Half a million people could be waiting for elective surgery by June 2023, according to the Australian Medical Association (AMA). 

Half a million. 

These are parents, children, friends and grandparents. They’re people who are trying to carry on as best they can while living with ongoing pain, disability or ill health. They’ve been told they need surgery to improve and yet they face a seemingly endless wait for a hip or knee replacement, tonsillectomy, cataract removal or other important surgery. 

The AMA notes that

Every delayed surgery has an impact on the patient, as it leads to further deterioration of health and impacts quality of life. This in turn has a significant economic cost due to loss of workforce participation and productivity.

Hard as their situation is, those patients are actually the lucky ones. At least they’re on the waiting list. If this were a theme park, those patients have made it through the front gates and are now queuing to get on the ride. 

Many, many others, though, are still queuing outside the gates. They’re on the hidden waiting list. 

The hidden waiting list

The hidden waiting list refers to the time a patient must wait for their first appointment with a specialist at a public hospital outpatient clinic after getting a referral from their GP – which may itself take longer and longer given the pressures on primary care. Only after this first specialist appointment can they be added to the official elective surgery waiting list (if indicated). 

The time spent waiting to see a specialist can be considerable, though there is no standardised reporting across the country. NSW does not keep any data on the hidden waiting list, meaning Victoria and Queensland are the two most populous states for which there are figures available. 

The AMA’s analysis of these figures shows that it takes: 

  • 150 days for 90% of patients to get an urgent gastroenterology appointment in Victoria and Queensland, instead of the target of 30 days
  • 930 days (2.5 years!) to get an urgent neurosurgeon appointment in Victoria. 

For non-urgent appointments, the situation is, predictably, even worse. It may take: 

  • 700 days (nearly 2 years) to see an ear, nose and throat specialist in Queensland
  • 1,400 days (nearly 4 years) to see an ear, nose and throat specialist in Victoria
  • Over 700 days to see an ophthalmologist, orthopaedic specialist or plastic/reconstructive specialist in Victoria or Queensland. 

The lack of transparency about the hidden waiting list limits patients’ choices. As the AMA observes, 

…a patient waiting for a non-urgent knee replacement would be aware that they could be waiting a year or more for this surgery on the elective surgery waiting list (as the target is 365 days), however may not be aware of the almost two-year wait for the outpatient appointment.

Were that data available, it’s possible we might see more patients choose to pay privately for their treatment rather than wait a total of 3 years in the public system. 

The significance of the hidden waiting list

Aside from its immense personal cost for patients, the hidden waiting list has significant implications for the health system. 

It means that Australia’s elective surgery backlog is not a short-term blip on the radar. It can’t all be put down to COVID-related disruption. And it won’t be over quickly. 

As the AMA’s 2022 Public Hospital Report Card demonstrated, waiting times for elective surgery are growing. More patients are being added to the elective surgery waiting list than are taken off through the provision of surgery. 

The official waiting list is ballooning. And, with the hidden waiting list stretching for years in some specialties, the demand for elective surgery is also likely to remain persistently high. A fresh approach is urgently needed. 

Back to the drawing board: a new system for elective surgery

Australia needs a completely fresh approach to elective surgery. Among other things, a comprehensive plan could include: 

  • A funding overhaul as called for by the AMA
  • Centralised waiting lists rather than catchment-based referrals to offer a patient the earliest available appointment at any hospital within a suitable distance rather than only at their local hospital
  • Surgical hubs to focus exclusively on elective surgeries. This would: 
    • Enable greater separation of elective and emergency care
    • Increase capacity
    • Maximise infection control. 
  • Better use of theatres to reduce downtime
    • As the CSIRO reported in 2022, “In many hospitals, operating theatres are not used to their full potential due to the dynamic nature of demand and the complexity of theatre scheduling. Theatre inefficiencies may lead to access block and delays in treating patients requiring critical care.”
    • CSIRO employed a machine learning model, which was able to predict daily counts of overall surgery with approximately 90% accuracy, informing long-term strategic planning and short-term staffing rosters 
    • Nottingham University NHS Trust runs ‘Super Saturdays’ where staff perform the same procedure all day to reduce changeover times and maximise operating time. 
    • Brigham and Women’s Hospital in Boston, Massachusetts dramatically improved first-case-starts-on-time rates through a multistep operational plan that included staggered starts, coordinated responsibilities, a visual pre-op Stop/Go checklist tool, real-time measurements and a feedback loop. 

Increasing capacity with mobile and modular operating suites

Flexible infrastructure offers a way to increase surgical capacity at both metro and rural hospitals. Meeting all required standards, these facilities can be used for the majority of surgical procedures performed in a major hospital. 

Mobile and modular facilities include day surgery suites, laminar flow operating theatres, outpatient clinics, decontamination and sterilisation services, and even mobile hospitals which can be established in remote regions.

If you would like to learn more about how mobile and modular facilities could help your hospital address its elective surgery backlog and hidden waiting list, please contact Q-bital Healthcare Solutions.