Patient care must not be compromised by bureaucratic benchmarks

Every three months, the residents of NSW are given a status update on the performance of their state’s public health system.

The quarterly Bureau of Health Information report paints a picture of how the system is functioning, from the number of ambulance call-outs to wait times in emergency and how long the average patient stays at hospital.

Of particular interest since the pandemic – and covered exhaustively by the Herald – has been the elective surgery waitlist, which rose to record lengths when COVID-19 precautions caused the postponement of thousands of non-urgent operations.

In the 2023 state election, NSW Labor ran on a platform of reducing the elective surgery waitlist, announcing a surgical taskforce to investigate ways to clear the list, sparing patients from the poor health outcomes that can come from waiting longer than recommended for life-changing operations, including hip and knee replacements, eye surgery, and cardiothoracic procedures.

By the end of that year, the number of patients overdue for surgery had declined to pre-pandemic levels.

But, as the Herald reported following the release of the latest BHI quarterly data in March, the number of patients overdue for elective surgery in NSW public hospitals tripled between the end of 2023 and the end of 2024.

While nowhere near the 18,000-person waitlist left after NSW’s Delta lockdown in late 2021, such a sharp upward trend in the number of people waiting too long for operations has not been seen outside of periods of pandemic restrictions. Eye surgeries, joint replacements and tonsillectomies were the procedures with the largest backlogs.

Doctors speaking about the release of those figures put the increase down to staff shortages and budget cuts. But, as Herald health editor Kate Aubusson reports today, doubts have been cast over whether the pressure to meet KPIs at some hospitals had led to surgeries being strategically categorised, so they did not appear as overdue on the books.

Among the allegations made by doctors at Sydney’s RPA and Westmead hospitals, which follow an ABC investigation into similar behaviour at Orange Hospital last month, are that hospitals have been effectively refusing patients because they will not be able to perform their surgery within the recommended timeframe, or changing the categories of patients.

It is excellent that NSW Health provides such detailed information about its system’s performance to the public. The data provided by the BHI through its online data portal is significantly more detailed and timely than comparable figures provided in other states.

But it is important that this information is a true reflection of public healthcare in NSW. Of particular concern are the allegations that patients experiencing serious conditions not captured by these data sets – including paediatric dental patients – are missing out.

As senior Sydney clinicians told Aubusson: if patients are waiting overdue for surgery, hospitals need better resources, not to be bumped from the waitlist. Patient care must not be compromised by bureaucratic benchmarks.

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