The ACT is the only jurisdiction in which the proportion of hospital patients not admitted on time has increased in every category. The wait times were impacted due to a ‘planned reduction in activity’. JON STANHOPE & KHALID AHMED reveal why our public health service is the sickest in the nation.

A freedom of information request from Leanne Castley, the opposition health spokesperson, has revealed some startling and deeply concerning figures on elective surgery waitlists in Canberra. 

It was revealed that 2289 Canberrans were overdue for elective surgery. More than 30 per cent of those on the waiting list have waited longer than the clinically recommended times. 

Alarmingly, more than a quarter of the patients in Category 1, requiring urgent surgery within 30 days, and more than half of the patients in Category 2 were waiting longer than the clinically recommended times for treatment.

The term “elective surgery” is a misnomer. There can obviously be serious consequences for a patient if the surgery is not performed in time. There are numerous peer-reviewed clinical studies that point to increased complications and additional costs due to any such delay.

Behind every number is a person – in pain and suffering – and a family and loved ones seeing them in pain but not able to ensure they receive the care they need.

Ms Castley linked the long waits to the “12-year delay for the Canberra Hospital expansion, which is still not complete and three elections late”. Health Minister Rachel Stephen-Smith shrugged off this claim and went on to insist that all jurisdictions had seen an increase in wait times. 

Not only was that not the case, and the minister was incorrect in making the claim, but surely the state of other jurisdictions’ elective surgery wait lists is hardly a justification for the egregious failings of the ACT health system. 

What is particularly disappointing is the complete lack of empathy and sympathy from the minister for the suffering of patients unable to access appropriate health care. 

One could reasonably expect the health minister to at least acknowledge patients’ and their families’ physical and emotional suffering, to comfort and if possible, reassure them with advice on the steps the government is taking to deal with the problem. 

Media reporting on this matter regrettably attracted some odious public commentary to the effect that those on waiting lists should get private health insurance if they can afford it. In other words, blaming the patients for the government’s failure to provide an essential service.

The number of surgical procedures performed obviously depends on the number of beds, clinicians and operating theatres. 

There are two channels for access to surgery, planned and emergency. Activity coming through the emergency department takes precedence, and if the capacity of the system is limited, will bump the planned activity – it may be the same surgeon using the same theatre to treat a road trauma patient instead of a patient on the waiting list. 

It is possible to isolate planned surgery activity from emergency surgery, but it would require investment in separate facilities and additional staff. Indeed, it was a 2020 election commitment of the Labor government to establish an elective surgery centre at the University of Canberra hospital precinct. However, along with a raft of other election commitments, it was abandoned. Ms Castley also refers to this as one of the reasons for the blowout in waitlists.

That there is a severe shortage of beds in the ACT’s hospital system against the government’s own projections of demand, is well established. Chart 1 provides an update with the AIHW data on the beds shortage that we have previously reported.

As at June 2022, hospital bed shortage in the ACT, against projected demand, had increased to 182 beds. The demand estimates in the chart are conservative as the actual population growth has been higher in recent years than previously assumed.

The consequences of the ACT government’s decisions are quite clear. The deferral of capital investment in our hospitals has resulted in a significant shortage of beds and a consequential blowout in wait times for surgery.

The government regularly refers to the additional bed capacity and extra theatres coming online. Regrettably, the extra beds have not been sufficient to meet demand, as the shortfall, as of 2022, demonstrates. 

In addition, in order for those beds to be utilised requires the allocation of additional recurrent funding for the employment of frontline clinicians and support staff. 

It is clear, from the most recent data published by the Productivity Commission, that the ACT government has given a very low priority to the employment of sufficient staff in our hospitals.

Chart 2 shows the real recurrent expenditure growth per person from 2015-16 to 2021-22.

As reported by the Productivity Commission, the national average annual growth in real per capita expenditure over the six-year period was 3 per cent. The growth in funding at a national level indicates that apart from population increase and changes in price, there was an increase in funding to cater for growth in per capita demand for hospital care emanating in the main from an ageing population and changes in technology.

The ACT stands out like a sore thumb as the jurisdiction with the lowest annual growth in health expenditure at a mere 0.1 per cent. 

Damningly, the Productivity Commission, in a note to the data table in its report, reveals that in the ACT “[e]xpenditure data includes substantial expenditures for NSW residents so the ACT expenditure is overstated”. In other words, the ACT government has in fact, in real terms, cut health and hospital expenditure. 

It is to the credit of ACT’s frontline clinicians and health staff that they have continued to provide quality professional services in this funding environment. However, the hard logic cannot be avoided – not enough staff means wait times (both in emergency departments and planned surgery) increase.

Accommodating health growth, within budget, is challenging for all jurisdictions. However, across Australia they seem to have done a reasonably good job with the major exception of the ACT. 

In this context, it is useful to note that if a jurisdiction has, say, 20 major hospitals, it could get away with deferring an odd hospital upgrade to invest in some other high-priority project or even indulge in a project with poor returns. For the ACT with only one tertiary hospital, there is no such flexibility.

In relation to waitlists, the minister’s claim that all jurisdictions have seen an increase is wrong. 

There is comprehensive national reporting on a range of measures relating to waitlists, which we are unable to discuss here due to space considerations. The most pertinent measure from the community’s point of view is the proportion of people not admitted within the clinically recommended time. Table 1 summarises the change from 2021-22 to 2022-23 in each urgency category and for all patients.

If the Minister’s claim was correct, we would expect to see an increase (a positive figure) for most if not all the jurisdictions. 

However, the ACT is the only jurisdiction in Australia in which the proportion of patients not admitted on time has increased in every category.

A note to the ACT’s data in the commission’s report states that the wait times were impacted due to a “planned reduction in activity” related to the Digital Health Record System and a fire in the operating theatres. There it is – it was all planned. 

Did the government contemplate using the capacity in the private system? Or for that matter, did the government consider why it is that the wait times for indigenous people increased much more than for non-indigenous Canberrans?

One can only hope that next time the minister sits with her cabinet colleagues to reflect on the state of health care in the ACT that they reflect on the impact which their priorities have on vulnerable and disadvantaged Canberrans.

Jon Stanhope is a former chief minister of the ACT and Dr Khalid Ahmed a former senior ACT Treasury official.