5 Nov 2021
As lockdown lifts across the nation, many remain locked out of timely care.
Today, Australian Medical Association President, Dr Omar Khorshid, said that the AMA’s Public Hospital Report Card 2021 shows that even during the 2020 lockdowns, hospitals were still overwhelmed – with backsliding or barely improved performance with dramatically reduced patient volumes.
What is remarkable about this year’s report card is it shows that our states hospitals continued to struggle in 2020 even when Tasmanians stayed home, and we were not dealing with the highly contagious Delta variant or high COVID-19 hospitalisations.
What we had was a once in a generation event – a dramatic reduction in hospitalisation from accidents, injuries, and illness. But it revealed that, unless we do something dramatic to help our hospitals, this is as ‘good as its gets’ when it comes to hospital performance for Tasmanians.
Since the data in this report card was collected, volumes have not only returned to normal but grown, and for Tasmania we are yet to feel the full brunt of COVID-19 on top of it.
‘Good as its gets’ is about to get much worse.
Key findings of the AMA’s Public Hospital Report Card 2021 highlight that Australians seeking emergency treatment and classed as Urgent – that is, needing treatment within 30 minutes or less only had a one in three chance of being seen on time in the worst-performing jurisdiction.
While reassuringly, Tasmania improved its performance on measures dealing with emergency department patients, with the percentage of ED (Emergency Departments) patients seen within the recommended 30-minute period rising from 56 to 58%, however, Tasmanians hoping to be treated and subsequently exit the ED in four hours or less were in for a shock.
AMA Tasmania President Dr Helen McArdle added, “if you are in an ED in Tasmania, you lose the lottery on this front as you are more likely to still be there after four hours than if you were in other parts of the country. As, overall, the percentage of ED visits completed in four hours in Tasmania fell from 62% to 60%, continuing a period of decline in this measure since 2013-14.”
Once again, Tasmania is the worst in the country on median wait times for elective surgery; despite having the second most beds per population, Tasmania has 2.75 beds per 1000 population. With the median waiting time for elective surgery easing from 57 days to 55 days. This performance was against a backdrop of the number of patients presenting to EDs (Emergency Departments) dropping 1.4 per cent in 2019-20, a temporary reversal of the trend of 3.2 per cent year-on-year growth over the previous five years.
The percentage of category two elective surgery patients admitted within the recommended 90 days fell from 43.1% to 36.7%, continuing a sharp decline in this measure since 2017-18.
The situation for Tasmanians waiting for essential surgery is not good. While called ‘elective’ surgery, this really is essential surgery. Yet despite putting a hold on non-urgent treatments and lower ED demand, we treated only 75 per cent within the recommended timeframe for what is known as Category 2 elective surgery. This means that 25 per cent of people will wait longer than 90 days for surgeries. Worse, if you are in Tasmania, you have got more than a 63 per cent chance you will be waiting longer than that – hard to believe for a world-class health system.
It doesn’t matter where you live – you will be waiting longer than ever. Your condition will probably worsen. We need to tell the truth here – no single jurisdiction improved its performance on this measure. Not one.
With this year’s report card covering a lockdown period, it was expected that performance would improve across the board. The fact that it only improved a little, in a few places, in an inconsistent way should worry all Tasmanians. Because as demand returns, your wait times will increase.
AMA Tasmania President Dr Helen McArdle remarked, “we need to remind ourselves that behind these figures are people. People who cannot work, who are in pain, who need treatment to get their lives and their health back. Many of the country may be leaving lockdown, but Tasmanians waiting for surgery will continue to be locked out of timely treatment.
One measure of a hospital’s capacity to cope is the number of beds available for those in our community who need them.
The ratio of beds available for every 1,000 Australians over the age of 65 (the most intensive users of public hospital beds) has been on a downward trend for 27 years, and the latest available data (for the pre-pandemic year 2018-19) shows it did not improve.
Our hospital staff have worked tirelessly to prepare to tackle COVID-19 head-on. They have delivered care in the most trying and worrying of circumstances. But they do not have what they need to continue to care for Tasmanians with non-COVID-19 conditions in a timely manner and consider tackling COVID-19 as well.
But if we look closely at the data, there are signs that hospitals, if given the capacity they need, can improve. Of those urgent patients who did arrive at the ED, more were seen within 30 minutes than last year.
Fewer admissions during the lockdown led to more free beds for those waiting for admission from the ED, therefore freeing up the ED to treat those still waiting outside. That tells us that performance can be improved if we give hospitals the beds, staff, and resources to do it.
Earlier this year AMA Tasmania welcomed the Tasmanian governments commitment to additional health funding over the next four years; however, we need to see this investment continue to grow in the future into our public elective surgery program. This investment will enable more doctors, nurses, and allied health staff to be employed ongoing in the public system and new beds to be opened to ensure these waiting lists never blow out to this extent again.
A permanent increase in funding would let the public health sector better plan and resource the management of elective surgery within our state and hopefully see an improvement not only in the 2022 Public Hospital Report Card but our four hours turn around treatment for patients presenting to the ED.
Time and time again our public hospitals have served Tasmanians well. It is time we returned the favour and developed a national partnership to give our hospitals what they need to do their job. They deserve better.
Published: 5 Nov 2021