Melinda Pascoe - Ministry of Health NSW

1. Elective Surgery Waiting List
Management – The NSW
Perspective
Melinda Pascoe
Principal Policy Officer - Surgery
July 2017

3. NSW Health Policy
• PD2012_011 Waiting Time and Elective Surgery Policy
http://www1.health.nsw.gov.au/pds/Pages/doc.aspx?dn=PD2012_011
• IB2012_004 Advice for Referring and Treating Doctors
http://www1.health.nsw.gov.au/pds/Pages/doc.aspx?dn=IB2012_004
• PD2012_038 Surgical Activity During Christmas/New Year Policy
http://www1.health.nsw.gov.au/pds/Pages/doc.aspx?dn=PD2012_038

4. Policy Background
• Prior to 2006 – Guideline only
• 2006: Major Policy overhaul (In excess of 20,000 overdues in 2005)
o Changed to a Policy from a Guideline
o Cosmetic and Discretionary Surgery exclusions introduced
o Clinical Priority Categorisation Reference List developed
• 2009: Minor adjustments (Approx. 1,500 overdues)
o Bilateral procedure management
o Refusal of Clinical review
• 2012: currently in draft

5. Intention of the Policies
• Clinically appropriate, consistent and equitable management of
elective surgery and waiting lists in NSW Public Hospitals.
• Transparent, patient focused processes.
• Covers all Local Health Districts (LHD) and the two Specialty Health
Networks (SHN) - St Vincent’s and Sydney Children's Hospitals.
• Applies to all patients requiring elective surgery/procedure regardless
of admission type (admitted or not admitted).
• Assist in meeting the Elective Surgery Access Performance (ESAP)
targets.

6. Elective Surgery Access Performance
(ESAP) Targets
l In 2014, the Commonwealth Government ceased funding National Elective
Surgery Target (NEST) reward payments.
l NSW committed to retaining targets for elective surgery, to ensure patients
continue to be treated within clinically recommended timeframes.
l Developed by NSW Health through consultation with the NSW Surgical
Services Taskforce (SST), Districts and Networks the ESAP Targets were
determined as follows:
• Category 1 ( admission within 30 days) 100% Overdues = 0
• Category 2 (admission within 90 days) 97% Overdues = 0
• Category 3 (admission within 365 days) 97% Overdues = 0

7. Principles of NSW Waiting List Management
• Allocation of a planned admission date should be based on the
patient’s clinical priority category.
• Patients must be treated in turn to ensure equity and
access based on clinical need.
• Other factors: previous delays, preadmission assessment
requirements, resource availability (special equipment) etc.
• Management of patients who are not ready for cared to ensure
they become ready for surgery or are removed from the list.

8. NSW Elective Surgery Access Performance
NSW Public Hospitals - NSW Health 2007-08 to 2015-16
190,000
195,000
200,000
205,000
210,000
215,000
220,000
225,000
50%
55%
60%
65%
70%
75%
80%
85%
90%
95%
100%
2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Elective Surgery Admissions (Number)
Patients Treated on Time (%)
Elective Surgery Admissions Category 1 (% admitted within 30 days)
Category 2 (% admitted within 90 days) Category 3 (% admitted within 365 days)

9. NSW Current ESAP
• In the January to March 2017 quarter, 97.1 per cent of elective surgery in
NSW was performed on time, an increase of point one percentage compared
to the same quarter last year. BHI Hospital Quarterly January to March 2017
• Current NSW performance
Category
ESAP Target
% Patients admitted
within clinically
appropriate time
June 2016 FYTD
Performance
June 2017 FYTD
Performance
(Draft)
1 - Urgent (30 days)
100% 100% 100%
2 - Semi-Urgent (90
days) 97% 97% 98%
3 - Non-Urgent (365
days) 97% 96% 96%

10. NSW Overdue Surgical Patients
December 2004 – December 2016
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000
Urgency Cat 1 (30 days) Urgency Cat 2 (90 days)
Urgency Cat 3 (365 days)
Waiting Time and Elective Surgery
Policy implemented

11. NSW Elective Surgery - Total Overdue Patients
June 2016 to June 2017
177
273
333
353
441
396
290
364
475
457
524
446
210
0
100
200
300
400
500
600
Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17
Number of overdue patients

12. National Perspective
AIHW Elective Surgery waiting times 2015 – 2016
l Of the 711,854 elective surgery admissions across Australia in 2015-2016,
the largest volume was undertaken in NSW, with 217,817 admissions from
the elective surgery waiting list, or over 30 percent of the total national
volume.
l Despite having the largest volume, 97.1% of patients in NSW were admitted
for surgery within clinically appropriate time frames, this was the highest result
achieved across Australia.
l In 2015 - 2016 NSW achieved:
• 99.8% for the category 1 - ranking second nationally
• 97.1% for category 2 - best performance nationally
• 95.6% for category 3 - ranking third nationally
l In NSW the percentage of elective surgery patients with wait time longer than
365 days was 2.0% which was the same as the national rate.

