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The hidden waiting list is hurting Victorians
AMA Victoria is calling on state Liberal and Labor parties to make improving access to public hospital outpatient services an urgent priority.A recent survey of AMA Victoria GP members has highlighted appalling consequences of funding cuts to public hospital outpatient services, President Dr Mark Yates said.
“While there has been attention to improving elective surgery and emergency waiting times in recent years, outpatient services have become the hidden disgrace of our public hospital system,” Dr Yates said.
“No relevant Department of Human Services reporting requirements, no hospital performance incentives and inadequate funding have led to cuts in services.
“The latest figures show Victoria has cut outpatient services by more than 500,000 or 10% over the past four years. Victoria now provides less than half the medical and surgical outpatient services per 1000 population than New South Wales.”
AMA Victoria surveyed member GPs earlier this month as a Family Doctor Week initiative to seek to identify the issues for patients and the health system.
“GPs are totally frustrated by the difficulties their low income and uninsured patients face in accessing a specialist for their medical condition,” Dr Yates said.
“The survey found the long wait for public outpatient services is literally hurting patients, putting pressure on already overworked GPs and overloaded emergency departments as well as increasing medication costs for governments and patients.
“Nowhere in the health system is the divide between the ‘haves’ and ‘have nots’ more apparent and having a greater impact on our community,” Dr Yates said.
The survey findings include:
• 68% of GP respondents found in the last 3 months access to outpatient appointments for their medical patients was poor or very poor
• 79% said access for surgical patients was poor or very poor.
• no respondents said access was very good, with 27% and 19% reporting access was acceptable for medical and surgical appointments respectively
• 83% of respondents felt that access to outpatient appointments had deteriorated over the last three years.
GPs felt waiting times for outpatient appointments were unacceptably long for a number of specialties, but were worse for:
• orthopaedics (92 per cent of respondents)
• neurology (66 per cent)
• gastroenterology (49 per cent)
• ear, nose and throat surgery (46 per cent)
• urology and cardiology (41 per cent)
• endocrinology (39 per cent)
• respiratory medicine (31 per cent).
When asked about the impact of the long wait for a specialist public outpatient appointment, the survey found that 82% of GP respondents had patients who had deteriorated due to an extended wait for outpatient appointments.
The majority of these GPs indicated that more than 40% of their patients:
• made more frequent visits to see their GP, and
• had decreased mobility and levels of activity.
More than a third of GPs also reported that, of their patients who had deteriorated, more than 40% had:
• presented more often to emergency departments, and
• needed higher doses of existing medications to maintain their health.
A small number of GPs reported a patient had died of a related condition during the extended wait for a public outpatient specialist appointment.
Many GPs provided de-identified case studies to highlight the impact of the delays in getting outpatient appointments in public hospitals. Examples included:
• young and mid-aged patients unable to work because of the pain and disability caused by their problems
• older patients unable to keep mobile at all, are home bound and depressed
• inability to get specialist opinions leading to delays in making serious diagnoses, as well as delayed follow-up of serious illnesses
• public outpatient clinics do not exist in some regional areas and for some specialties in metropolitan areas
• as appointments in some specialties were so hard to come by, patients were encouraged to see specialists privately, which often meant incurring out-of-pocket expenses
• the demand pressures on outpatient department staff were excessive and often unreasonable.
“These stories are the human face of the pain and suffering that far too many people are forced to endure as they wait for an appointment to start them on the road to treatment,” Dr Yates said.
“The uncertainty and long wait to get an appointment with a specialist impacts on people’s mental health, ability to work, ability to manage independently, and on their rate of recovery.
“People are enduring severe pain and disability, feel worthless and lose faith in the health system and this is just to get over the first hurdle of a specialist appointment. The wait for definitive treatment such as surgery can be a further year away.”
Dr Yates said public outpatient services were a key entry point for people to access specialist care, whether surgical or medical. “Timely and equitable access to public outpatient services is fundamental to a quality public health system,” Dr Yates said.
“Disadvantaged Victorians should have at least the same level of access as people in other states.”
Dr Yates called on the state Liberal and Labor parties to commit to improving access to outpatient services by:
• doubling the capacity for outpatient services at public hospitals
• meaningful, accountable public reporting at least every three months about:
• the range of outpatient services in each region
• the time for first appointment at each hospital for the range of specialties
• the time for follow-up appointments
• performance against agreed targets.
Background
The survey
The AMA Victoria GP Section distributed the survey “Exposing the hidden waiting list for outpatient appointments” to Victorian GP practices on Friday 7 July. Almost 100 responses were received in the week.
The survey was designed by GP members to provide a snapshot of the impact of the current standard of public outpatient services in Victoria. It was not intended to provide a definitive statistical analysis of the performance of the state’s outpatient services that is the responsibility of the Department of Human Services.
Comparisons with other states
Reduction in access is amply demonstrated by figures released by the Commonwealth in The state of our public hospital reports. In Victoria, the number of occasions for outpatient services has fallen in both per capita and total numbers over the last three years: (see table below)
In 2004/05 1013 occasions of care were provided in Victoria per 1000 people.
The comparable figure for NSW in 2004/05 is 2471, and the rest of Australia excluding Victoria is 2136. So Victoria has less than half the public hospital outpatient services of other states.
When only medical, surgical and obstetric outpatient services are counted, a similar picture emerges with 1.5 million occasions in Victoria compared with more than 4 million in NSW, which produces a per capita rate in Victoria half that of NSW (AIHW 2006).
Table: occasions of all outpatient services (including, medical, surgical, dental, allied health, alcohol & drug) at Victorian public hospitals
Year 2001/02 2002/03 2003/04 2004/05
Total number of occasions
5888000 5857000 5665000 5299000
Occasions/1000 population 1221 1198 1103 1013
Source: Department of Health & Ageing 2004, 2005, 2006
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