The Auditor-General has announced the release of her report Waiting Lists for Elective Surgery and Medical Treatment.
It’s always hard to tell in the political hurley burley, what’s actually true.
But there’s nothing quite like the cold hard eye of an auditor.
Here are the highlights:
— Overall, elective surgery waiting lists are 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.
— Current practices in compiling the waiting lists have compromised the policy intention of promoting clinically appropriate, consistent and equitable management of elective surgery waiting lists. In particular, downgrades of patients’ urgency category, often without documented clinical reasons, raised considerable doubts about the reliability and appropriateness of the clinical classifications for patients on the waiting lists.
— In the absence of required documents, Audit was unable to form a view on the validity of the clinical reclassifications. In particular, Audit found that in 2009-10, 259 patients in Category 1 were reclassified and most of these reclassifications (97 percent) occurred without documented clinical reasons; and 55 reclassifications (32 percent) had no evidence of having been approved by a doctor.
— There were deficiencies in processing patients on to the elective surgery waiting list. These included:
— many patients’ consent forms were partially completed by patients, and did not meet the requirement to demonstrate that patients fully understood the information provided by doctors about the nature of the operation, and the material risks inherent in the treatment;
— the consent forms did not always have a witness’s signature. This may expose ACT Health and the medical practitioners to risks, including potential legal risks and adverse outcomes for patients; and
— Request for Admission (RFA) forms were sometimes kept in the surgeons’ private rooms and not forwarded to the hospital for processing in a timely manner.
— Notwithstanding increased funding by the Commonwealth and ACT Governments in the recent years, the elective surgery waiting lists have not shown improvements. In 2008-09 (latest available comparative information), the ACT compared unfavourably to other jurisdictions. Data for the ACT from ACT Health indicated a general worsening situation of waiting lists for elective surgery in 2009-10, compared to 2008-09.
— The strategies implemented by ACT Heath have not been adequate to address increased demand, and reduce the waiting lists for elective surgery. Other than recent progress made in outsourcing various surgical procedures to private sector providers, there has been limited progress or improvements on other options, such as transferring patients to other doctors with a shorter waiting list; transferring
patients to another hospital; or increasing theatre utilisation.
— Further, recent reviews commissioned by ACT Health indicate significant issues concerning the delivery of surgical services and management of operating theatres, which have contributed to the long waiting lists.
— ACT Health is implementing the Elective Surgery Access Plan 2010-13 to meet the immediate needs of increasing demand for elective surgery, and introducing changes in elective surgery management. The success of this Plan depends on its effective implementation, which requires adequate resources, engagement of hospital staff and improved communication with, and cooperation from surgeons and other medical professions.
— There were significant delays in assessing medical appointments in areas reviewed by Audit, namely the Urology and Gastroenterology units at the Central Outpatients Department in The Canberra Hospital.
— A recent internal review of the outpatient services at The Canberra Hospital (TCH) conducted by ACT Health found deficiencies in strategic planning, inconsistent applications of policies and procedures across the hospital’s Outpatients Departments (OPDs), ad hoc processes for managing the waiting lists,
and inefficient communications with clinicians, consumers and staff. The review report included 35 recommendations to address strategic and immediate operational needs. ACT Health advised that implementation plans are being developed by the hospital to address the recommendations.
As these things go, it’s pretty bad, and makes one wonder about a long serving health minister who told the public and the Assembly that the claims, now upheld by the Auditor-General, about the management of waiting lists were not true.