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INCREASING levels of vaccination against COVID-19 in the community have seen a continuing reduction in the number of new infections and hospitalisations from COVID-19 in Australia, particularly in the two most populous states of New South Wales and Victoria. Modelling by NSW Health authorities that predicted a worst-case scenario of 3900 patients admitted to hospital with COVID-19, including 947 in intensive care, has thankfully not been realised.
Steering our way through the recent surge in COVID-19 cases has understandably been the top priority of governments and health authorities. Now that the peak of cases seems to have passed, at least for now, we need to start thinking about what life on the other side of the outbreak looks like and what living with COVID-19 means for our health systems.
One of the less recognised impacts of the COVID-19 pandemic has been the cancellation and restriction of elective surgery in both public and private hospitals. This was necessary at the height of the pandemic to free up hospital capacity for COVID-19 cases. However, the burden of diseases other than COVID-19 in the community remains, and the deferred caseload of patients requiring elective surgery must now be addressed.
Elective surgery cases may not be life threatening, but they are life impacting. These include procedures such as cataract surgery allowing patients to regain eyesight, and joint replacements allowing patients greater mobility and reduced pain.
Deaths from non-COVID-19 causes have been increasing in some countries as a result of the strain of the pandemic on health systems. It’s easy to forget that while COVID-19 has tragically claimed the lives of almost 1900 Australians since the start of the pandemic, in this same period some 9000 died from colon cancer. Maintaining access to procedures such as colonoscopy for cancer screening is critical to prevent this number rising.
The longer we defer elective surgery procedures, the more public waiting lists will continue to grow, including with patients with deteriorating or debilitating conditions. The average waiting time for non-urgent elective surgery in NSW in 2021 is 256 days, up from 246 in 2019 but a significant decrease from the record high of 330 days in July to September 2020 – longer in rural areas – and is expected to increase as the COVID-19 impacts continue.
This measure likely underestimates the real waiting time of patients requiring elective surgery in public hospitals due to delays in being seen in outpatient clinics, many of which have been cancelled due to COVID-19 restrictions.
Meanwhile, we have private hospitals with capacity available and doctors willing to undertake surgery. We need to mobilise the resources of our public and private health systems in response to the current crisis and for what comes after.
Elective surgery can be readily transferred to private facilities. Public hospital surgeons can move whole operating lists to private hospitals to free up beds and staff for COVID-19 cases. The logistics may be challenging, but they are by no means insurmountable. The training of specialists and medical students, seriously disrupted by the pandemic, can be restored. Emergency surgery cases can be redirected to designated private facilities. All of this can be achieved in a COVID-safe way, keeping patients without COVID-19 separated from those who require admission to a public hospital with this infection.
COVID-19 is likely to be a continued strain on our health resources for some time, even after we have fully vaccinated more than 90%of our adult population.
Canada, with 75% of the total population fully vaccinated, still has 1749 patients admitted to hospital with COVID-19 and 550 needing intensive care out of a population of 38 million. The experience of this and similar countries suggests that, even when high rates of full vaccination are achieved, COVID-19 is likely to place significant strain on our health system while there are significant numbers of unvaccinated members of the community.
The burden of managing COVID-19 cases as we enter the phase of living with COVID-19 will inevitably fall on the public hospital system, which is already struggling with the growing demands of an ageing demographic. We saw this in pre-pandemic times with the predictable shortages of hospital beds that occur every winter with seasonal influenza. States without significant COVID-19 cases are already seeing their public hospitals struggling with ever-growing waiting lists for elective surgery and lengthening queues of ambulances ramping at emergency departments.
Australia is fortunate to have one of the world’s best public health systems, which will no doubt rise to the challenge of managing the COVID-19 outbreak with distinction, as it has done so far. We also have the major advantage of possessing a private health sector of an equivalent size, with the capacity to assist with these efforts. The more than 600 private hospitals across the nation already perform 66% of all elective surgery. It’s time for these hospitals to join the response to COVID-19 to take pressure off the public system.
Our state health authorities need to think creatively to meet the challenge of living with COVID-19 and break down the barriers between the public and private systems. The private health sector has the capacity to assist and is eager to do so. Perhaps utilising the private health sector more to achieve the best health outcomes for public patients will be, like working from home and telehealth, one of the few positive legacies of the COVID-19 pandemic.
Dr Anthony Chambers is the Group Chief Medical Officer of Nexus Hospitals and a surgeon in public and private practice in Sydney.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.
I am waiting on investigative services for colon and urinary symptoms have private cover and am now on a long term waiting list this govt thinks I don’t exist but Covid deniers do and get preference
Am I the only one concerned that operating on public patients in private hospitals undermines the perceived value of private health insurance? The public patient pays nothing while the elderly private patient who has saved and contributed to private health insurance all their life pays excesses and gaps for exactly the same service and product.
Patients talk to each other and the word is out there – don’t bother keeping private insurance – public patients get the same service for free.
Great article Anthony with some critical messages.
As a GP, I have seen the direct impact of cancellations of “non urgent” elective surgery – eg. late diagnoses of colon cancer, serious falls due to deteriorating eyesight and uncontrolled chronic joint pain due to immobility. Many of these patients have joined “hidden waiting lists” as they have been unable to access outpatient appointments and they have not yet joined the formal public surgical waiting lists.
As you say, there are more than 600 private hospitals across the nation already performing 66% of all elective surgery, with capacity to take pressure off the public system. The excessive back log in “non urgent” public elective surgery is an urgent issue.