Elective surgery is essential surgery: AMA, RACS, J&J and private hospitals warn of looming public health crisis

MedTech News: Michael Buckland, CEO of McKell Institute and former Chief of Staff and Policy Director to NSW Labor Opposition Leaders, led the panel discussion on the impact of elective surgery bans during the COVID-19 pandemic imposed by the state governments on public and private hospitals.

The panel, including Australian Medical Association President, Dr Omar Khorshid; Royal Australian College of Surgeons NSW Chair A/Prof. Payal Mukherjee; Catholic Health Australia CEO Pat Garcia; and Johnson & Johnson Medical ANZ Managing Director Sue Martin, warn of a looming public health crisis if governments continue to take a stop-start approach to essential surgery which is planned to remove cancers, alleviate pain and prevent deterioration of a patient’s medical condition.

Catholic Health Australia CEO Pat Garcia noted “About 40% of hospitalisations occur in the private hospital system, so it is an integral part of our health system. The private hospital system is under a lot of strain and that strain comes from the COVID-19 pandemic, including additional costs from cross infection controls, PPEs and RATs.

“When you suspend elective surgeries, you’re strangling the revenue stream for this part of the hospital system at a time when the system is already struggling. In Victorian and New South Wales we had wards of beds fully staffed not being used for months on end. The capacity does exist within the private hospital system to deal with elective surgeries. We just need to be clever about the way we use it.”

Mr Garcia reflected on whether the community concerns on elective surgery backlogs will be a major issue at the upcoming Federal election. “If you, your child, or family member can’t get surgery within the clinically recommended timeframe, it bothers people. So absolutely, this is going to be an election issue.”

Australian Medical Association President, Dr Omar Khorshid is facing his first experience of elective surgery shut downs in the public and private health sector in Western Australia.

He said “We’re all scratching our heads wondering what these private facilities are going to be used for, how they’re going to contribute to the great effort and looking after the health of Western Australians, when in fact they’re going to have nothing to do. In the public side, we must acknowledge that the capacity is not there. We don’t have the beds, we don’t have the staff and so we are having to focus on the sicker patients and recognise the staffing issues.

“But if you are going to have to slow down elective surgery in the public, it should be done to the minimum level possible to minimise the number of people whose care is deferred. Similarly on the private side, we shouldn’t be having state-wide arbitrary decisions made by power hungry Premiers and Chief Health Officers who’ve gotten used to telling everyone what to do.”

Dr Khorshid noted that the impact of COVID is felt disproportionately amongst surgical patients and the private hospitals. “We’re going to face this problem for months and years to come. Once we are back to normal, we don’t have that extra capacity to go above 100% for a sustained period in order to catch up with this [elective surgery] work that hasn’t been done.”

Royal Australian College of Surgeons (RACS) NSW Chair, A/Professor Payal Mukherjee, said “We’ve learned that our workforce cannot be replenished. From the point of view of RACS, we know that every time elective surgery is stopped, it also impacts training. But it’s not just having a long-term plan in the workforce and increase the workforce in the public sector. It’s also making sure that the workforce is representative of the clinical needs and in the right geography, such as in rural health, areas that will be worst hit by Delta, or specific socioeconomic areas.”

According to 2022 research commissioned by Johnson & Johnson Medical, three in five (60%) Australians rated waiting times for elective surgeries as ‘poor’ or ‘very poor’, making it the lowest-performing aspect in the healthcare system. The majority (55%) of respondents opposed the NSW Government’s decision to suspend elective surgery during the Omicron outbreak, with only a quarter (24%) supporting it.

Johnson & Johnson Medical ANZ Managing Director, Sue Martin, said “This is a national problem. There needs to be cooperation between the State and Federal governments. The community is telling us that these power struggles is not creating solutions for elective surgery.

“Multiple stakeholders [surgeons, hospitals, industry and insurers] need to be part of this solution with government. These decisions should be made in consultation with all of the stakeholders that can potentially minimise some of these huge impact on patients.

“We have an aging population and the increased burden of chronic disease is not going away. We need a longer-term solution for a sustainable healthcare system, both across the public and private healthcare sector.”

Dr Khorshid said “There is no doubt that our health system is going to get harder and harder to run, more and more expensive to run. We need to have funding conversations now in order to prepare for that future. Unfortunately, reform with our system of government and the split responsibilities for health is difficult. What we need is big reforms.

“We think that the affordability of private health insurance is going to be an increasing problem. Up until COVID, we had 20 consecutive quarters of a drop in the proportion of Australians who had private health insurance, and that says that the affordability is a concern particularly with low wage growth amongst younger Australians.

“We put out a prescription for private health insurance which talks about some of the levers that government can pull right now that doesn’t cost much money. The only one with any real budgetary implication would be restoring the 30% rebate to 30%. Otherwise, looking at Lifetime Health Cover, looking at the Medicare Levy surcharge, tweaking those levers that have worked in the past, is likely to go some way of improving the sustainability of that part of our health system and make sure the Australians can afford their insurance.”

Dr Khorshid noted that the public hospitals are a “much harder problem”. Reforms would require the Federal Government to pay 50% of the costs “so they can’t claim that public hospitals are a state issue anymore”. It’s a collaboration and the funding should be a collaboration.

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The AMA believes that the cap the Commonwealth has in place on public hospital expenditure should be removed. That equates to $20 billion over 4 years. It’s the kind of change needed to make a difference to public hospitals.

He continued “At the moment we’re not measuring health outcomes and the way the public hospitals perform. We are only looking at how much throughput there is and how much they’re paying for it.”

Another area for improvement put forward by the AMA is looking for opportunities to keep people out of hospital “through better primary care and better aged care”.

In answering Health Industry Hub‘s question on whether there were examples of best practice in the OECD on optimally managing elective surgeries during the pandemic, Ms Martin commented “While there has been no perfect solution, countries that have managed this better, have tended to be more nuanced in their response. Here in Australia, it has just been very severe in regards to what has been required or what has occurred. Whilst that was necessary at the start of the pandemic, to still be doing that now, two and a half years later, is probably where we are not keeping up with other countries around the world.”

Dr Khorshid added “COVID has taught us…that we can make very big changes very quickly when we need to. Unfortunately, whilst we did great things in that first year, things are starting to slow down to the normal pattern of ‘reform is hard’.

“Our two parties at the moment don’t seem to think that health is going to be much of a battleground [during the Election]. We’ve got news for them…watching what’s happening in South Australia and looking at repeated polling says that health is important to Australians.”

He said “We want to see governments not just investing but opening their minds to reform so that we can all get together as an industry…turn that into some concrete reforms that can actually take us down this path of addressing the sustainability issues and attracting the funding that we need to make sure we prepare both our private and public systems for the challenges.”