13. Statewide Strategies to improve and
maintain Elective Surgery Performance
l Elective Surgery Access Performance (ESAP) targets are included in the
annual Service Agreements between NSW Health and the Districts/Networks.
l Performance against the targets is managed in line with the NSW Health
Performance Framework.
l Hospitals with performance issues are placed on ‘Performance Watch’ . They
are required to send weekly reports and targeted teleconferences occur
fortnightly with the Surgery and Performance Teams.
l The Surgical Services Taskforce convenes monthly to review and approve the
elective surgery performance dashboard. This provides a District/Network
view of multiple surgical performance indicators.

14. Statewide services to improve and
maintain elective surgery performance
The Ministry of Health Surgery Team:
l Provide Policy advice and monitor compliance.
l Host monthly teleconferences with Surgery Wait List Managers to discuss end
of month overdue predictions and issues impacting performance.
l Host bi monthly teleconferences with Wait List Managers and Booking Clerks
to discuss operational issues.
l Conduct an annual Staff Development Day for Wait List Managers and
Booking Office staff.
l Conduct site visits, education and training sessions and audits/reviews of
surgical services with a focus on waiting list management.
l Develop and distribute a quarterly Surgery Newsletter.
l Provide telephone advice via the Surgery Access Line.

15. Surgery Newsletter
• Distributed quarterly - March,
June, September and
December
• Relaunched in June 2016 as
an eNewsletter
• Contents include
performance updates,
frequently asked questions,
staff profiles and redesign/
innovation projects.
• 310 people currently on the
Distribution List

16. Surgery Access Line 1800 053 456
The Surgery Access Line (SAL) aims to ensure all
patients have timely access to health care and
are admitted to hospital according to their clinical
need. The SAL was established to:
• Provide an information service regarding
elective surgery admissions and waiting lists at
NSW Public hospitals.
• Enquire on behalf of patients and investigate
surgery options that are available.
• The Surgery Access Line provides information
regarding current waiting times and
investigate options for earlier treatment.

17. Surgery Access Line
Facts
353 calls received since October 2016
Provided 35% of these callers with information
Provided 62% of these callers with options
3% of callers made a complaint
Common questions
Am I on the waitlist? How much longer will I have to wait?
What is the process of having surgery in NSW as a public patient? How much is it?
Can I have a breast reduction? Tummy tuck?
I’m on a waitlist in one area but I’m moving soon, can I have my
surgery in another area without starting again on the list?

18. Local Strategies to improve and maintain
Elective Surgery Performance
l Models of care
o High Volume Short Stay Surgery Toolkit
http://www1.health.nsw.gov.au/PDS/pages/doc.aspx?dn=GL2012_001
o Emergency Surgery Guidelines
http://www1.health.nsw.gov.au/PDS/pages/doc.aspx?dn=GL2009_009
o Preoperative Preparation -ACI Perioperative Toolkit
https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0010/342685/
The_Perioperative_Toolkit.pdf
l Waiting List Management
o Recommendation for Admission (RFA) volumes > capacity.
o Discretionary and cosmetic procedures.
o Management of “Not Ready for Care” patients.
o Regular audits.
o Pre Admission Processes/Patient notification.

19. Local Strategies to improve and maintain
Elective Surgery Performance
l Operating Theatre capacity
o Operating Theatre utilisation/first case on time/turn around time.
o Booking of sessions (over and under booking).
o Management of vacated sessions.
o Additional sessions/extended sessions/weekend sessions.
o Review Operating Theatre schedule.
l Pooling of cases where appropriate.(e.g. cataract surgery).
l Transfer patients to a surgeon with a shorter waiting time/another facility.
l Purchase activity from Private Providers.

20. Thankyou and Questions