What the Tasmanian Liberals will do:

Put a stop to endless waiting for elective surgery.

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In 1998, the State Labor Party promised to reduce waiting lists, but today there are thousands more Tasmanians on waiting lists and Tasmanians wait much longer than the national average.¹

At the end of May 2009, there were 4,094 Tasmanians who had been waiting longer than clinically-recommended times – more than half the waiting list.  Of the 4,094 ‘over boundary’ cases, there were 2,847 waiting at the Royal Hobart Hospital, 875 at the Launceston General Hospital, 292 at the North West Regional Hospital in Burnie and 80 at the Mersey.²

It is clinically recommended that:

• Category 1 patients are admitted within 30 days as their condition has the potential to deteriorate quickly;
• Category 2 patients are admitted within 90 days as they have a condition causing pain, dysfunction or disability; and
• Category 3 patients are admitted within 365 days.

Waiting longer than clinically-recommended for elective surgery often means increased pain, worsening symptoms and frequent GP visits (sometimes forcing GPs to close their books to new patients).  Often those waiting will present as emergencies to our hospitals, and some waiting for surgery will die.  There were four deaths of patients waiting for cardiac surgery in 2008-09.³

“We do know people who have been on elective surgery waiting lists become emergencies”
(Health Minister, Lara Giddings, Budget Estimates, 23 June 2009)

In the year to May 2009, only 72% of Category 1 patients, 51% of Category 2 patients and 68% of Category 3 patients were admitted within clinically recommended times.

In Tasmania, in the year to June 2008, there were 2,886 patients who waited more than a year for surgery, and of those, 173 waited longer than 500 days.⁴

The Federal Government’s State of our Hospitals Report 2009 shows the number of Tasmanians waiting longer than a year for surgery was 10.1% compared to 1.8% in New South Wales and a national average of 3.0%.

This is totally unacceptable and totally unfair to Tasmanians.

“Our performance on elective surgery at the Royal Hobart Hospital has been lacklustre to say the least …”
(Acting CEO of the RHH, Michael Pervan, in evidence to the Parliamentary Inquiry into the Public Hospital System, 2009)

The Tasmanian Liberals will –

• Provide surgery in private hospitals for public patients who have been waiting longer than the clinically recommended timeframe.

Your operation on time or performed in a private hospital at no cost to you

Under the Liberals, if you need an operation and you can’t get it done within clinically-recommended timeframes in a public hospital system, you’ll get it done in a private hospital at no cost to you.

By transferring patients who have been waiting longer than clinically-recommended timeframes to a private hospital for their surgery, the Liberals’ plan –

• Acknowledges that the sooner people have their surgery, the better health and quality of life they can enjoy;
• Reduces the stress of endless waiting on patients and families;
• Helps take the pressure off our public hospitals;
• Helps take the pressure off our GPs, ensuring more can see new patients.

How will it work?

The Liberals will form a strategic partnership with the private hospital system in Tasmania to help reduce endless hospital waiting lists.

We will work from the ‘back of the list’ to ensure those waiting longest get their operations first in a private hospital.

The Liberals’ partnership with the private hospital system will be evaluated after a two-year period, and if the partnership is delivering for Tasmanians and remains cost-effective, it will be continued.

Under the Liberals’ plan it is our preference that public patients recuperate in a public hospital bed after surgery.

Government data already captures those waiting beyond clinically-recommended timeframes. Those who have been waiting longest will be contacted and their operation will be arranged with their local private hospital.

In the majority of cases, they will be able to keep their own specialist as most specialists in Tasmania work in both the public and private hospital system. 

Will doctors support this?

Many doctors feel frustrated they are unable to get as much theatre time as they would like in a public hospital.  We believe doctors will welcome the opportunity to get better results for their public patients and will actively participate in this scheme. They are equally frustrated with the current backlog. Doctors will receive fair reimbursement for participating.

Can our private hospitals provide this service?
Private hospitals in this State have the capacity and ability to partner the State in the effort to reduce hospital waiting lists.

Of the 660 diagnostic categories of patients treated in acute public hospitals, private hospitals can treat 653 of these categories. The exceptions include transplants, bypass surgery (in Tasmania) and neonatal cardiac/vascular surgery.

