment at the election, if I understand it, was 22 800.

Dr WOODRUFF - The words were, 'An extra 8300.'

Mr ROCKLIFF - And then the extra 8000 was over four years, is my advice.

Dr WOODRUFF - That is not what your media release said. That is not what you told Tasmanians. That is not what the average person would have understood that to mean.

Mr ROCKLIFF - Yes, but the four year elective surgery plan and the extra funding took that up to 30 000. An extra 30 000 over four years.

Dr WOODRUFF - Tricky language designed to deceive people.

Mr ROCKLIFF - No, that's not true, Dr Woodruff. We can get that information for you. So, the clinicians said they could achieve a target of 22 800 admissions for the first year of the four year plan, however, hospitals are tracking to deliver an 11 per cent uplift in the first year to around 20 300 admissions. The statewide surgical and pre-operative services committee considers the required total of admissions over the four years to be achievable, around 20 400 admissions per year over the remaining three years.

Dr WOODRUFF - So, you standby that commitment?

Ms MORGAN-WICKS - Through the minister, I cannot speak to the actual commitment because I do not have that in front of me but I can only speak to the four-year plan which the surgical and peri-operative committee have developed and approved. The first-year target was for 22 800 surgeries to be performed. It was always a stretched target noting that the budget was handed down later in the year. They have worked very hard particularly in the first quarter of this year with additional COVID-19 load on the system to deliver and we predict over 20 300.

They are going to continue in that ramped-up state, so it has taken them time to ramp up in both resources and in infrastructure in opening an additional theatre capacity, and in the service plan we have said 20 300 - I believe that is correct - per year over the next three years to deliver the four-year plant and to try to bring the waiting list number down to 5400 which was a target that the clinicians actually have chosen as the lowest amount that they'd had in terms of elective surgery waiting list back in 2016. They actually knew the patients on the list, they could actively manage them from week to week and make sure they were bringing on the right patients for scheduled surgery.