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Health – Elective Surgery Waiting List

Dr Rosalie Woodruff MP

Dr Rosalie Woodruff MP  -  Monday, 23 November 2020

Tags: Elective Surgery, Hospitals, Health

Dr WOODRUFF - More than two years ago, in October 2018, then premier Will Hodgman said the elective surgery waiting list at that point was 'not good enough'. Since then the waiting list has increased by more than 2000 patients and its last recording is 11 342 people so, minister, is that good enough and who is responsible for that deterioration and the poor result we're left with in Tasmania?

Ms COURTNEY - I thank the member for her question. Obviously the recognition of our elective surgery waiting lists was demonstrated in our commitment in this Budget, with $45 million that will provide around 8500 additional surgeries above and beyond. I am very conscious that earlier in the year in response to COVID-19 and our escalation plan we had to cease a lot of non-urgent elective surgeries, so it was only category 1 and urgent category 2 cases that were able to still proceed. This had a large impact on our waiting lists and I am very conscious, particularly from our engagement with members of the community and I know that other members of parliament have engagement with the community as well with regard to the impact that it has on people's lives. I am very cognisant of that.

Dr WOODRUFF - Catastrophic waiting times.

Ms COURTNEY - As I outlined in one of my previous answers, throughout its term the Government has made significant investments into additional elective surgery. This $45 million, as well as the money brought forward from the federal government, will have a very positive impact to our elective surgery waiting lists. I don't want to see Tasmanians languishing on waiting lists like they did under previous governments.

Dr WOODRUFF - Come off it, it's the worst it's ever been. Please don't go back six years ago, that is shameful.

CHAIR - Order, Dr Woodruff.

Ms COURTNEY - People were waiting 10 years under the Labor-Greens government. I have said that there was more work to be done. We clearly acknowledge that and this Budget has an additional $45 million through the coming years to make sure we are delivering more surgery. We'll be working through that to ensure we can deliver additional surgeries. We recognise that this is a challenge but it is not unique to Tasmania; this is a challenge facing healthcare system in lots of places. We want to ensure that people are getting the care they need it, which is why we have this additional funding.

Dr WOODRUFF - Minister, since the last election two years ago the overall waiting list for elective surgeries is up 60 per cent but the category 1 waiting list for urgent surgery is up more than 75 per cent. Why has the waiting list for urgent surgery been increasing so much more quickly?

Ms COURTNEY - With regard to the waiting lists and the clinical management of those, I'm happy to ask Dr Lawler or one of the deputy secretaries to answer about the management of waiting lists that it is clinician led. We have a team that looks at how we can deliver elective surgery in the best way for patients, noting the location, the distribution and the capacity within our system to do different types of elective surgery. I am more than happy for the secretary to provide further advice with regard to the management of elective surgery waiting lists.

Ms MORGAN-WICKS - Perhaps while I make some comments in relation to the impact of COVID-19, Ross Smith our Deputy Secretary would be able to join the table, but I ask Mr Jeffrey step back from the table, given our numbers permitted.

Ms COURTNEY - You get the clean seat, Ross. To the table for Hansard is Ross Smith, Deputy Secretary of Policy Purchasing Performance and Reform.

Ms MORGAN-WICKS - If I may comment in relation to the COVID 19 impact on elective surgery, noting on 25 March 2020 National Cabinet acting on the advice of the Australian Health Protection Principal Committee agreed all non-urgent elective surgery was to be temporary suspended. Only category 1 and some urgent category 2 surgery was to continue until further notice at that time. I also note in mid-April 2020 the North-West Regional Hospital and North-West Private were closed. This was on 12 April 2020 for deep cleaning due to the COVID 19 outbreak on the north-west coast and also had impact in terms of elective surgery schedules undertaken in that hospital.

A decision to resume some elective surgery from 27 April 2020 was made by National Cabinet and also reviewed on 15 May 2020 with category 1, category 2 and selected category 3 procedures permitted and guided by principles endorsed by National Cabinet. That included procedures representing low risk, high value care as to determined by specialists. The selection of patients who were at low risk of post-operative deterioration, given the health environment we were operating in at that time, children whose procedures have exceeded clinical wait times, IVF, endoscopic procedures, screening programs and critical dental procedures.

Regarding the Tasmanian position with respect to elective surgery during the COVID-19 pandemic, we have had to take care with respect to the monitoring of impacts of capacity of beds that are available for COVID-19 presentations at any point in time. We've also had to monitor the available pharmaceuticals available and the potential impact in terms of a critical deterioration that may require ventilator assistance that also impacts in terms of a pandemic.

Dr WOODRUFF - Thank you, I appreciate that, but none of that answers the question, which was why is the waiting list for category 1s, for urgent surgery, increasing so much more quickly? You just confirmed there was no break, no cessation in category 1 electives during the COVID-19 period. They were allowed to continue. Why has that continued to go up so much more than category 2 and 3?

