The Canberra Liberals have accused the ACT Government of falling well short of its emergency and elective surgery goals, following the publication last month of the 2022–23 ACT Health Budget.
The government set a target that 70 per cent of Emergency Department presentations would be treated within clinically appropriate timeframes, but less than half (48 per cent) of all emergency patients were treated on time in 2021–22, despite almost 10,000 fewer presentations than the previous year (a 6.5 per cent drop).
Shadow Health Minister Leanne Castley said the ACT had the worst ED wait times in the country despite Health Minister Rachel Stephen-Smith’s promise in February last year to fix them by October 2021.
“The Health Minister has been in the job more than three years, yet she has failed to fix our appalling ED wait times like she promised,” Ms Castley said.
Canberra Health Services denied that the ACT had the worst ED wait times in the country.
“The ACT performs well in treating the most urgent patients on time,” a spokesperson said.
All Category 1 patients and 76 per cent of Category 2 patients (above the national average of 71 per cent), the highest urgency categories, were seen on time in 2020–21, according to the Australian Institute for Health and Welfare’s Emergency Department Care report.
The median length of stay for ACT ED presentations in Categories 1, 2, and 3 was consistent with, or better than, the national averages for the same period. (National comparisons for 2021–22 are not yet available.)
According to the Budget, presentations for Categories 1 and 2 were lower in nearly all months of 2021-22 compared with 2020-21. Timelines improved at the start of the financial year, but declined after January 2022 in the less urgent categories 3, 4, and 5.
This was because COVID-19 patients and staff absences due to sickness and isolation had increased pressure on the health system and the workforce, the Budget stated.
“Our hospitals and emergency departments,” the CHS spokesperson said, “continue to experience significant pressure due to a combination of patients with COVID where additional infection control precautions are required, patients who have completed their treatment but are awaiting aged care, NDIS or other longer-term care options, and higher numbers of admissions for patients with medical conditions. There is also pressure from chronic staff shortages caused by COVID, isolation, and other illness at various points throughout the pandemic.
“Despite the various challenges, the hospitals continue to manage bed capacity across the system on a day-to-day basis to ensure we can continue to deliver quality, safe care.”
The number of COVID patients in hospital put additional demand on the system, CHS stated. Despite these COVID challenges, CHS had put in place improvement programs in both EDs, and the government had provided significant resourcing to respond to the COVID pandemic across the health system.
“All health systems across Australia and the world have faced significant challenges during the COVID-19 pandemic, and we are extremely proud of the amazing efforts from our dedicated public health system staff in managing all the competing priorities during an exceptionally challenging time,” the spokesperson said.
Staffing pressures from unplanned leave is now slowing and decreasing, CHS stated. COVID leave has fallen after peaking in March and remaining high in April and May. Personal leave is now close to pre-COVID levels. Junior medical staff absences are tracking at one in 10 – a significant improvement over earlier this year, when one in four junior medical staff were on leave.
However, higher numbers of staff are taking annual leave after a long period when they were not taking leave.
“We are actively supporting this so that staff get appropriate breaks from work,” the CHS spokesperson said.
Nor, CHS maintained, was it fair to compare the ACT to other jurisdictions, as the Liberals had. Canberra’s two public hospitals with EDs service the ACT and surrounding NSW region; other jurisdictions have a mixture of busy metropolitan hospitals and small general hospitals with little waiting time.
“Direct comparison with other jurisdictions can be misleading due to the different ways jurisdictions manage presentations to emergency departments,” the spokesperson said. (For example, the ACT does not use ambulance ramping.) “The recommended comparison is peer hospital or national average results.”
Ms Castley claimed that Canberrans had been told to stay away from ED unless absolutely necessary, and ED staff approached patients and suggested they go home.
Canberra Health Services has advised that non-urgent patients seek an alternative such as their GP or a government Walk-in Centre.
“We continue to offer and promote a range of options for our community to access safe and effective healthcare,” the spokesperson said. “Our Walk-in Centre presentations have increased, and we would like to thank Canberrans for being more selective in choosing where they seek healthcare so that the emergency department is reserved for the management of those with urgent and emergency needs.”
Elective surgeries
Recent Estimates hearings revealed only 14,031 elective surgeries had been done, compared to the government’s target of 14,800, Ms Castley observed.
“It is no surprise the government is falling way short of its own ED and elective surgery targets when it has been underfunding our health system for years, and burnt-out staff are leaving in droves,” Ms Castley said.
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According to the Health Budget, 98 per cent of Category 1 (urgent) elective surgery patients were admitted for surgery within clinically recommended timeframes (30 days), nearly meeting the government’s target of 100 per cent.
But just over half (56 per cent) of Category 2 (semi-urgent) elective surgery patients were admitted for surgery within clinically recommended timeframes (90 days), well below the government’s target of 80 per cent.
Category 3 (non-urgent) elective surgery patients should be admitted for surgery within one year; the government’s target is 93 per cent, but only 79 per cent were treated within one year.
The Budget stated that the percentage of Category 2 and Category 3 elective surgery patients admitted on time declined as “long wait” patients of the same categories are admitted to surgery, as their total wait time was recorded upon admission. The relatively low result for Category 2 patients indicated that overdue patients in this category had been prioritised for surgery, consistent with their clinical urgency. Suspensions in elective surgeries due to COVID-19, and workforce shortages resulted in lengthened waitlists, waiting times, and patients falling overdue against clinically recommended timeframes. As hospitals prioritised “long wait” patients, the percentage of patients treated on time would remain below target.
COVID-19 related impacts such as a decreased workforce with the increased emergency surgery demands, impacted the delivery of elective surgery, especially during the Omicron wave (which put 500 non-urgent elective surgeries on hold).
Nevertheless, a spokesperson said that Canberra Health Services had achieved two record years of elective surgeries.
A total of 14,031 elective surgeries were performed in the 2021–22 financial year. Although 800 fewer than the target of 14,800, this was likely the second-best result for elective surgeries in a single year, Ms Stephen-Smith said in July. Canberra Hospital achieved 98 per cent, the Private Provider program achieved 101 per cent, and Calvary Public Hospital Bruce achieved 90 per cent of their overall elective surgery targets, despite the combined impacts of COVID-19 and Territory directions that non-urgent elective surgeries be ceased at Calvary temporarily.
The ACT Government has invested almost $30 million to meet its target of 60,000 elective surgeries by 2024–25. Over the next three years, the government expects to deliver almost 46,000 surgeries.
Joint replacement surgeries
The government reduced the number of joint replacement surgeries from 500 to 340, despite hundreds of people being on the waiting list, Ms Castley remarked.
Canberra Health Services explained that there would be some short-term, planned reductions to support staff training when the Digital Health Record was implemented later this year, despite the government investing extra funding to minimise disruption.
“This is a normal part of implementing health IT systems on the scale of the DHR, and will be offset by the long-term benefits for all Canberrans,” the spokesperson said.
“Joint replacement surgery activity, among others, has been planned to account for this implementation, and to ensure the most urgent patients are able to receive their surgeries. Additional joint surgeries were delivered last financial year to ensure the total planned number over a two-year period is still completed.”
