Public Hospital Report Card 2023

Western Australia

AMA WA President’s Introduction

Dr Mark Duncan-Smith

AMA WA President

WA’s 2023 report card has fulfilled my prediction a year ago that “the WA Government will go back to its old ways of starving WA Health of operational budget, and not have a focus on quality and safety of patient care again”.

WA’s performance overall is very poor, with only one glimmer of light. WA is top of the leader board for the four-hour rule, but this metric doesn’t capture the time patients spent waiting in ambulances, to get into our ED departments.

Ambulance ramping in WA is continuously at crisis levels. Ambulance ramping - or the time in excess of 30 minutes, spent by patients in ambulances waiting to get through the front door of WA’s EDs - increased by 103 per cent in the year 2020-21, compared to 2019-20.

Triage Category 3 (Urgent) Emergency department presentations (seen within the recommended 30-minute time period) in Western Australia are 25 per cent below the national average and 39 per cent behind Victoria, which is the best performing state on this indicator.

The current data comes from WA’s COVID-free era when the other states and territories were crippled by COVID-19. We in comparison had business as usual and yet we did not top all the other states for performance.

WA may be the richest state, but our health system is the sickest.

Our hospitals routinely run at or near 100 per cent occupancy, well over the 90 per cent where international studies have established that bed block, ramping, cancellation of planned surgery, increased surgical and general hospital mortality all start and then increase predictably. Where our health system is now is and was predictable.

We have increases in the number of over-boundary planned surgery cases, ramping that has peaked at 6,972 hours in July 2022 and preventable deaths in our hospital system.

The McGowan Government increased non-COVID health operational budget in 2022 by 3 per cent, less than CPI.

Despite the McGowan Government claiming WA has the best state economy in Australia and possibly the world, it appears they have assessed that a sick WA Health system will not lose them votes, as they increasingly retreat to rhetoric that medical systems are sick everywhere, so why would it be different here.


Emergency department

Western Australia - COVID-19 impact on public hospital emergency department patient volumes

Following the slowdown in emergency department presentations due to COVID-19 restrictions, in 2020-21 emergency presentations in Western Australia increased by 7.3 per cent compared to the year before, and significantly above the average yearly increase of 4.5 per cent since 2016-17.65 The decline in emergency department performance in Western Australia continued in 2021-22.

Waiting times

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

Only 33 per cent of Category 3 patients – one in three - in Western Australia emergency departments are seen within the recommended 30-minute time period. This is a drop of 10 per cent compared to the year before. Western Australia was the worst performing state on this indicator in 2021-22.

Source: The State of our Public Hospitals (DOHA 2004-2010). Australian Institute of Health and Welfare (AIHW). Emergency department care 2010-2020-21

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

With 65 per cent of emergency department visits completed in four hours or less, Western Australia is the best performing state on this parameter. However, this is a 6 per cent drop in performance compared to the year before.

Source: Australian Institute of Health and Welfare (AIHW). Emergency department care (2011-12 to 2021-22): Australian hospital statistics.
Note: National emergency access targets were abolished with effect from 1 July 2015

Planned surgery

Waiting times

Following the increase in 2020-21 in the number of performed Category 2 planned surgeries by 16 per cent, in 2021-22 WA recorded a 23 per cent drop in planned surgery admissions, with around 20,000 less people having access to surgeries they were assessed as needing.

Median waiting time for elective surgery (days) - Western Australia

Median wait time for planned surgery in 2021-22 in Western Australia was 43 days, 18 days longer than the best performing state and an improvement of 3 days compared to the year before.

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 2020-21): Australian hospital statistics

Category 2 patients

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

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 Western Australia government per person funding for public hospitals (constant prices)66

Source: Australian Institute of Health and Welfare (AIHW) 2022, Health Expenditure Australia: 2008-09 to 2019-20 viewed 10 February 2022 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
WA Government 5.5% -1.2% -3.2% 0.77%
Commonwealth -1.4% 4.9% 7.4% 2.80%

65 Australian Institute of Health and Welfare 2022. Australian Hospital Statistics: Emergency department care 2020-21 table 2.2 viewed 1 February 2022 https://www.aihw.gov.au/getmedia/0d0d6cbf-e764-4a89-a71a-b03c5156235d/Emergency-Department-Care-2020-21.xlsx.aspx

66 Note: The funding data in the AMA Public Hospital Report Card 2022 differs slightly compared to the Public Hospital Report Card 2021 for Western Australia. The data change is in line with the latest updates from AIHW and their ongoing work program to consolidate the data. For more information see Australian Institute of Health and Welfare (AIHW) 2022, Health Expenditure Australia: 2019-20 – Different Reports on Health Expenditure https://www.aihw.gov.au/reports/health-welfare-expenditure/health-expenditure-australia-2019-20/contents/comparison-and-alignment-of-health-expenditure-estimates/different-reports-on-health-expenditure