As ACT healthcare workers continue along the path of building a health system to be proud of, there’s no denying the current system is under intense strain.
Only a few weeks ago that the ACT Government announced significant new health funding, in response to a worsening operating deficit. From here they then announced that efficiency measures will be introduced to bring the health expenditure back to a sustainable level, which we expect will impact on service delivery.
Some of this is foreshadowed in the latest Public Hospital Report Card with an increase in hospital attendances, reflecting the after-effects of COVID-19. During the period under review, ACT services were also disrupted due to a fire event at the North Canberra Hospital.
Despite these challenges, I want to acknowledge the incredible work being done by our doctors, nurses, allied health and support staff. With all the things that have been thrown at our healthcare workforce, they have performed magnificently.
It’s encouraging to see improvements in performance in important parts of the ACT health system with ED waiting times a notable contributor. Unfortunately, elective surgery performance continues to struggle with little relief in sight.
While there’s been many ups and downs over the past few years, there’s reason to be optimistic about the future with a new acute services building opening at the Canberra Hospital and further bedding down of the Digital Health Record. In addition, work to streamline the services between the Canberra Hospital and North Canberra Hospital campuses is starting to be reflected in the wait time data.
Workforce continues to be a particular challenge for the ACT with a need to have adequate remuneration combined with a focus on improving hospital culture, clinical autonomy, and doctor well-being.
The way forward also includes better access to data on clinic and surgical wait times and improving the way we engage with patients, and their wider treatment team, to provide a truly integrated and seamless care experience.
Finally, we need to better support general practice and avoid alternative models of care that fragment patient care and often lead to multiple presentations to fix an issue. We need to reduce avoidable hospital admissions and increase the capacity for preventative care with the patient’s regular General Practitioner.
Key Takeaways
Despite a notable improvement in ED performance, ACT hospitals continue to underperform compared to historical and national averages. Just 45 per cent of Category 2 planned surgeries are being seen within the recommended 90 days, while only 51 per cent of “urgent” ED presentations are being seen on time.
Figure 1: ACT performance 2023‒24 compared to the previous year
| Cat 3 ED on time |
4-hour rule |
Median surgery wait |
Cat 2 surgery wait |
| ✔️ |
✔️ |
❌ |
❌ |
Figure 2: ACT performance 2023‒24 compared to national average (below or above)
| Cat 3 ED on time |
4-hour rule |
Median surgery wait |
Cat 2 surgery wait |
| ▼ |
▲ |
▼ |
▼ |
Emergency department performance - ACT
The ACT has seen significant improvements in both the number of patients completing their ED presentation within four hours or less and the percentage of Category 3 patients being seen on time. Noting a worrying fall in national performance, the territory has risen from the worst performer to above average in terms of the “four-hour rule”. Although the percentage of Category 3 emergency department patients being seen within the recommended time has improved for the fifth year in a row, the ACT’s figure sits at 51 per cent, 10 per cent below the national average. Note that data was not available for 2015–16.
Figure 3: Percentage of Category 3 (urgent) ED patients seen within the recommended time of under 30 minutes — ACT
Figure 4: Percentage of ED visits completed in four hours or less — ACT
Planned surgery performance - ACT
The overall median waiting time for planned surgery has worsened slightly to an above average 50 days in the ACT. The percentage of Category 2 planned surgery patients being admitted within the recommended time has fallen for the sixth year running, dropping from 75 per cent to 45 per cent between 2018–19 and 2023–24, making the ACT the worst performer in the country for this metric.
For the 55 per cent of Category 2 patients who do not receive their surgery on time in the ACT (recommended to occur within 90 days), the average wait time is alarmingly high at 214.7 days. 34 per cent of ACT Category 3 patients are not admitted in the clinically recommended time of 365 days. These patients are waiting on average 660 days, or almost two years, before receiving treatment.
Figure 5: Median waiting time for planned surgery (days) — ACT
Figure 6: Percentage of Category 2 planned surgery patients admitted within the recommended (90 days) — ACT
Public hospital expenditure – ACT
Figure 7: Per person average annual percentage increase in public hospital funding by government source (constant prices) — ACT
|
2012‒13 to 2022‒23 |
2012‒13 to 2017‒18 |
2017‒18 to 2022‒23 |
| Federal |
2.02% |
3.58% |
0.49% |
| ACT Government |
2.54% |
-1.18% |
6.39% |
Figure 8: Public hospital funding, per person, by government source (constant prices) — ACT
The most recent public hospital funding data is from 2022‒23. In the ACT, the vast majority of public hospital funding (68 per cent) comes from the state government. This is the highest proportion in the country, and far above the national average of 61 per cent.
