Victoria Shadow Minister for Health David Davis
VIC Coalition To Increase Health Transparency By Releasing Outpatient Waiting Lists
Victor P Taffa
A Victorian Liberal Nationals Coalition Government will end Premier John Brumby’s cover-up of Public Hospital Outpatient waiting lists by releasing Quarterly Waiting list numbers and the time patients wait to get an appointment, both of which are kept secret by Labor.
Launching the Policy in Bayswater today, Shadow Health Minister David Davis said Victoria’s outpatients had been denied transparency and choice because of John Brumby’s secretive cover-up of waiting lists.
“A Coalition Government will end this scandalous cover-up by publishing both the outpatient waiting list numbers and the time patients wait to receive an appointment for surgery in Victoria’s public hospitals.” Mr. Davis said.
“These waiting lists and times are shrouded in secrecy under Labor, with no central collation or public reporting of waiting times or waiting lists and no benchmarking of performance.”
“Within the first 12 months of a Coalition Government, we will introduce a model based on that currently operating in Western Australia which will measure results monthly and report quarterly, both in hard copy and electronic formats.”
“This reporting a first for Victoria will cover all metropolitan and regional hospitals and we will also work with rural health services to develop appropriate reporting frameworks.” Mr. Davis said.
The Coalition’s plan to increase transparency and choice for patients waiting for outpatient appointments in Victorian Public Hospitals includes:
- Releasing data disclosing the number of outpatients waiting for appointments in Victorian Public Hospitals;
- Releasing data disclosing the waiting time from doctor referral to definitive Hospital Care;
- Publishing a Quarterly Outpatient Care report with data on Hospital and Health Service Performance;
- Disclosing data on the timeliness of outpatient care in Hospital Annual Reports and in the State Budget;
- Employment of Ten Outpatient Nurse Coordinators who will provide information and guide patients through the appointments process to ensure that each appointment delivers maximum benefits to patients;
- Disclosing outpatient data by network, Health Service and Hospital, including data by Specialty Outpatient Appointment type that shows how many patients are waiting and their likely waiting times;
- Restoring confidence in the accuracy of data by undertaking a full and open audit of Hospital Outpatient Data;
- Stop the practice of hiding waiting times to see outpatient specialists by measuring and publicly reporting aggregate figures tracking patient progress to surgery or other procedure from the time of doctor referral to definitive care.
“This policy will deliver the transparency and choice that has been demanded by the Auditor-General, the Victorian Healthcare Association, the Australian Medical Association, and the National Health and Hospitals Reform Commission.” Mr. Davis said.
“Victorian outpatients want more information, communication and access to care in a timely manner.”
“Increasing transparency will allow patients to make informed choices about their healthcare and the government and health agencies to allocate resources where they are most needed.”
“John Brumby has ignored numerous warnings and failed to take action on outpatient reporting, which means Victorians do not know the truth about how many desperately sick Victorians are waiting for an appointment to even go on the waiting list for elective surgery.”
“Labor has an appalling record of manipulation and secrecy when it comes to providing waiting lists and waiting time information, for outpatients and elective surgery.” Mr. Davis said.
“Some outpatients are forced to wait for years while suffering in pain and discomfort for an appointment.”
“Labor has also used the secrecy surrounding outpatient waiting lists to hide the true number of Victorians waiting for elective surgery and hospital treatment.”
“These hidden lists have become the ‘waiting list before the waiting list’ for elective surgery, with some patients waiting years to join the reported waiting list and begin their ‘official’ wait.”
“Nobody in Victoria knows the true number of Victorians waiting for outpatient appointments and Victorians deserve to know the truth about their hospitals.”
“John Brumby’s record of cover-up and manipulation means he cannot be trusted to tell Victorians the truth about our hospitals.” Mr. Davis said.
This announcement today builds on the Coalition’s announcement in April this year that a Coalition Government will overhaul access to information about Victorian hospitals by requiring data on the performance of our public hospital emergency departments to be made publicly accessible online in real time.
Definition Of Outpatient Care
The Victorian Government defines outpatient care as services to patients requiring specialist medical, Paediatric, allied health, diagnostic, obstetric or surgical assessment and care. It includes any consultation or procedure provided by a public hospital to a person who is not currently admitted to the hospital. (1)
Outpatient services are a core part of the Victorian public health system, and play a vital interface role between primary healthcare services and hospital inpatient services. The Auditor General confirmed this in his 2006 report stating: “Outpatient clinics also perform an important preventative role through the early diagnosis and management of medical conditions, which may reduce the demand for costly inpatient services.”(2)
There has been significant research undertaken in Australia into the requirements of patients waiting for outpatient care. One authoritative study in the Australian Health Review (3) found the key needs for patients in the outpatient setting are as follows:
- Information available for them to make informed decisions.
- Communication and education of how the process works.
- Access to care in a timely manner.
- Being kept informed on how long they will be waiting for treatment.
