Elective surgery waiting lists - radio interview

Federal President of the AMA, Dr Rosanna Capolingua, good morning.

DR CAPOLINGUA: Good morning.

LEON DELANEY: How are you today?

DR CAPOLINGUA: I'm well, thank you. Happy New Year to you.

LEON DELANEY: And to you too, thanks very much for being available. I see in the papers today that you're saying this is really a negligible amount of money, it's a drop in the bucket, and it's really not going to make much difference. It must be a step in the right direction though, surely?

DR CAPOLINGUA: Yes, we want to look at the very positive things. The first positive thing is, of course, that they're focusing on elective surgery, and focusing on patients being treated, and the second positive thing is that they're doing it together for a change, the State Health Ministers and the Federal Health Minister, are working together with the same sorts of goals. So they're the two positive things.

But, $150 million across the whole of Australia, across 25,000 patients, when there are many multiples more than that on a wait list in Australia, is a start, it's a scratch, but it's not a sustainable initiative, and what we need to see is the ongoing sustainability of the hospitals and the doctors, to be able to treat patients in appropriate clinical times, and in appropriate clinical settings, and that means more money and more beds, and hopefully we'll see that in the Australian health care agreement negotiations.

LEON DELANEY: We've seen promises in the past, and some success at keeping those promises, to reduce waiting times for either elective surgery or various other things, and only to see them blow out again after the promise ...

DR CAPOLINGUA: That's right.

LEON DELANEY: ... and after the target has been met, and this has happened time and time again. So that's the point you're making about sustainability, isn't it?

DR CAPOLINGUA: That's right, exactly. Sure, best endeavours are often made, sometimes people will tell you it's the way they cut the numbers that make it look like they've succeeded in making a difference, but if you believe that in reality we do get to treat more patients, then what happens of course is that we've got an increasing demand, the population has grown, and continues to do so, it continues to live longer, it continues to have increasing health needs, and we have not built capacity into the system, to cater for that increasing demand.

So we end up blowing out again, and you take these people that hopefully we'll be able to treat under this initiative, and there's doctors asking me where and how we're going to do that, and they'll be replaced by others, or indeed, in order to get through this wait list initiative, we will have a bank up of others, so that the wait list will become longer, or the tails get extended because of the need to count these numbers going through.

You've got to make a bigger change, you've got to make a significant investment in a sustainable way of creating capacity in the system.

LEON DELANEY: That reference you made to the idea of figures being fiddled to make it look as if success has been reached, is there some truth behind that suggestion, the suggestion being that people are either reclassified, or put into different categories, in order to make the waiting lists look better than they really are, does that actually happen?

DR CAPOLINGUA: It certainly appears to occur in different states, at different times, re-cutting the list, reclassifying is exactly what we get told occurs, and of course tidying up lists, patients who've been on the list for so long that they've either gone to the private sector to have their surgery, or they've passed away, or something else has happened, so those numbers are there as well.

Overall though, if we stop focusing on those little bits, and think about the large number of people who need to be able to get into our public hospitals for treatment, either for elective surgery and they're on a wait list, or acutely because they're sick and in need, in order to ease the by-pass that occurs, the ambulance ramping, the huge pressure in the emergency departments, in order to ease that, you've got to have beds to be able to appropriately admit patients. And across the country, we need more beds.

LEON DELANEY: Absolutely. With the ambulance ramping, we saw evidence of that again yesterday, on the front page of the Telegraph, I think it was, with reports that when you add up the figures, ambulance patients are being forced to wait a combined total of 718 days on trolleys outside the doors of emergency departments, for the year just ended. Now that's an appalling figure, isn't it?

DR CAPOLINGUA: I think we need to seek ... you know, we talk about these terms, and we've become blas about what they mean. You know that means that you've got a human being who's sick and scared - maybe old, maybe not so old - maybe in pain, lying on a trolley, outside the emergency department, either still in the back of the the ambulance, which would be hot and uncomfortable, with some ambulance officer trying to care for them, or they're in some other triage area outside, ramped up.

I've even seen patients on the floor in an emergency department, in this country, on the floor, because they ran out of trolleys. Now is that OK for us as Australians, to accept? We're talking about someone, your mother, father, son, daughter, best friend, grandparent, who's in pain, and suffering, having to endure that experience, because we haven't catered sufficiently for their needs in our public sector, in this wealthy country. I mean I think that's a question we've got to keep asking ourselves.

LEON DELANEY: Yes, in those terms, when you put it that way, that $150 million being carved up yesterday, is almost an insult, isn't it?

DR CAPOLINGUA: It's a scratch on the surface, it's a start, let's ... it's a very small ...

LEON DELANEY: It's important to be diplomatic, isn't it?

