Specialist clinics in public hospitals provide planned, non-admitted services to patients. To attend a specialist clinic, patients must have a referral from their GP, hospital doctor or other health professional. These specialist attendances often result in patients being added to the elective surgery waiting lists.
The available data shows that by the time a patient is added to the official elective surgery waiting list, they have already waited the period between referral from their general practitioner to the date of a consultation with an out-patient specialists to assesses their surgery urgency or need. This period between the referral and the patient being officially added to the elective surgery list is known as the ‘hidden waiting list’.
Similar to the elective surgery urgency categorisation, the outpatient urgency categories are classified as:
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Urgent (Category 1) – specialist consultation recommended within 30 days of being added to the outpatient wait list
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Semi-urgent (Category 2) – specialist consultation recommended within 90 days of being added to the outpatient wait list
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Non-urgent (Category 3) – specialist consultation recommended within 365 days of being added to the outpatient wait list.1
Although there is no consistent national reporting methodology on the number of people waiting to see a specialist as an outpatient in the public system, some States and Territories have started reporting their own figures.2,3,4 In Tasmania for example, in 2021 there were over 57,000 patients waiting to see a specialist in the public health system for their medical condition.5 That includes patients waiting over 800 days to see a specialist with urgent referrals.6
Looking into the future, significant investment in public hospital resourcing will be required to not just to overcome delays further exacerbated by COVID-19, but also to restore the capacity of public hospitals to provide access to surgery to all those who require it within the clinically indicated time frames. International evidence also indicates that surgeries in the time of COVID-19 are more expensive than in normal times due to costs associated with infection prevention and use of personal protective equipment (PPE).7,8
Moreover, costs associated with delayed elective surgeries go beyond the health system. Every delayed surgery has an impact, leading to loss of quality of life and further deterioration of health. Loss of health impacts on productivity and results in increased societal cost. For example, an individual waiting for a procedure to manage chronic pain is unable to work, and often must rely on prescription medication to manage their pain. This will incur costs to the health system through more consults with their General Practitioner, more medicine subsidised by the pharmaceutical benefits scheme, and through income support from the Government due to an inability to work. This could also lead to further health issues, including mental health issues, for an individual due to their limited ability to participate in work, physical and social activities.
Australia urgently needs a recovery plan for its public hospital system, with funding associated with it, that will factor in clearing of backlog of elective surgeries, establishing enough capacity to meet the population demand and factoring in the possibility of repeat waves of COVID-19 infections into the future. Improved funding and more innovation are the only ways forward. Ultimately, people should be kept out of hospitals for as long as possible. To achieve that, a range of measures will have to be agreed among all stakeholders to better support general practice to deliver the type of care that will enable people to have a much better quality of life and thereby not need to rely on hospital services as much.
1 Queensland Government Queensland Health 2022. Queensland Reporting Hospitals – Outpatient Indicators http://www.performance.health.qld.gov.au/Home/SpecialistOutpatientIndicators/99999?Indicator=Category1
2 Victorian Agency for Health Information 2022. Victorian Health Services Performance – Specialist Clinics – Urgent first appointments https://vahi.vic.gov.au/specialist-clinics/urgent-first-appointments?nid=8586
3 Queensland Government Queensland Health 2022. Queensland Reporting Hospitals – Specialist Outpatient http://www.performance.health.qld.gov.au/Hospital/SpecialistOutpatient/99999
4 Government of South Australia SA Health 2021. SA Health Specialist Outpatient Clinics Waiting Time Report https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/about+us/our+performance/specialist+outpatient+waiting+time+report/specialist+outpatient+waiting+time+report
5 Tasmanian Government HealthStats 2022. Health System Dashboard Publication date: 28 January 2022, Accessed on 28 January 2022 https://healthstats.dhhs.tas.gov.au/healthsystem
6 Tasmanian Government Tasmanian Health Service 2022. Estimated outpatient waiting times Southern Region Waiting times as of 31 December 2021 Release date: 28 January 2022 Accessed on 28 January 2022 https://outpatients.tas.gov.au/clinicians/wait_times/wait_times
7 A J Fowler, T D Dobbs, Y I Wan, R Laloo, S Hui, D Nepogodiev, A Bhangu, I S Whitaker, R M Pearse, T E F Abbott, Resource requirements for reintroducing elective surgery during the COVID-19 pandemic: modelling study, British Journal of Surgery, Volume 108, Issue 1, January 2021, Pages 97–103, https://doi.org/10.1093/bjs/znaa012
8 COVIDSurg Collaborative, Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans, British Journal of Surgery, Volume 107, Issue 11, October 2020, Pages 1440–1449, https://doi.org/10.1002/bjs.11746