- Support on the day, waiting time in the actual clinic and coordination of care.
- Choice of Hospital and Medical Practitioner.
In 2006 the Victorian Auditor-General found “Timely access to outpatient services is important to patient wellbeing and has the potential to affect patient outcomes and demand on other areas of the health system. Promptly diagnosing and treating medical conditions may prevent unnecessary inpatient admissions reducing demand on health services and associated health care costs. (4)
In 1999, Labor promised in its health policy to be “Regularly publishing comparative data about hospitals including waiting list data.” After eleven years in office the Brumby Government has failed.
It is extraordinary that after eleven years the Brumby Government has never released detailed information about outpatient waiting times and the number of patients booked waiting for outpatient appointments.
In fact outpatient waiting list information is not even collected centrally in Victoria and is only collected in patchy and inconsistent formats at individual hospitals. It is astounding that the Victorian Department of Health – supposedly managing a major modern health and hospital system – has no idea how many Victorians are waiting for appointments, where they are waiting, at which hospital and what specialist appointment type the appointments and waits are for.
Proper health planning, including workforce planning, cannot occur in a virtual information vacuum on the precise numbers of outpatient treatments and appointments and their timeliness.
Mr. Lance Wallace, the Department of Health’s Executive Director of Metropolitan Health and Aged Care Services confirmed at a parliamentary committee hearing last year that the Department does not monitor the number of patients waiting for an outpatient appointment:
“I think the answer to that question is that the information is monitored at a local health service level. The department has not monitored those sorts of datasets…I can tell you how many people are treated, but there are no centrally maintained lists.”(5)
The Departmental Secretary Fran Thorn also confirmed that it was not the policy of the Brumby Government to measure timeliness of treatment in the outpatients setting:
“Ms THORN — And I am repeating my answer. It is a matter of policy for the government what it chooses to measure and report on, and at this stage it is not part of the performance reporting framework to measure waiting times for outpatients.”(6)
Six Warnings That John Brumby Ignored
1. Australian Medical Association (Victoria), 2001
“News of a drop in the number of people on the elective surgery waiting list for public hospitals is great news, but the government needs to be up-front about the long waiting times to actually get on the waiting lists…Doctors are telling us that some patients are waiting up to six months just to get an appointment for outpatient departments at public hospitals. It is only after they are seen that their names are recorded on the official waiting lists.”
2. Auditor-General Report, 2006
“DHS should develop a range of benchmarks to measure service delivery performance in outpatient services, include measure of access and timeliness…Even though various government policies identify the need for timely health services, DHS does not collect this type of information for outpatient services…DHS should take time to develop and report measures of access (waiting times) for outpatient services.”(7)
3. Australian Medical Association (Victoria), 2006/07
“The opportunity to restructure performance measures should also encompass the Department and hospitals addressing the glaring data hole about waiting times for assessment in outpatient clinics. Until this information is also known it is not possible for the government to ensure equity of access to care for Victorians.”
4. Auditor-General Report, 2009
“Address the need to measure hospital performance in providing access to specialist outpatient appointments (Recommendation 4.4)…The access indicators omit some key patient groups and aspects of timely access to care…reflecting these aspects of timely access to care within the performance monitoring framework will improve its balance, better reflecting access along a patient’s journey through the system.”
5. National Health and Hospital Reform Commission, 2009
“We are recommending National Access Targets across the continuum of health services – including primary health care services, mental health services, aged care assessment, public hospital outpatient services…Currently public hospital waiting lists measure the length of time people wait for elective surgery, but they do not routinely measure the time that people wait to get an outpatient visit (in order to be put on a waiting list for elective surgery), nor do they necessarily measure waiting time for various medical procedures (such as diagnostic scans or radiotherapy)…This set of National Access Targets identifies the maximum time in which patients should be able to receive access…Public hospital outpatient services: within 2 weeks for first appointment for urgent patients with a Life-threatening condition and within 3 months for other patients.”
6. Victorian Healthcare Association, 2010
“Waiting times must include the time spent waiting for specialist consults, and the time spent waiting for all diagnoses at all hospitals…The development of an elective surgery access indicator to include an accurate measurement of the time taken from general practice referral to any definitive treatment.”
1. About Public Outpatient Services, Frequently Asked Questions, page 1
2. Victorian Auditor General, June 2006, Access to Specialist Outpatient Care, page v
3. Australian Health Review, 2003, Vol. 26 no 21, Stakeholder perspectives on outpatient service performance: what patients, clinicians and managers want to know, page 69
4. Victorian Auditor General, June 2006, Access to Specialist Outpatient Care, page 3
5. Standing Committee on Finance and Public Administration, August 17 2009, Corrected Transcript, page 46
6. Standing Committee on Finance and Public Administration, August 17 2009, Corrected Transcript, page 32
7. 2006 Auditor General Report – Access to Specialist Medical Outpatient Care, page 17