Ms COURTNEY - With regards to the management of the elective surgery waiting list, this is done by clinical expertise. I am happy for Ross Smith, Deputy Secretary, to talk about that and the way we have the structures in place for that decision making to happen appropriate by the professionals in that area.

Mr SMITH - Thank you, minister. If you are looking at the indicators in the Budget Papers -

Dr WOODRUFF - The category 1 waiting list has gone up from 525 to 923, far more than the overall waiting list time, which has gone up from 7098 to 11 342. During the COVID 19 period as I understand it, the overall waiting list for elective surgeries went up 1.5 per cent, but the category 1 waiting list during the COVID-19 period went up 14.5 per cent. I don't understand and I would like an explanation for why urgent surgeries continued to go up so fast?

Ms SMITH - To be able to probably cover the same thing at each hospital those decisions are taken by clinical leaders in terms of the prioritisation of the waiting list. It was certainly the case in 2019-20 last year's surgery, whilst category 1 and urgent surgery was prioritised, the level of surgery - the volumes of surgery - weren't as great as we were anticipating. The announcement at the end of December 2019 about the additional $15 million that would assist in making sure we got higher volumes in 2019 20 was not possible through the COVID-19 restrictions. We were not able to do as much as we had originally envisaged.

That has been carried over into this year. The priority for this year through the additional state Government boost that the minister mentioned and that additional $15 million, will ensure that we are focusing very intently on making sure over boundary patients, including category 1 patients, are prioritised.

CHAIR - Ms Dow.

Dr WOODRUFF - Especially category 1. Clearly there is a problem with the clinical decisions that have been taken -

CHAIR - Order, Dr Woodruff. Please don't ignore me from the Chair.

Ms COURTNEY - I would like to make a comment. I have confidence in the decision making of the clinicians within the health system. These are difficult decisions that they have to make, weighing up a range of different bits of information to get the best outcome for Tasmanian patients. This is why I am excited about the $45 million in this Budget. This is needed and it will be very helpful. It will make a difference to many Tasmanians.

CHAIR - Ms Dow.

Dr WOODRUFF - The Treasurer told them to cut their waiting list by 15 percent, so it makes it hard.

CHAIR - Order, Dr Woodruff. The next time I try to move on and you keep talking, you will be asked to leave.


Dr WOODRUFF - Minister, last Budget August 2019 the then treasurer, Peter Gutwein, demanded budget efficiencies across all departments including the department of Health. Surgeons were directed to cut 15 per cent of their priority patients from their waiting lists. The increasing size of the waiting list which has occurred for category 1 patients and for other elective surgeries will lead to more adverse outcomes amongst this patient group. That is a medical fact. The number of people admitted as an emergency patient for the surgery that they are waiting for has surged more than 50 per cent since March between March 2018 and June this year. In the year to June, 131 patients were faced with the situation of being admitted through the emergency department for surgery for their elective surgery that had not been undertaken. In that same period the average overdue days for a category one patient also more than doubled. Doesn’t this indicate the massive growth of the waiting list is putting people’s lives at risk for what are mostly entirely avoidable reasons.

Ms COURTNEY - That is quite a broad question. The Premier has been very clear and when he was treasurer that any efficiencies that were made across departments were not being made into the frontline services. I want to make that very clear so that is something that is, it is wrong to suggest otherwise. With regards to -

Dr WOODRUFF - Excuse me, sorry to interrupt. Can you clarify that, that was not correct that surgeons were not instructed to cut 15 per cent of their waiting list that was widely reported at the time that, that was the case.

Ms COURTNEY - I am not aware of any allegations, except you raised them today. It has not been raised with me.

Dr WOODRUFF - They were widely reported in the media last year by surgeons.

Ms COURTNEY -The Premier, when he was Treasurer, made it very clear - as I did - that efficiency dividends that had been previously implemented were not around frontline delivery. This is why we are continuing to invest. We have seen, earlier in the year, $600 million further invested in Health - $9.8 billion in our expenditure in health care has been extraordinary over the last few years. Yes, we have had a response to COVID-19 but the underlying Health expenditure is increasing dramatically. We recognise there is demand there, we are responding. We want to make sure we are continuing to deliver the best health care services for Tasmanians. This Budget has $45 million to support more elective surgery so we can address some of the waiting lists.

I absolutely acknowledge we need to address the situation for Tasmanians who are on a waiting list for too long. That is what we are doing in this Budget. I know that being on a waiting list can have a huge impact on Tasmanians, and I acknowledge that. It is also why I have recently come out with Our Healthcare Future paper, which acknowledges some of the health challenges we have in Tasmania, in chronic and complex conditions, and how we can work with the primary health sector, as well as others, to look at how we can care for people better and earlier, so that conditions do not deteriorate. This is a really important body of work.

