Hospital waiting lists need quality control, not simplistic cutting to a target
WHEN statistics about hospital waiting lists are being thrown around in the media, it’s easy to forget that there are real people behind the headlines.
Increasing access to hospital treatment can make a big difference to the quality of life of thousands of Australians currently on hospital waiting lists. But in an effort to get the numbers right, we should not lose sight of why it is so important to improve those waiting-list statistics.
Many Australians waiting for surgery live with conditions that cause significant pain and disability. Often they cannot work or participate fully in family and community activities, and daily life can be a struggle.
As well as the difficulties involved with living with a chronic condition or disability, people on hospital waiting lists often have the added stress of not knowing when their operation will take place. Operations can be scheduled and then cancelled at the last minute if a more urgent case comes up.
People waiting for surgery often feel like they are in limbo, unable to get on with their lives until they receive the operation they need. Sometimes this can go on for months, or even years.
Of course hospitals can’t treat everyone at once, and it is important that people requiring emergency or lifesaving treatment are the highest priority for surgery. However, it is a mistake to think that people whose conditions are not immediately life-threatening are not also in desperate need.
This is why the Consumers’ Health Forum of Australia supports the Federal Government’s allocation of $600 million in additional funding to help reduce waiting times for surgery and the agreement between the Commonwealth and State/Territory Governments to work together to achieve this goal.
In particular, we welcome the commitment from the Federal Government to end the ‘‘ blame game’’ in health and to improve coordination between different levels of government in the delivery of health care.
Hospital waiting lists are a good place to start in improving collaboration between jurisdictions. But for this initiative to be a success, the focus needs to be on improving overall hospital performance and not just on increasing throughput of patients. Improving the experience of people undergoing surgery in hospital should be one of the outcomes attached to this additional funding.
One important area often nominated by consumers as needing improvement is in communication between hospital staff and patients (and their families and carers), including involving them in planning their post-operative care, in hospital as well as in relation to their discharge arrangements and follow-up care in the community. As poor post-operative care can delay recovery, and in some cases compromise the outcomes of surgery, involving consumers in improving the delivery of care after surgery makes both medical and economic sense.
Providing hospitals with
to increase elective surgery activity could place additional stress on a system that is already struggling to provide adequate post-operative care to existing patients. Therefore it is vital that some of the additional resources are targeted at improving care for patients after their operations, both in the hospital and postdischarge in the community.
It is also important that those people in the greatest need of treatment benefit from this initiative. This may not occur if the additional funding is tied simply to increasing the numbers of surgical procedures performed as this will create an incentive for hospitals to increase the numbers of the most straightforward procedures, at the expense of more complex and difficult operations. This could result in people with relatively minor conditions being treated before those with more serious problems. To ensure that the funding is used as equitably as possible and to achieve the maximum benefits to consumers, the quality of life of people on waiting lists needs to be taken into account when determining priorities for treatment.
This may not be easy to achieve. This is partly because the commonwealth has not previously played an active role in this area, and does not have a good understanding of how waiting lists are managed by hospitals. The media makes the issue look simple, but in actual fact how waiting lists are constructed and managed is extremely complex. Factors such as the role of the private hospital system in performing some elective surgical procedures on behalf of public hospitals, and decisions made by specialists about where their patients receive treatment, can both have an impact on waiting list statistics but they are also not well understood.
These issues cannot be overcome in the short term and may present barriers to the effective targeting of this funding. However, by focusing on increasing the quality of hospital care, rather than on achieving simplistic targets for increasing activity, this initiative has the potential to provide immediate benefits to people currently on waiting lists as well as ongoing improvements in hospital care in the future. Mitch Messer is chairman of the Consumers’ Health Forum of Australia