Elective Surgery Report Card released

ACT Chief Minister Katy Gallagher has released a new ACT Surgery Report Card as part of her ongoing commitment to open government and increased transparency. The report card is attached for your information and reference.

The ACT Government has made significant progress on elective surgery, with more people than ever having operations, reduced waiting times and fewer people on the waiting list. The volume of surgery has increased and there has been a reduction in the number of people waiting for surgery longer than clinically recommended time period. There was a 16% increase above last financial year's performance which means 11,336 people from the ACT and NSW had their operations in 2010-11. They also outsourced about 150 surgeries to the private sector in an attempt to improve access for consumers.

The Government deserves to be commended for this work. 

The health care is a complex system and it is not as simple as completing more surgery.  Surgery is one part of the health system and capacity for surgery is dependent on operating theatre access, surgeons, nurses, anaesthetists. Surgery is also dependent on having wards for recovery and rehabilitation programs.  For example, someone having primary joint replacement (ie, knee or hip) requires a place in rehabilitation program to recover and regain full movement.  If there are not places available in the rehab programs then surgery cannot be done.  From the consumer perspective we want to have a coordinated approach to surgical admissions so that we have the best opportunity to have treatment and recover.

Kerry Burton is working with HCCA on the National Access Program.  Kerry is interested in collecting consumer stories on elective surgery.  Kerry can be contacted at the HCCA office Monday to Thursday.

What is the National Access Program?

The ACT Government is currently involved in large scale clinical redesign and health service planning to underpin an ambitious capital works program. This is a significant body of work for and has great potential to bring about structural changes to clinical practice, and to improve efficiencies as well as health outcomes for consumers. HCCA is committed to working with the Government to provide independent, effective consumer input in the developing solutions to intractable.

In April 2010 the Council of Australian Governments agreed to sign the National Health and Hospitals Network Agreement. The reforms outlined in the Agreement are designed to drive major improvements in service delivery and better health for patients, whilst equipping the health and hospital system to serve the Australian community into the future.

The agreed reform program will change health funding. This funding will be linked to health performance targets, known as the National Access Targets. 

They are:

• the 4 hour access target - 95% of all clinically appropriate presentations to emergency departments will have been assessed, treated and either admitted, transferred or discharged within 4 hours of arriving at the emergency department.

• the elective surgery access target – 95% of all people accessing elective surgery should be admitted for surgery within clinically recommended times.

To meet these targets, ACT Health has established the National Access Program to develop and implement the required structures and processes within hospitals in the ACT. The goals of this program of work are to support the delivery of safe and effective care for patients, regardless of the hour of the day, aiming to have the right person in the right place at the right time to meet these targets.

HCCA has received funding for a Consumer Coordiator to work with policy makers and clinicians to ensure consumer perspectives are included in this work.

Expanding Hospital Services in the ACT - ACT Government discussion paper

The ACT Government has released a discussion paper on five options for enhancing hospital services in Canberra.  Each option would deliver an extra 400 beds and range in cost from about $690m to $795 million.  We are pleased to see that the HCCA proposal to include a sub-acute facility has been costed and included as an option (Option E).  Another option (B) is to consolidate services in a 'super hospital' at Woden but the Minister went on the record in early February saying that this is an unlikely option.

The discussion paper is a good start to the conversation and we encourage people to read the paper. This is available in the Community Consultation section of the ACT Health website. 

HCCA is interested to find out more about the type of beds that are being proposed.   We spoke with the ABC this week about this.  A story is available on the ABC website.

A six week consultation period will run from 25 February 2011 – 14 April 2011.  Community consultation fora will be announced soon.
 
This has been a long running issue.  The ACT Legislative Assembly referred to the Standing Committee on Health, Community and Social Services for inquiry and report the proposed four new options for future ownership and management arrangements of Calvary Public Hospital, put forward by the Minister for Health on 19 August 2010.  HCCA appeared before the Committee and made a submission (350 kb Pdf).  The Standing Committee will report to the the Legislative Assembly at the end of March.
 
HCCA is currently considering the discussion paper and will prepare a comprehensive response.  We are interested to hear your views.

ACT Auditor-General’s Report into Waiting Lists for Elective Surgery and Medical Treatment

On 17 January, the ACT Auditor-General submitted the Performance Audit Report titled ‘Waiting Lists for Elective Surgery and Medical Treatment’ to the Legislative Assembly. 

Russell McGowan was interviewed by ABC News on the recommendations included in the recently released report on waiting lists by the ACT Auditor General. This news story is available online.

Australian Hospital Statistics for 2008-09 showed that elective surgery waiting times had worsened in the ACT. Allegations had been made about possible manipulation or mismanagement of the elective surgery waiting list and that some patients had been downgraded to lower categories.

The objective of the audit was to provide an independent opinion to the Legislative Assembly on whether:

• information on waiting lists published by ACT Health was complete, reliable and timely;
• ACT Health effectively managed the elective surgery policy and related systems and procedures to promote clinically appropriate, consistent and equitable treatment of patients in public hospitals; and
• access to medical services (non-surgical) was effectively managed and timely.

The Report found waiting lists had not improved despite extra funding from the Federal and ACT governments. The Performance of ACT Health in the management of elective surgery waiting lists in the recent years was below other jurisdictions, and no improvement had been recorded for most key performance indicators over time.

The Audit acknowledged that management of the waiting lists for elective surgery and medical treatments was a complex process that could be influenced by practices of various parties within the system, including doctors, and by a number of factors, some of which were outside the control of ACT Health.

It also noted that Canberra’s public hospitals provide emergency and elective surgery to ACT residents and those in surrounding areas. As most emergency surgery was conducted at TCH, the pressure of delivering emergency surgery also impacted on the delivery of elective surgery.

The Audit found that, overall, elective surgery waiting lists were administered in the ACT within a sound framework of policies, guidelines and procedures. However, ACT Health’s implementation and monitoring processes were not managed well to deliver the intended outcomes.

From consumer perspective, the findings of the report are obviously concerning and disappointing. Obviously, it is unacceptable that some patients have not been added to waiting lists for months because of a communication failure between clinical staff and the hospital booking office, as indicated in the report.

HCCA has long advocated for a single patient administration system across The Canberra Hospital and Calvary, integrating the two hospitals’ databases to better manage waiting lists across the ACT. We welcome the fact that ACT Health is working on this and keenly await its implementation in October next year.

The Audit’s findings are timely. The ACT Health Elective Surgery Access Policy, referred to in the audit, is currently under development. HCCA recently commented on the draft policy and this Audit gives ACT Health the opportunity to further improve its policy for the benefit of consumers as well as clinical staff. The Audit is relevant for inclusion in the ACT Health Patient & Family Centred Care Discussion Paper 2011, which is also under development.

The ACT Government’s response has been positive: it has accepted the majority of all 11 recommendations and HCCA will be closely monitoring its progress in implementing them.

A full copy of the Performance Audit Report Waiting Lists for Elective Surgery and Medical Treatment, is available online (1.18Mb, 95 page document). 

Karen Jameson

Policy Officer