Victoria needs an elective surgery roadmap
February 28, 2022
Opinion editorial by Tom Symondson, CEO of the Victorian Healthcare Association. This article was first published in The Age on 28 February 2022.
Today is a big day for our public health system. After many months of operating at reduced capacity to ensure the sickest Victorians were prioritised for care, public hospitals have been given the green light to resume all types of elective surgery.
If you are one of the 80,000 people waiting for a procedure, this is undoubtedly great news. Before COVID-19, Victoria’s waiting list generally hovered around 45,000 people. So, there are clearly enormous numbers waiting longer than usual for treatment today.
But exactly how Victorian hospitals will catch up on this unprecedented waiting list in a new ‘COVID normal’ environment remains unclear. And unfortunately, it’s likely to take years, not months.
While the elective surgery waiting list is always a political football in state election years, the growing issue of delayed and deferred care warrants an urgent bi-partisan approach. Traditionally, state governments have sought to neutralise concern about public hospital waiting lists with ‘elective surgery blitzes’ in the lead up to an election.
But a blitz will be much harder, perhaps impossible, to execute this year. One reason for this is our genuinely exhausted workforce. Asking healthcare workers to work huge amounts of overtime, at weekends and at night, as they have been for the past two years, is not feasible after a Code Brown, where many were asked to defer much-needed leave. Many had already been without a break since 2019.
The recent Code Brown followed an extreme two years. Healthcare workers watched in horror as this insidious virus killed their patients despite their best and most valiant efforts. At the same time, they feared for their own health and that of their families. And thousands ended up sick with COVID-19 themselves.
We can’t ask our people to work any harder. There are real fears for our workers’ health and wellbeing, and any hospital CEO will tell you they’re worried about losing good staff. In New South Wales, nurses and paramedics recently went on strike over their working conditions and burnout.
Our public hospitals also need to retain the ability flex up for any future surges from COVID-19 and the flu, which has been largely non-existent due to social distancing. It’s a fine line to walk given we’re still learning about COVID-19 and could be hit by a new variant at any moment.
Another way of cutting the waiting list is to contract private hospitals to assist. While this might work in the longer term, private hospitals will be catching up on their own waiting lists in Victoria for some time. They, too, have been working at reduced capacity to ensure we had the resources and personnel for COVID-19 patients.
The other issue is funding. While the states have always been seen as the health system managers, the pandemic is a once-in-a-lifetime event that warrants more Commonwealth investment. The consequences of delayed and deferred care could far exceed the toll of COVID-19 in coming years. Fixing the backlog within a reasonable timeframe will not come cheap.
As a starting point, the Commonwealth should be funding half of all hospital growth costs for the states and territories (it currently funds only 45 per cent – a change introduced by Tony Abbott when he was Prime Minister). This would take away a major barrier for the states and territories as their hospitals recover in coming years.
We also need a plan to treat people as efficiently as possible. This requires strategic thinking and investment beyond a one-off surgery blitz. As part of our pandemic response, we created specialist hubs for testing, treatment and vaccination. We may need to apply this to elective surgery.
Earlier this month, the UK released a national plan to reduce its massive waiting list. Along with increased funding, it is creating dedicated surgical hubs to take pressure off emergency departments and community diagnostic centres to make assessments for surgery easier.
These steps are worth considering. Last week, a parliamentary inquiry in Victoria heard Victorian hospitals had varying problems with their elective surgery waiting lists because some had faced more emergency COVID-19 demand than others. This would no doubt apply to the rest of Australia, where health service performance has been hugely variable, due to COVID-19 outbreaks.
If we believe in universal access to our public health system and want timely treatment for all, it’s time for the Commonwealth to step up with funding to help the states create an elective surgery roadmap. We cannot afford to keep people waiting for treatment indefinitely, but we can’t push our healthcare workers any further than we already have. Without them, there is no health system.