Hospital crisis: Covid’s new curse lies in wait

Elective surgery backlogs in public hospitals could reach half a million by June in worrying new data from the Australian Medical Assocation.

Concerning data from the Australian Medical Association show a significant decline in elective surgeries, with a backlog to hit half a million by June.

One in every 50 Australians faces being stuck in growing elective surgery backlogs at public hospitals that could explode to half a million patients by the middle of this year unless urgent action is taken, doctors have warned.

New analysis by the Australian Medical Association shows waiting lists have hit record levels and workforce constraints are hampering states’ ability to clear the logjam of operations suspended during Covid-19.

Despite an uptick in activity levels in late 2020 and the first half of 2021, the number of surgeries performed has plunged to a 10-year low in latest national figures.

The number of patients admitted for elective surgery in public hospitals in 2021-22 dropped by more than 130,000 nationally from the previous year, the lowest in a decade. Only 623,000 patients were admitted for surgery in public hospitals nationally, an 18 per cent decline from the 758,136 patients admitted in 2018-19 prior to the pandemic.

 

A new report by the AMA has calculated what it says is the backlog of patients who should have been admitted for elective surgery but either languished on a waiting list, could not get a timely outpatient appointment, or simply gave up on the system and put up with injury and pain.

The estimated backlog taking into account all of these patients is far greater than official wait list figures indicate, with many of the patients for long periods of time unable to get a referral to even be placed on a waiting list.

The doctors’ group estimates the elective surgery backlog that grew exponentially during the pandemic totalled more than 306,000 people six months ago and is set to hit 508,000 if last year’s pace of elective surgery does not increase substantially.

The backlog represents the difference between the actual surgeries performed and those that would have been performed had usual activity kept pace with an annual growth rate. A backlog of half a million ­patients would take eight months to clear even if no new ­patients were admitted.

AMA president Steve Robson said: “This is a horror figure. We are now at a critical point where access to timely elective surgery is out of reach for many Australians.”

The figures have prompted the AMA and other medical leaders to warn of a Britain-like crisis in hospital waiting lists and a need for Anthony Albanese and ­national cabinet to urgently reform the funding model for the health system.

The number of surgeries performed has plunged to a 10-year low even after a post-Covid uptick.

The report’s release comes as the Australasian College for Emergency Medicine revealed figures that indicated emergency departments were critically understaffed with managers unable to recruit and an exodus from the profession due to unsustainable working conditions.

A national survey conducted by ACEM showed average ­national shortfalls in public hospitals of 28 per cent for specialist emergency department trainee roles, and 30 per cent for junior medical officers. Some rural and remote areas reported emergency staff shortages as high as 85 per cent for specialist trainee roles. ACEM president Claire Skinner said some rural emergency ­departments were on the brink of having to close.

The survey followed a public plea by Britain’s Royal College of Emergency Medicine to Australia’s leaders to learn lessons from what is being described as the collapse of the chronically underfunded NHS in Britain.

Half of all Australians rely purely on the public system for their healthcare. More than 6 per cent of public patients nationally now wait for longer than a year for their surgery, compared with 1.8 per cent five years ago. ­Although nationally elective surgery increased in 2020-21 to pre-pandemic levels, hospitals have not been able to catch up. Victoria is faring the worst, with the AMA’s analysis finding it accounts for 44 per cent of the ­national elective surgery backlog.

The AMA elective surgery report calculated the surgery backlog in public hospitals by subtracting actual elective surgery admissions from what would have been the estimated admissions under pre-pandemic activity levels, taking into account an annual growth rate.

It said a significant amount of the backlog was made up of patients who had not even been added to official waiting lists because of a critical lack of outpatient services where referrals must be provided by specialists.

AMA’s president said the 18 per cent drop in surgeries is a ‘horror figure’ and that elective surgery was now out of reach for many Australians.

This was indicated by the fact not only had surgeries ­performed plummeted, but the ­numbers of patients added onto waiting lists nationally had also declined by more than 12 per cent. Elective surgery suspensions did not fully account for the drops in activity.

“It is likely that other factors are contributing to this backlog, including a backlog in hospital outpatient appointments, workforce shortages and furloughing of staff due to Covid-19, and hospitals simply not being able to expand their capacity to meet demand,” the report found.

Nationally, one in five patients needing tonsils out or a hip replacement has been on a waiting list longer than a year, latest Australian Institute of Health and Welfare data shows, while almost one in three of those needing knee replacements has been waiting longer than year.

Former Australian Orthopaedic Association president ­Michael Gillespie said many people were waiting for months in agony. “People with arthritic hips and knees will tell you it’s a ­massive disability and a huge drain on the community looking after them while they’re waiting for surgery,” Dr Gillespie said. “Wait times have always been unacceptably long and now it’s only been made worse.”

 

The AMA is calling for an ­urgent national plan to address the surgery backlog with funding to allow hospitals to permanently boost their capacity. The AMA is calling for a specific national agreement on elective surgery backed by long-term funding commitments from commonwealth and state governments that deliver permanent ­additional capacity in public hospitals. These would include upfront advance payments provided by the commonwealth with a ­particular focus on workforce and ­expanding the capacity of outpatient services.

Federal Health Minister Mark Butler’s office indicated current agreements, in which the commonwealth contributed elective surgery funding on an activity basis, were adequate, together with the states’ ability to draw on the resources of private hospitals under contracts.

A Victorian government spokesperson said the state had invested $1.5bn into its Covid Catch Up Plan to “lay the foundations to do more elective surgery permanently”. It has promised to build up to perform 240,000 surgeries every year by 2024, 40,000 more than pre-pandemic levels. The NSW health department said the state’s public hospitals had performed more elective surgeries than any other jurisdiction in 2021-22.

The Grattan Institute’s health and aged care program director Peter Breadon said: “It’s absolutely true there is a big backlog,” said. “Hospitals are under a lot of pressure, and there’s still thousands of patients in hospital with Covid. So resolving this backlog does require a bit of a medium and long-term plan.”