9 December 2003

MANY PATIENTS STILL WAITING TOO LONG FOR ACCESS TO ELECTIVE SURGERY

Four years on from his 1999 examination of surgical services in WA hospitals, Auditor Des Pearson has revisited the issue of access to elective surgery and waiting times.

His report "Patients Waiting: Access to Elective Surgery in Western Australia", tabled in Parliament today, concludes that patients are still waiting too long, with average waiting times for elective surgery remaining constant at around 4½ to 5 months.

Mr Pearson finds there is still much that can be done to reduce waiting times - though he acknowledges the efforts made by the health system over the past four years to improve access for elective surgery patients in the face of resource restraints, increasing demand pressures, a shortage of fully-trained surgeons and nurses, and higher bed occupancy at teaching hospitals.

The report shows that many people are still waiting longer than clinically desirable for their procedures:

• 35% of elective surgery patients had waited longer than the maximum recommended time - some urgent patients had been waiting longer than 6 months, the recommended time being 30 days.
• 47% of semi-urgent patients are waiting longer than the clinically desirable time of 90 days.
• In 2003 there were 1,050 patients who had waited longer than 1000 days, including 280 patients who had been waiting more than five years.

Compounding this situation were high occupancy rates in hospitals, with the consequence that unexpected emergency admissions could result in patients having their surgery deferred, sometimes at the last minute.

Most of the pressures for surgery were in the teaching hospitals, where the waiting time averaged nearly six months over the last four years.

In response the hospitals had introduced a number of measures to improve access, including increased same-day surgery, day of surgery admission and improved bed management, however, Mr Pearson suggests additional measures, such as making more use of non-teaching hospitals and scheduling elective surgery more evenly throughout the year, could be taken.

In reviewing the information held by the Central Waitlist Bureau, Mr Pearson found that the publicly reported waiting list information includes only those procedures in the definition of surgery used by the Australian Institute of Health and Welfare - meaning that effectively the reported list represents only 13,500 of the 29,000 patients waiting for elective procedures.

The reported list excludes a wide range of procedures such as colonoscopies, various endoscopic procedures, procedures associated with obstetrics, and gastroscopies, and also excludes patients at most country hospitals.

Further, publicly available waiting time information does not currently include the time between visiting a GP and subsequently being put on the waitlist.

Consequently, patients do not know the full waiting time for their procedure, nor do hospitals have a true picture on which to make resourcing decisions.

The Auditor General also expresses concern that the Department of Health does not have a single set of comprehensive guidelines on waitlist management that can be used by all hospitals or a set of guidelines for specialists to help ensure a consistent categorisation of patients into the various urgency categories and monitoring of urgency categories (as is the case in some other States).

Ends/.

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