As I said previously, I think in response to Mr Tucker's question, there is a good opportunity for this at the moment. The collaboration we saw throughout COVID-19 was extraordinary. I am really grateful for the way that our state and all our healthcare professionals, both in and out of the state Government system, worked so well together. I am excited by what we can do together in the future to address some of the long-term challenges we have had in Tasmania.


Dr WOODRUFF - Minister, in October 2018, when Michael Ferguson was the Health minister, he responded to what were shocking new elective surgery waiting lists at the time by saying -

While demand is increasing, it's important to note that the percentage of elective surgery patients being seen within a clinically recommended time remains stable at 70 per cent.

Minister, is 70 per cent of people seen on time the acceptable benchmark for elective surgery?

Ms COURTNEY - With regards to the mechanism with which our benchmarks are reported and, indeed, reported within the Budget Papers, I will ask the secretary and perhaps the CMO, if appropriate. It might actually be Ross Smith who talks about those, but I want to make it clear we recognise there is a challenge. We recognise that people are on the waiting list and have been for too long and why we have $45 million in this Budget. It is an extraordinary amount of money, I am looking forward to that being rolled out as quickly as possible. I will look to the clinicians to understand what the best way to roll that money is out. I want to see a positive impact for those people waiting too long and I appreciate that particularly with the impact of COVID 19 what this has meant for many Tasmanians and their families.

With regards to some of the targets highlighted within our Budget papers I will get the deputy secretary, Ross Smith, to talk to those. I place on the record as Health minister, I want Tasmanians receiving the best quality care in a timely way that predicates and underpins our healthcare future. A document we have put out for immediate actions and consultations we know there are improvements we can make across here. We know there are improvements we can make to ensure that patients, particularly those with chronic and complex illnesses do not deteriorate. I have high confidence by collaborating across a system we can achieve better outcomes. We might go to Ross.

MS WOODFRUFF - Thank you, minister my question was about clarifying the 70 per cent benchmark.

Mr SMITH - In terms of the benchmarks every year following the handing down of the Budget in the normal cycle, the department sits down with surgical team leaders and works out the clinical priorities for how we allocate elective surgery and how we deal with the list within the capacity that exists within the hospitals. Last year, if you can look at the indicators on page 140 of Budget Paper 2, it says, whilst there has been a minor decline in the category 1 seen on time from 71.8 per cent to 68 per cent in 2019-20 and is a result of the lower levels of surgery able to be performed in that year because of the COVID 19 impact.

What we target, and what we have agreed in terms of category 1, is trying to target that 100 per cent of category 1 patients seen within clinically recommended times. With the increase in volumes funded in this year's Budget where we are targeting 19 116 elective surgeries, which is a significant increase on the 15 000 this year, it will provide a better chance of being able to look at that target. We are targeting a significant improvement in terms of those indicators through the increased volumes.

Dr WOODRUFF - Minister, the number of patients seen on time for elective surgery is now 49 per cent. Going back to Michael Ferguson's comments when he was minister at the time, he thought 70 per cent was what was required. Before the last election your Government set a goal of 90 per cent of patients in on time. This is in the Building Your Future document, your target number 24, '90 per cent of Tasmanians will be treated within clinically recommended time frames for their elected surgery by the end of the next four year term of Government'. Minister, is reaching 90 per cent still your goal? Will the money you have committed be how you get there? Is it possible to get to 90 per cent given we are at 49 per cent now?

Ms COURTNEY - As the Minister for Health I would want a target the highest proportion possible of people being seen on time. We have seen improvements when we came to Government in March 2014, out of category 3 patients they were waiting, on average 530-odd days over boundary. In June this year it was 179 over boundary. That is still not good enough but there is more work to be done and it clearly demonstrates improvements have been made. We know COVID-19 has put unexpected and unprecedented pressure on our health system. I remember standing with the federal minister, Mr Hunt, in January and bringing forward the $15 million in surgery. No one had anticipated that within a couple of months we would have ceased the majority of surgery across Tasmania for a period of time. That has had a real and significant impact. I can't understate the impact of COVID-19 on surgery for those patients, and particularly those who are continuing to wait. We have $45 million in this Budget and we also have the additional funding from the federal Government, 8500 additional surgeries.

I cannot predict how many people are going to be put on a waiting list in a period of time. However, I can charge the clinicians responsible for managing these with the responsibility to use this significant amount of money appropriately. I know the clinicians we have in Tasmania want to provide care in a timely way. I have an expectation that this money will be used and decisions will be made prudently to ensure it has a maximum positive benefit for patients across Tasmania -

Dr WOODRUFF - So you've walked away from the goal?

Ms COURTNEY - No, I have not - that is verballing me. I have said nobody predicted a global pandemic. We are committing $45 million additional funding into elective surgery. This is a strong initiative. This is an extraordinary amount of money for an extraordinary number of surgeries that will be delivered, and I am very pleased that this will have a positive impact on those waiting lists.

Dr WOODRUFF - Do you still have that as your goal?