Public Hospital Report Card 2022

Tasmania

AMA TAS President’s Introduction

Dr John Saul

AMA TAS President

Tasmania's population is expanding and ageing, and we still, albeit tenuously, retain the luxury of achieving a balance of highly skilled and dedicated staff who excel at personalised care more akin to community-sized hospitals; chances are the cardiologist on staff knows the patient's oncologist as well as their GP, and so on.

While all of us in health care know the enormous benefits of this for both staff and patients, once again, we find ourselves at a crucial crossroads, and this time the wrong turn could have grave consequences.

We must ensure Tasmania's three main public hospitals are sufficiently resourced to navigate the nuanced balance of gold-standard patient care while at the same time providing opportunity for our doctors.

COVID shone a light on our healthcare system like no other time during my career in medicine; every level of government appealed to us all to stay at home and stay safe and help our hospitals arm themselves for the tsunami of patients anticipated, and by doing this, we were assured that we would all, hospital systems especially, come out better for it on the other side.

This is quite different from the reality we are now facing in our public hospitals, with a largely burnt-out workforce, access, and bed block at all-time highs, blown out wait times whether it's for planned surgery or specialist appointments and morale and recruitment and retention at the lowest I've ever witnessed.

If the predicted COVID-protected hospital environment had worked, the figures we see in this year's AMA public hospital report would be measurably different.

Only 43 per cent of patients in Triage Category 3 in Tasmania were seen within the recommended time in the 2021-22 reporting period, a drop of six per cent compared to the previous year.

We saw a further drop in our emergency department presentations completed within four hours by seven per cent compared to the pre-pandemic 2018-19.

As for planned surgery, Category 2 planned surgery wait times during 2021-22 median wait in Tasmania was 62 days, the longest wait time in Australia and 37 days longer (over an extra month longer) than the best-performing state, granted this is a slight improvement compared to the year before; however, as it's only by three days, it's just not enough to celebrate.

In the Category 2 planned surgery, where patients are admitted within the recommended time (90 days), we saw only 42 per cent of patients on the Category 2 planned surgery waiting list seen within the recommended timeframe. At the same time, pleasingly, this is a six per cent improvement compared to the year before; for clarity, Tasmania has been the worst-performing state in this area yearly since 2013-14, with these minor improvements being achieved by short-term funding injections rather than the long term planned investment with strategic surge capacity allowances built-ins that are needed.

In Tasmania, in 2022, over 57,000 patients were waiting to see a specialist in the public health system for their medical conditions. That includes patients with urgent referrals waiting over 880 days (nearly three years) to see a specialist, such as a neurosurgeon.

In 2020-21 there was an increase in public hospital expenditure per person in terms of both state and federal funding, with the Tasmanian government investing $1,678.00, a significant increase compared to the year before ($1,375.05) and the federal government investing $1,230.00 and while we have no recent data available on this, it shows we are somewhat heading in the right direction.

With emergency department wait times and bed block unrelenting, it is no surprise that our doctors are at the end of their tether when little seems to have changed or the ad hoc measures put in place are quickly overtaken by demand growth. The government needs to implement sustainability.

For Tasmania's public hospitals, workforce issues must remain our primary focus, recruiting medical staff, from interns to consultants. The time is right now for Tasmania while we are still small enough that we can afford to experiment with new patient care models by developing innovative policies and hospital systems that are sufficiently resourced and flexible enough to grow with the population.


Emergency department

The growth in emergency department presentations in Tasmania continued in 2021-22. After the 10.8 per cent increase in 2020-21,71 an increase of 1.8 per cent was recorded.

Waiting times

Percentage of Triage Category 3 (Urgent) emergency department patients seen within recommended time (< 30 minutes) - Tasmania

Only 43 per cent of patients in Triage Category 3 in Tasmania were seen within the recommended time in 2021-22 reporting period.

Source: The State of our Public Hospitals (DOHA 2004-2010). Australian Institute of Health and Welfare (AIHW). Emergency department care 2010-2021-22

Percentage of emergency department visits completed in four hours or less - Tasmania

Source: Australian Institute of Health and Welfare (AIHW). Emergency department care (2011-12 to 2020-21): Australian hospital statistics.
Note: National emergency access targets were abolished with effect from 1 July 2015

Planned surgery

Waiting times

The suspension of planned surgeries due to COVID in 2020 resulted in an increase in wait times and the number of patients on the wait list in 2020-21.72

Even with the extra investment by the Commonwealth Government to clear the surgical backlog ($15 million in Community Health and Hospitals Program funding),73 in 2021-22 Tasmania had the longest median wait time for planned surgery in the country. On average, Tasmanians waited 62 days for planned surgery, a slight improvement compared to the year before when they waited 65 days.

Median waiting time for elective surgery (days) - Tasmania

In 2021-22, median wait in Tasmania was 37 days longer than best performing State.

Source: Australian Institute of Health and Welfare (AIHW). Elective surgery data cubes (2001-02 to 2006-07): Australian hospital statistics. Australian Institute of Health and Welfare (AIHW). Elective surgery waiting times (2007-08 to 2021-22): Australian hospital statistics

Category 2 patients

Percentage of Category 2 elective surgery patients admitted within the recommended time (90 days) Tasmania

42 per cent of patients of category 2 patients were seen within the recommended time in Tasmania in 2021-22. Even with slight improvement compared to the year before (from 36 per cent) Tasmania has been the worst performing state on this parameter every year since 2013-14.

Source: The State of Our Public Hospitals (DoHA 2004-2010) FOI request reference 253-1001 lodged June 2011. 2011-12 estimate based on State and Territory Government published data; State and Territory data for 2012 calendar year published by Australian Institute of Health and Welfare (AIHW) National emergency access and elective surgery targets 2012: Australian hospital statistics. Australian Institute of Health and Welfare (AIHW) Elective surgery waiting times 2013-14 to 2021-22: Australian hospital statistics.
2010-12 data not available

Public hospital funding

The most recent public hospital funding data is 2020-21, so it is partially affected by COVID-19.

Commonwealth and Tasmania government per person funding for public hospitals (constant prices)

Source: Australian Institute of Health and Welfare (AIHW) 2022, Health Expenditure Australia: 2008-09 to 2019-20 viewed 17 February 2023 https://www.aihw.gov.au/reports/health-welfare-expenditure/health-expenditure-australia-2019-20/contents/main-visualisations/overview

Per person average annual per cent increase in public hospital funding by government source (constant prices)

2008-09 to 2012-13 2013-14 to 2017-18 2018-19 to 2020-21 2008-09 to 2020-21
Tasmanian Government 5.4% 5.8% 9.4% 6.04%
Commonwealth 1.3% 1.5% 4.8% 1.66%

71 Peter Gutwein Premier of Tasmania 2020. Media Release Date of Borders to Reopen https://www.coronavirus.tas.gov.au/media-releases/date-for-borders-to-reopen

72 Tasmanian Government Department of Health 2021. Statewide Planned Surgery Four-Year Plan https://doh.health.tas.gov.au/__data/assets/pdf_file/0005/438845/Planned_Surgery_Plan_2021-22_to_2024-25.pdf

73 Ibid