“The public system … is geared towards acute medicine. The private system on the other hand does elective surgery very well … so let us build on the strengths that different systems have”.
(Dr Geoffrey Couser in evidence to the Public Hospital inquiry, 2008)

Won’t this deter people from retaining their private health insurance?

No, private cover provides immediacy. This policy provides hope. Privately-insured patients will still take precedence in a private hospital and will not have to wait.  Public patients will have to wait for at least the clinically-recommended timeframe before having their operation in a private hospital because the Liberals’ plan takes those public patients from the back of the list first.

Further, it is our preference that patients be transferred back to a bed in a public hospital for recuperation once they have received their surgery.

What is the cost?

The Liberals’ plan is capped at $10 million over two years.

The Liberals’ plan complements the work of public hospitals who will still be undertaking the full range of elective surgery.

We are not taking elective surgery away from public hospitals, but our private hospitals will work simultaneously on elective surgery, taking the pressure off public hospitals.  The beneficiaries will be Tasmanians who need their surgery sooner rather than later.

Will it help GPs?

Yes.  Through our consultations with GPs, we know that doctors are getting increasingly frustrated as their patients become sicker while waiting longer for elective surgery.

GPs can often spend a good part of their day (unbillable hours) ringing the hospitals advocating for their patients.  This means they’re seeing fewer patients per day than they might otherwise.  We’re advised that ensuring people have their surgery on time will mean more GPs will be able to open their books to new clients.

Will this increase productivity in the workplace?

Yes.  If a patient is forced to wait months or even years for an operation, often their quality of life and productivity in the workplace suffers.  They might be on strong medication, painkillers, or may be forced to take time off work to attend doctor’s appointments.   Some might even spend time in a hospital while waiting for surgery.

Ensuring elective surgery on time will boost productivity and decrease the amount of time people have to take off work related to their illness.

The Government’s own Demographic Advisory Council states that one of the main factors that influence productivity is the health of the workforce.

Why not deter public hospitals from admitting private patients?

In 2007-08 there were 12,193 patients with private health insurance admitted to Tasmanian public hospitals – an increase of 12.8% on the previous year.  On an average day, 115 patients with private health insurance occupy beds in Tasmanian public hospitals.

Under Australian Health Care Agreements, a public hospital cannot turn away a patient with private health insurance if that patient seeks treatment in a public hospital. 

In the two years while this policy is in operation, the Liberals will look at hospital demand strategies in other States where they have been successful in actively encouraging private patients back into the private hospital system.

Isn’t Labor using the private hospital system already?

Yes, but only to a limited extent.  The Government is funding 1,002 cataract operations by increasing the volume of surgery contracted through private hospitals.  If it was implementing this policy already, why are there still 4,000 Tasmanians waiting longer than clinically-recommended.

The Liberals’ strategic partnership with private hospitals to undertake elective surgery on public patients who have been waiting longer than clinically accepted timeframes is far superior to anything the Labor Government is doing.

In evidence to a Parliamentary Committee recently, one GP said:

“Why are we doing 1,000 cataracts?  Because they are quick and easy and they will drop the waiting list for the hospital probably from 10,000 to 9,000 about one month prior to the next State election. That is what it is about”.

Does this operate elsewhere?

Yes. Queensland operates Surgery Connect where Queensland Health pays for public patients to have their operation done where there is spare and appropriate surgical capacity in the private system.

Labor Premier Anna Bligh recommitted to Surgery Connect at the 2009 State election for a further three years, saying it had helped keep Queensland’s waiting lists the shortest in the country.

Tasmanians also deserve to have the shortest waiting lists in the country.

References:

1. Tasmania’s Elective Surgery Improvement Plan, DHHS, 1 September 2008, Version 0.B - “Tasmanian patients wait longer than the national average and are amongst some of the longest waiting patients in Australia”.
2. Answer to a Question on Notice No. 26, July 2009.
3. Answer to Question on Notice – July 2009
4. DHHS Elective Surgery Improvement Plan, September 2008 , Version 0.B