Leaving it all on COVID’s watch | AMA (WA)


COVID-19 Hospital Waiting Room

Leaving it all on COVID’s watch

Friday March 24, 2023

Dr Mark Duncan-Smith, AMA (WA) President

The Government is set to reduce COVID-19 leave available to WA public sector employees. The rationale is that there is a decline in community risk and we’re returning to normal working arrangements. 

Ironic then that COVID-19 is being used as cover for another damning statistic on the state of our public hospital system. 

The Australian reported on Tuesday that elective surgery cancellations were rising, with monthly cancellations climbing to more than 2,000 a month from May 2022 onwards, while averaging fewer than 2,000 a month between October 2021 and April 2022.

As reported: “The number of cancellations peaked at 2,478 in November 2022 – the final month for which statistics were provided, and well above the 1,104 recorded in April 2022 when elective surgery bookings were temporarily paused because of the arrival of COVID-19 in the State.”

I made it clear to the media at a media conference and through a media release that COVID was not the cause of yet another poor outcome for the health system under the McGowan Government.

“These high and increasing rates of elective surgery cancellation are and were predictable and foreseeable. It was also preventable, which is an indictment of the McGowan Government’s approach to the public healthcare of West Australians,” I said.

“In an article in January, I wrote “Early indications for 2023 are that it will be business as usual, with access block and poor work conditions for our healthcare professionals”.

“Our WA public hospitals are consistently approximately 100 per cent occupied. They are sometimes greater than 100 per cent occupied, as we are all aware of the ‘over-census beds’.

“Once hospital bed occupancy goes above 90 per cent, the rates of poor outcomes go up, including ramping, cancellation of elective surgery and hospital death rates.

“85 per cent has been identified as the best bed occupancy rate for efficiency (National Audit Office, 2013). When occupancy rates go over 90 per cent, the result is regular bed crisis (Bagust, 1999) and increased cancellation of elective surgery.

“Bed occupancy rates are also positively related to increased surgical mortality and overall mortality (Bosque-Mercader, 2022).

“Access block is multifactorial but the primary determinate is the capacity of the system.”

Health Minister Amber-Jade Sanderson took a different approach, attributing the statistics to the challenges COVID created for the system.

As reported: “Factors including the Omicron outbreak, staff furloughing, sick leave, COVID-19 infection control protocols, and high rates of RSV (respiratory syncytial virus) added unprecedented pressures to the system,” she said.

She said some surgeries were now being scheduled on weekends and others were being outsourced to private hospitals in an effort to address the backlog. Most surgeries were rebooked within a matter of days. “Each of the health service providers is undertaking measures to safely reduce elective surgery waitlists, but the pandemic did have an impact and understandably it will take time to catch up,” Ms Sanderson said.

Unsurprisingly, opposition health spokeswoman Libby Mettam had a significant difference of opinion.

“We’re well past the point where COVID can be used as cover for the health issues across our hospital system,” she said.

“The peak of these cancellations was in November so you certainly cannot blame COVID for that.”

As I pointed out, on 21 April 2022, there were 9,314 new COVID cases, 248 in hospital and 9 in ICU. On 18 November 2022, there were 9,065 new cases, 179 in hospital and 3 in ICU. Yet elective surgery cancellations went up and up.

You might sense my frustration in my comments to the media.

“Increased capacity has been requested for years, and I have previously specifically lobbied heavily for the McGowan Government to adopt a policy to reach and maintain the national average of beds per head of population. As yet, they have not.

“JUST THE AVERAGE, that way, we would at least have a fighting chance of reducing access block, and these predictable and preventable poor measures of our inadequate health system.

“These cancellations are part of a vicious cycle that feeds the downward spiral of WA’s health system. A system under such strain is not a productive or enjoyable place to work, placing more stress on the workforce, exacerbating attraction and retention problems, compounding capacity issues and compromising patient care.”

Open more beds. Reduce the pressure. You can’t leave all your excuses to COVID.