DR CAPOLINGUA: It's important to be a little bit positive at this early stage, it's the new world, and I want to believe that everyone is well intended, and that there's a fresh opportunity to be able to get the attention to where it's needed, and we have to keep boiling it back down to that human being who needs care in this country, and what are we able to give them, and the doctors and nurses who are trying so hard to look after them in that environment?

LEON DELANEY: Yes. Well, according to the figures published in the Telegraph, with the $43.3 million that New South Wales gets, there'll be an extra 8,700 procedures, but there's 56,000 people on the waiting list.

DR CAPOLINGUA: That's right, 56,000 just in New South Wales, hey? And the initiative is meant to treat 25,000 across the country. It is valid to look at some of those numbers, isn't it?

LEON DELANEY: Yes. OK, so we ...

DR CAPOLINGUA: So we've got a lot more work to do, haven't we?

LEON DELANEY: We certainly do. So, we've got this much money, how are we going to use it, to actually make a difference? What's the plan, what have they put forward?

DR CAPOLINGUA: The $43 million? Well, each State had to put forward their own plan, and New South Wales, I haven't seen the detail of how they're going to do that. Actually I did have phone calls from doctors in New South Wales, saying to me, "How are we going to do this? We're already under so much pressure, how are they going to expect us to deliver these numbers?"

And they're worried about patients being compromised under the pressure of being able to take on this additional, if it is additional, elective surgery. It's going to be down to the grass roots of the people delivering the services.

What I believe would be needed is that operating theatre time that is now not available in the public sector, needs to be made available. In other words, you extend the operating times by paying the staff, the nursing staff in particular, to stay on, to do longer sessions, to do extra cases in the day where possible, and indeed the surgeons then have to be there to be able to do the work, you have to have the beds to put the patients in that are needing in-patient services.

It is really an art of engineering as far as getting the operational level up and running, and I hope they talk to the doctors about how they can make that happen.

LEON DELANEY: Yes, that certainly seems to be the case, that I've heard suggestions from medical professionals before, that operating theatres actually lie idle, because the budget just isn't there, to get the doctors and nurses to work in those theatres.

DR CAPOLINGUA: That's right, there is capacity in a lot of the public sector, it has been left lying idle, as you say, because that way you come in under budget, or you come in with the budget, and you close the budget blow-out, because if you don't treat people, it costs you less. That's a bit Yes Minister, isn't it?

LEON DELANEY: It certainly is.

DR CAPOLINGUA: A cheaper hospital to run, along with no patients in it. So let's go back and remind ourselves that that's what the public hospitals are for. The Governments, State and Federal, are responsible for the delivery of healthcare to Australians, and if we have capacity there, they have to invest in it sustainably, not just $150 million and a flash in the pan, but sustainably through the Australian health care agreements, to ensure that we open up that capacity to treat the people.

LEON DELANEY: Indeed. And the other paradox there is of course we might have operating theatres lying idle, but if we opened them up, and ran them more ... at a greater rate, do we actually have the beds in the wards ...

DR CAPOLINGUA: That's right.

LEON DELANEY: ... available to put the patients when they convalesce?

DR CAPOLINGUA: Yes, I mean there are closed wards as well, I mean New South Wales health administration is notorious for opening desks, and closing beds, I understand, so let's close a few desks, shall we?

LEON DELANEY: And open a few beds, yes.

DR CAPOLINGUA: And open a few beds.

LEON DELANEY: OK, it's a start, it's a drop in the bucket, but it's better than no drops in the bucket, so what should happen next?

DR CAPOLINGUA: Well, I think the next thing is the Australian health care agreement negotiations. The current round of Australian health care agreements expires at the end of June, and we really need a serious investment and increase in funding in the Australian health care agreement, and appropriate indexation.

The other furphy that's being touted at the moment is that we don't need people in hospital beds, that everything can be done in primary care, in preventative medicine and primary care, and allied health providers. And let me tell you, preventative medicine is absolutely something we need to invest in, we need to teach Australians to be healthy, and to live better lives, and we need to get doctors to make sure that they actively engage with patients to understand what their risk factors are, and to live more appropriately and have management in place to prevent them from getting diabetes or heart disease.

All of that needs to happen, but it'll take a long time before that has an impact on the need for beds, a very, very long time, if we ever turn that tide around with the obesity epidemic, as it is now.

Primary care, there is only so much that can be done by general practitioners, and physios and social workers and OTs out in the community, all of them very valid roles and very important providers of healthcare, but sometimes you need to go to hospital, and we have to be able to deliver that as well.

LEON DELANEY: Indeed. Dr Capolingua, thanks very much for your time today.

DR CAPOLINGUA: Thank you.

LEON DELANEY: Dr Rosanna Capolingua, the Federal President of the AMA.

Ends