Doctors fear elective surgery lists will blow out again
Victorian doctors have warned that cutting elective surgery to meet state government hospital budgets could reverse the hard work done to get waiting lists to the lowest level since the pandemic began.
In 2022 the state government announced a $1.5 billion elective surgery blitz and last October released a plan to further reduce waiting lists, including high-intensity theatre (HIT lists) that focused on single procedures such as cataract surgery or hip replacements and “Super Saturdays”.
Judith Tope, who needs an operation and is in intense pain, has been told she must wait up to two years for surgery.Credit: Simon Schluter
In May, Health Minister Mary-Anne Thomas boasted that waiting lists had hit a four-year low, with 62,228 Victorians waiting for elective surgery as of March 31 – the lowest number since 2019-20.
But some health services have now cut back on elective surgery as they scramble to make savings to meet the Health Department’s proposed budgets as the government tries to control debt.
In an email to staff last month, Western Health chief executive Russell Harrison said additional surgery – both in-house and in the private sector – would cease from July 1. “There will be no more weekend or high intensity lists for the foreseeable future,” he wrote.
Neurosurgeon Dr Patrick Lo, the former Victorian chair of the Royal Australasian College of Surgeons, said elective surgery blitzes had worked wonders, with medical staff coming in on the weekend to power through procedures.
“The waiting list has come down significantly over the last four years, but with this nebulous approach, I can only see it going up again, and my concern is that our patients will not be receiving appropriate treatment in an expedient manner,” Lo said.
“Everyone deserves to have their health come first. And if we drop the ball, then who’s going to suffer? The public. That’s what I’m concerned about. You can hear the frustration in my voice, can’t you?”
Leading Victorian orthopaedic surgeon Adjunct Professor John Cunningham said it was incredibly frustrating that some elective surgery had stopped at the end of the financial year.
He said there was uncertainty about the future.
“When the machinery of the health system is turning fast you develop a certain momentum, and it’s very pleasing for surgeons to be able to get through these cases and provide benefit to patients,” Cunningham said.
If people could afford private health insurance, Cunningham said it was a good time to consider taking it out.“The waiting list for non-urgent public patients is likely just to get prolonged.”
Melbourne ophthalmologist Associate Professor Julian Rait, the former Victorian president of the Australian Medical Association, said he was concerned about a reduction in cataract surgery at The Royal Victorian Eye and Ear Hospital.
“One of the consequences of deferring cataract surgery is that you increase the risk of falls and injuries because people who have poorer vision navigate steps and curbs much less effectively and are at greater risk of a fall or a fracture,” he said.
Delaying cataract surgery can cause other problems, as patients become vulnerable to falls and other accidents.Credit: Simon Schluter
“It’s really a false economy to hold back cataract surgery because it may have consequences for people in terms of health and safety and lead to further costs.”
The Royal Victorian Eye and Ear Hospital said it was engaged in ongoing discussions with the Health Department. “No confirmed decisions have been made regarding our overall service delivery for 2024-25,” a spokesperson said.
The Health Department said the Victorian government delivered $1.5 billion over two years to clear surgery backlogs that were built up during the pandemic.
It said some associated programs such as surgery in private hospitals and after-hours surgery were being reviewed but no decisions had been made.
“The Victorian government is investing around $20 billion in our health services over the next year alone – that’s more than 25 per cent of Victoria’s entire expenditure and includes an uplift in the price we pay hospitals for every occasion of care,” a spokesperson said.
Opposition health spokeswoman Georgie Crozier said Labor’s funding cuts would mean more Victorians who need vital surgery will have to wait longer.
Liberal Georgie Crozier says it’s clear Victorians will have to wait longer for many surgeries.Credit: AAP
“It’s Victorians who are paying the price for Labor’s ongoing mismanagement of the health system.
Labor’s priorities are all wrong when they continue to push ahead with a $200 billion rail line whilst they cut funding to health that will impact tens of thousands of Victorians who need vital surgery,” she said.
A government spokesperson said despite ongoing workforce shortages and increased demand, the surgery reforms had helped reduce the planned surgery waitlist by 30 per cent since April 2022.
“Over the past two years we have reformed the way we deliver surgery and these reforms are here to stay – opening 10 rapid access hubs, creating two public surgical centres and establishing patient support units, and we’re on track to deliver the most surgery in Victoria’s history this year,” they said.
Australian Medical Association Victoria president Dr Jill Tomlinson said health services across the state were suspending elective surgery in response to the budget constraints imposed by the Health Department.
“It is very concerning, and it makes me wonder whether the government and department have not learned from the pauses in elective surgery across the pandemic,” said Tomlinson, who is a hand surgeon.
She said a stop/start approach to delivering elective surgery was inefficient and disruptive to patients and the surgical workforce.
“We saw it across the pandemic – it actually reduced and decimated the surgical workforce, such that they then had to spend money on training people to build up the surgical workforce again.”
Judith Tope, 41, is on the waiting list with Monash Health to have category 3 (non-urgent) elective surgery.
“Recently I developed a severe bout of endometriosis where my bowel is now fused to my uterus. I haven’t been able to urinate promptly since February. I’m in pain, 24/7. I need a bowel resection plus a full hysterectomy. And they’re telling me a two-year wait,” Tope said.
Tope, who has young children and works in retail and commercial cleaning, is worried the budgetary constraints will lead to further delays.
“To think that I could be like this another two, three years ... I’m not just worried about the physical impact and my pain levels, I’m worried about my mental health as well.”
A Monash Health spokesperson said the health service’s annual budget was currently being developed in close consultation with the Department of Health to deliver the care its community needed.
A senior executive at a major Melbourne metropolitan hospital, who spoke to The Age on the condition of anonymity to protect their job, said the hospital had been told to find $150 million in savings over the next two years.
One of the proposals was to stop doing category 3 elective surgery for the next two years. Category 3 surgery is classified as non-urgent surgery that is normally performed within 12 months.
“That just blows my mind, because when we close down category 3 surgery for a month that blows the list out by hundreds. If it took two years, it would be many, many thousands of people waiting for elective surgery.”
The executive said the hospital had been conducting elective surgeries on Saturdays to clear the backlog from the pandemic.
If waiting lists blow out, it might be time to consider private health insurance.Credit: Tribune
“That will absolutely cease,” they said, resulting in less orthopedic surgery, colonoscopies and bariatric surgery procedures done at the hospital.
“I just feel as though we’re heading towards a space where it’ll be like America, where you’re really only going to be getting elective-style surgery if you’ve got private health insurance.”
Rachel David, the chief executive of Private Healthcare Australia, said there had been an 8.8 per cent increase in health insurance membership since the beginning of 2020. Membership had surged in the outer northern, western and south-eastern suburbs over the past year.
“It indicates to me that at no point did people in those outer urban areas perceive that waiting lists were ever under control in spite of the government’s measures,” David said.
“With the current funding crunch in Victoria it is likely to get worse. It really means that we’re going to have to double down and work with the government to address health inflation and inflation in our sector so we don’t have premium increases as people who are struggling continue to join health funds.”
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