The Royal Australasian College of Surgeons (RACS) is calling for the restoration of surgery in Victoria to minimise the growing waiting list for elective surgery in both public and private hospitals.
“The elective surgery restrictions imposed intermittently over the last 18 months resulted in a growing waiting list for elective surgery in both public and private sectors. This has impacted negatively on the health of the Victorian community. We believe that the current stabilisation of the COVID-19 situation with high vaccination rates, fall in the number of COVID-19 cases and a gradual reduction in hospital in-patient ICU cases presents an ideal window of opportunity for government to restore surgery to full capacity,” said RACS President Dr Sally Langley.
RACS has contacted the Victorian Department of Health with a proposal to work together on an agile and nuanced plan to support a rapid change to the current system and address the issue of elective surgery and waiting lists.
RACS Victoria State Committee Chair, Dr Matthew Hadfield said that modelling suggests the possibility of further waves of COVID-19, adding that this can be managed using certain principles.
“First, elective surgery can be stopped at short notice as and when required. We recommend further detailed discussions with government to identify triggers that require restrictions to be implemented, making for a far more transparent system.
“Secondly, we commit to the principle that urgent surgery, whether in public or private, must be treated with the priority that it deserves. Delays are occurring all over Victoria due to the 50 per cent cap and this is affecting urgent and semi-urgent cases,” he said.
Dr Hadfield added that while the Victorian government’s gradual increase in percentage operating capacity will eventually restore elective surgery to its normal capacity, it is too slow and risks running into the Christmas and New Year period when many of the available workforce will be looking for well-earned leave.
The College’s proposals made to the Victorian Department of Health are as follows:
• There are many small private hospitals and day-procedure centres which do not form part of the COVID-19 response nor contribute to it. They are ready to recommence surgery and should be allowed to do so without numerical or category restrictions as soon as possible. The less complex but needed procedures they carry out form an enormous part of the surgical waiting list and require urgent attention.
• The larger private hospitals, which have agreements with the government to form part of the COVID-19 response, have significant unused operative capacity. In addition, they have ICU bed capacity, and their nursing staff are often not deployed to care for COVID-19 patients in streaming public hospitals. These organisations should be allowed to use that capacity to address the waiting list in the private and public sector. It is best to allow individual hospitals to decide the make-up of operating lists to maximise utilisation. This process should not impact any capacity which is set aside to deal with urgent cases transferred from the public sector.
• The arrangements to use private operating capacity for patients transferred from the public sector, although well intentioned, has proved less successful than intended. RACS is willing to work with the government to address the barriers which have prevented the seamless transfer of care for urgent public patients.
• The public hospitals remain under pressure. There will be restrictions on operating capacity for some time to come particularly in the streaming hospitals. However, even in these hospitals, it is possible to reintroduce some less complex day surgery that will not impact on their COVID-19 response. This change within the public sector is likely to have a beneficial effect on overall waiting lists.
• Fellows of the Royal Australasian College of Surgeons arrange their work according to clinical need and urgency. RACS recommends there should be no exclusion of any discretionary procedures (sometimes referred to as cosmetic) as many of our Fellows, particularly our Specialist Plastic and Reconstructive surgeons, include these procedures within their overall workload. This recommendation is line with similar measures introduced by government on dental surgery.
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About the Royal Australasian College of Surgeons (RACS)
RACS is the leading advocate for surgical standards, professionalism and surgical education in Australia and New Zealand. The College is a not-for-profit organisation that represents more than 7000 surgeons and 1300 surgical trainees and International Medical Graduates. RACS also supports healthcare and surgical education in the Asia-Pacific region and is a substantial funder of surgical research. There are nine surgical specialties in Australasia being: Cardiothoracic surgery, General surgery, Neurosurgery, Orthopaedic surgery, Otolaryngology Head-and-Neck surgery, Paediatric surgery, Plastic and Reconstructive surgery, Urology and Vascular surgery. www.surgeons.org