Thursday 29 June 2006 Estimates Committee B ( Lara Giddings)


Mr FINCH - It seems you cannot mention surgery these days without waiting lists for elective procedures. But it does not seem to be such a problem these days at the Launceston General Hospital. Can I get a comment and an explanation please?

Mr AYRE - Well I think that has been one of our success stories in the elective surgery area in the State. The LGH was able to obtain funding through the elective surgery fund in 2004-05 and we were able to change some of the ways that we did business at the LGH and concentrate on some of our most urgent categories. We have been able to maintain and significantly improve our performance in some of this area, particularly the most urgent surgery.

Mr FINCH - I do not know the funding of which you speak. Was that not available to the Royal?

Mr AYRE - It was a five-year funding program through the PSIF, through ESIF, and the LGH had to bid for that and we bid to do extra activity and we were able to achieve our activity and so we were able to get funded. This was repeated in the 2005-06 financial year and because of the success we have been able to actually add that to our base funding, which the Government has announced $2 million in each year for the next four years which will be $8 million.

Mr FINCH - Could I get an elaboration on the figure of 75 per cent who are proportionate urgent patients admitted within 30 days for elective surgery, perhaps with breakdown between the three main hospitals. Can we get that figure?

Ms GIDDINGS - Are you talking generally as a general waiting list?

Mr FINCH - Yes. There is 75 per cent proportion of urgent patients admitted within 30 days for elective surgery.

CHAIR - In the performance information? And you want to know whether those figures were met in every hospital - 75 per cent in that time line?

Ms GIDDINGS - Year to date, 58.7 for 2005-06 at the Royal Hobart; urgent patients admitted at the LGH, year to date is 88; North West Regional Hospital is 81.

Mr FINCH - Thanks. So elective surgery patients are not treated at the first try as it were? Could you give me the figures for postponements at the three hospitals?

Ms GIDDINGS - In the public hospital system it is sometimes necessary to postpone a booking for elective surgery. Surgeries are frequently postponed for patient related reason such as underlying medical condition and patient convenience. About 43 per cent of postponements are for patient-related reasons and 57 per cent of postponements are for hospital related reasons. Reasons for hospitals postponing surgery include an overriding emergency, lack of available beds and non-availability for surgeon and other clinical staff. We have developed a policy on hospital initiated postponements to ensure that hospital initiated elective surgery postponements are handled appropriately and sensitively and that patients are offered support and assistance when postponement leads to significant inconvenience. There were 6416 postponements during the period 1 July 2005 to 30 April 2006.

Mr FINCH - Is that the whole of Tasmania?

Ms GIDDINGS - Yes. That would be statewide. Ninety per cent of postponements occurred prior to admission and 10 per cent on admissions. Fifty-seven per cent were, as I have said, patient-related reasons and 43 per cent for hospital related reasons. It is actually the other way around. So I would want clarification as to which briefing is right. It makes a big difference. We might clarify that for you because it does make a significant difference.

CHAIR - Okay, Mr Finch.

Mr FINCH - I suppose the point that I am trying to get at is is that a figure to work on? To try and make sure of -

Ms GIDDINGS - Look, the waiting list area is one that we are acutely aware of. You would know in the public debate I have had about waiting lists that I have always said that waiting lists are only one piece of the puzzle so to speak. You have got to look at a whole lot of data to really see what is happening in our hospital system. Now, we have invested significant amounts of money - from memory $455 million dollar recurrent - every year now in Health and Human Services and what I expect is that we want to see results from that. That is where the occasions of service data is really important. That is how many people have we seen through our Department of Emergency Medicine? Are there more Tasmanians being seen through the DEMs? Are there more Tasmanians getting their elective surgery through?

Those are the sorts of figures and pleasingly there has been positive movement in those areas; that the occasions of service has been going up. You will not necessarily see that reflected in the raw figures of waiting lists because every day people drop off the waiting list, other people come onto the waiting list. What is important in terms of waiting list data is to actually look at the waiting times that people are on the list for and, again, the recent report by the Australian Institute has shown that the medium number of days that people are waiting is decreasing. So, the data is from 42 to 34 and I think the most up to date is about 32 days that people are on our waiting lists. Looking at all the data, the waiting lists, there is more that needs to be done. I am as much aware as you would be in terms of individual constituents that approach you with their individual health needs and that we do need to continue to put our efforts into this area.

The LGH has certainly been one of the shining examples in terms of being able to work on their waiting lists. We have put significant investment now into the Royal Hobart Hospital as well over this next four years. We have got the new operating theatres that the tender has now gone out for. We expect that we will see more surgery being completed through the Royal Hobart Hospital as well.

In relation to postponements, we have a target to halve the number of hospital initiated postponements. The correct figure is 43 per cent postponements are patient related and 57 are hospital related, just to clear that up.

Mr FINCH - That postponement figure seemed to me to be pretty high. When people go to a lot of trouble to get there, prepare themselves for it and then for it to be postponed.

Ms GIDDINGS - Absolutely. I know it is not ideal that people turn up and then are told to go away but there are often unforeseen circumstances that happen and that is an unfortunate side of trying to manage your surgeries as best as you can. You equally do not want to keep surgeries empty on the idea that perhaps there might be an emergency that turns up. You need to keep your surgeries working, operating. Unfortunately, the downside to that means that at times people are told that what they are being admitted for will not actually happen. The new Geriatric Evaluation Management Unit will help with this, the new transitional unit will help with this as well because part of the other problem is we have some bed blockers in our hospitals. It may well be that we have a surgeon available to do the surgery but we do not have the recovery bed for the patient to go into either so the GEN and the TCU will hopefully also free up bed space at the Royal Hobart Hospital which would help us impact our waiting lists.