We need a plan to return to elective surgery


Dr Rachel David, the chief executive of Private Healthcare Australia, says a plan is needed to support a timely return to elective surgery.

This week, there will be around 25,000 elective surgeries delayed across Australia. It was the same last week, and it will be the same next week. A three-month shut down will mean around a third of a million surgeries will have been delayed across Australia. We need to start planning to catch up this shortfall.

The scale of these surgeries in Australia is large. Around 2.3 million people are admitted to hospital for surgery each year, and two thirds of surgical patients are admitted to a private hospital. Our estimate is at least 60% of surgeries are being cancelled across the public and private sector, though data are still being collected.

‘Elective surgery’ is a misnomer – a better label would be ‘surgery for non-life-threatening. conditions’  The most common examples of surgeries that are being delayed include knee reconstructions, gynaecological procedures, removing skin lesions and cataract replacements. These procedures relieve severe pain and discomfort, save sight and improve people’s ability to move around and live independently.

Delaying surgery is very costly. Most importantly, the patient is still living with their health problem, often in pain. We know people waiting for surgery have higher care needs from family and friends. People with difficulties moving around are less likely to exercise, which will lead to more health problems down the line. Some people waiting for surgery for conditions like endometriosis and joint problems will be relying on opioid painkillers, which can cause addiction and death. Mental health issues among this cohort are also expected to increase, as there are strong correlations between mental health and other chronic health conditions, and mental health and pain.

Prior to the pandemic, waiting times for elective surgery in the public system were growing rapidly. In 2018-19, almost 900,000 Australians were added to public hospital waiting lists. Median waiting times have increased by more than 20% over the past four years.

For some procedures, the waiting times were already extraordinary. The median wait time for a knee reconstruction in a NSW public hospital last year was 209 days – almost seven months. For a septum operation in South Australia, the median wait time was 273 days. Nearly a quarter of patients needing cataract surgery in Tasmania are waiting for more than a year.

As urgent surgery is continuing, the less urgent is put off. Next week, there will be a similar rate of urgent surgery, and another set of less urgent surgery will be put off again. Waiting times for less urgent surgeries are expected to go through the roof even with a short shut down of elective surgery.

In private hospitals, most of the time these types of surgeries can be done in a couple of weeks. However, the shut down of elective surgery is going to increase waiting times in private hospitals as well.

We need to make sure that everyone is ready to go again as soon as possible. It’s rough for those of us in the industry to see specialist hospitals mothballed, nurses stood down, surgeons not working and some hospitals nearly empty in the midst of a health crisis. While it’s clearly better to increase ICU capacity and not need it (yet) than be overrun, we are spending millions of dollars each week to not treat people. The excess capacity we have developed for COVID 19 is important, as is preserving personal protective equipment, but we need to develop a plan to ensure that our resources are being used in the best way possible.

In the United Kingdom, 4.4 million people were waiting for elective surgery last year (there is very little private health in the UK). The Royal College of Surgeons there is calling for a five-year plan to catch up on elective surgery.

I hope the plan we develop will be measured in months, rather than years. Private health insurers are already putting aside contingency funds to clear the backlog as quickly as possible.

We will need a structured approach. First, we need to ensure that people whose surgery has been delayed are looking after themselves as best they can. We need to encourage telehealth, now covered by both Medicare and private health insurance, so people can keep in touch with their health care team and get access to expanded services such as psychology, physiotherapy and dieticians through telehealth.

Second, we need to quickly build our stocks of personal protective equipment, so it doesn’t have to be reused or reserved. The government is seeking to purchase as much as possible, and we need to quickly increase our domestic manufacturing capacity.

Third, we need to identify areas where there are low risks of community transmission of COVID 19 and start safely reintroducing elective surgery in disciplines where there is little chance of needing an intensive care unit stay. Many day procedures fit this category of very low risk.

In some states and in many regional areas, the risk of community transmission is very low, there is significant underutilised hospital capacity, and there are many people living in pain. Where the risk of surgery is low, we should be looking to relieve that pain as soon as we can. We don’t have to open up the floodgates all at once, but we need to relieve the pressure where we can.

Our response to COVID 19 has been excellent so far, but it is fragile and could start going wrong at any time. We need clear and consistent guidelines for ramping up elective surgery where we can, and then pulling back when we must.

Without a plan, a broad and lengthy delay in elective surgeries will cause much pain and suffering for thousands of Australians. Let’s start working on that plan now.