Public Hospital Report Card 2023

Victoria

AMA VIC President’s Introduction

Dr Roderick McRae

AMA VIC President

This year’s Victorian public hospital report highlights the ongoing need to address substantial challenges in the delivery of emergency healthcare, its ability to meet planned, now urgent, demand, and basic hospital funding.

Patients are experiencing longer than ever emergency department wait times, and it is now significantly impacting their health outcomes. In the 2021-22 reporting period, only 58 percent of Triage Category 3 Victorian patients presenting to emergency departments were seen in the recommended 30 minutes. While this is the national average (albeit a poor one), this is 14 percent less than New South Wales. Patients who are discouraged from going to emergency departments then create additional burdens on our GPs, and yet our GPs are also desperately under-supplied and under-supported– creating a worsening vicious cycle.

AMA Victoria acknowledges Victorian hospitals have made significant strides in comparison to last year’s report card in terms of reducing wait times for planned surgery. In fact, Victoria is the best-performing state in this parameter with a median wait time of 25 days – making it the only state nationally to have improved its pre-pandemic performance in this area.

However, although planned surgery wait times are reducing, about 10,000 fewer patients were added to the planned surgery list this year compared to last year. We must consider whether the true levels of demand are being met by our limited supply of surgeons or whether patients are simply waiting longer for outpatient clinic appointments to even reach the planned lists. Given that the national estimate for the average expected growth of the planned surgery waiting list is around 2.1 percent each year, we can be almost certain that a dangerous “hidden waiting list” lurks behind Victoria’s figures. This means Victoria must address its supply of surgeons and public hospital outpatient clinic capacity now to prevent the hidden waiting list rearing its head in the future.

In 2020-21, 56 per cent of patients for Category 2 planned surgery were admitted within the recommended 90 days, marking a drop of 6 per cent compared to the year before, on top of the 14.5 per cent drop in 2020-21. Overall, Victoria has recorded a drop of 26 per cent in this category compared to the pre-pandemic 2018-19. Moreover, the remaining 38 per cent of patients who are overdue on the waiting list (a patient is considered overdue if the number of days they waited for planned surgery exceeded the clinically recommended time) on average waited additional 190 days in June 2022, on top of the 90 days that is clinically indicated for Category 2 planned surgery. By December 2022, that number has grown to 217 days. This means there could be patients in Victoria who wait for almost a year for a surgery that is indicated to be done within 90 days.

Our public hospitals need to have better workforce planning to ensure adequate numbers of doctors (both hospital doctors and GPs) and other healthcare staff are available, and more investment to increase bed numbers and outpatient clinic capacity (both physical and mental health). Victoria’s health system needs far more responsibility-sharing and collaboration between the State and Federal Governments to ensure adequate levels of funding are available for our public hospitals.


Emergency department

Victoria eased restrictions that were introduced to manage the spread of COVID-19 at the end of September 2021. By then there was already significant spread of the virus in the community.55 The outcome was a significant pressure on Victoria’s emergency departments in 2021-22 reporting period.

Waiting times

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

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 - Victoria

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

Throughout 2021-22 the pandemic continued to affect the delivery of planned surgery in Victoria.56 On 2 April 2022 the Victorian Premier announced a significant investment to catch up with the backlog of planned surgeries in Victoria “designed to exceed pre-pandemic levels by 25 per cent”.57

Under the plan, 40,000 extra surgeries would be performed over 2022-23, building up to record 240,000 surgeries every year in 2024. In addition, Frankston Private Hospital was to be transformed into a public surgery centre with the capacity to support up to 9,000 public patients per year once fully operational in 2023.58

Waiting times

In 2020-21, with the number of Category 2 planned surgeries conducted dropped by 8.6 per cent compared to the year before in Victoria.59,60 Still, 2021-22 On average, Victorians waited 25 days for planned surgery. Victoria is the best performing state on this parameter. However, similar to other states and territories, this data may be affected by the hidden waiting list – patients who are waiting to see a specialist as an outpatient in the public hospital system, who will eventually be added to the waiting list.

Median waiting time for elective surgery (days) - Victoria

Source: Australian Institute of Health and Welfare (AIHW). Planned surgery data cubes (2001-02 to 2006-07): Australian hospital statistics. Australian Institute of Health and Welfare (AIHW). Planned 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) Victoria

In 2020-21, 62 per cent of patients for Category 2 planned surgery were admitted within the recommended 90 days, marking a drop of 14.5 per cent compared to the year before. 2021-22 marked another drop of 6 per cent, down to 56 per cent of patients in Category 2 who were admitted in recommended time.

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 planned surgery targets 2012: Australian hospital statistics. Australian Institute of Health and Welfare (AIHW) Planned 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 affected by COVID19 response.

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

Source: Australian Institute of Health and Welfare (AIHW) 2022, Health Expenditure Australia: 2008-09 to 2020-21 https://www.aihw.gov.au/reports/health-welfare-expenditure/health-expenditure-australia-2020-21/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
Vic Govt 6.2% 4.1% 8.5% 5.63%
Commonwealth -0.3% 3.4% 14.8% 2.85%

55 https://www.premier.vic.gov.au/slowing-spread-and-keeping-our-state-safe

56 Andrews, D (Victorian Premier) 2020, COVID-19 capacity boost as planned surgery blitz starts, media release, Office of the Premier, Melbourne, 15 March 2020 https://www.premier.vic.gov.au/covid-19-capacity-boost-planned-surgery-blitz-starts

57 https://www.premier.vic.gov.au/covid-catch-plan-deliver-patients

58 Ibid.

59 Australian Institute of Health and Welfare (2021). Australian Hospital Statistics: Planned surgery waiting times 2019-20 Table 4.12 viewed 5 August 2021 https://www.aihw.gov.au/reports-data/myhospitals/sectors/planned-surgery

60 Australian Institute of Health and Welfare (2022). Australian Hospital Statistics: Planned surgery waiting times 2020-21 Table 4.12 viewed 1 Feb 2022 https://www.aihw.gov.au/getmedia/9d847d52-b1d3-4366-9900-1a0d4db1055d/Planned-surgery-waiting-times-2020-21.xlsx.aspx