The community expects the Mid North Coast Area Health Service (MNCAHS) to look at the broad spectrum of health care need and prioritise its funding according to the areas of greatest need. Our community, like every other, suffers from a range of ailments and diseases which require interventions and treatments.
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The community expects its Area Health Service to provide an appropriate range, volume and mix of health services, within available resources, to service each of these needs.
The MNCAHS accepts that demand for services is and will always be higher than its capacity to meet all the expectations of the community. We must therefore prioritise on the basis of clinical need across all services, from community health and emergency to medicine, renal services, cancer, aged care and surgery (including orthopaedic surgery). It is not just about orthopaedics, it is about all services. The community would consider it unreasonable and irresponsible if disproportionate levels of funding were allocated to one area of clinical need at the expense of others.
The letter by orthopaedic surgeon Dr Mark Baker regarding elective orthopaedic surgery at Port Macquarie Base Hospital (PMBH) requires the following response and clarification.
During 2001-02 and 2002-03, the Area Health Service increased the amount of funds for elective surgery across the Area in real terms by $6.5 million.
Port Macquarie Base Hospital (PMBH) received the single largest allocation of $1.85 million to undertake an extra 709 elective operations. Of this, $1.052 m or 56.8 per cent was provided to undertake an additional 180 orthopaedic operations.
Almost half of the total new money allocated to PMBH went to perform 89 major new orthopaedic operations. This increase represented 36 per cent of the total allocation of new funds for orthopaedics over this period for the Area.
I reject the claim that waiting times for orthopaedic surgery waiting times at PMBH were growing exponentially and, according to Dr Baker, reached a theoretical level of 10 years at one stage. According to published figures (available from the Department of Health website at www.health.nsw.gov.au\waitingtimes) the clearance rate for Dr Baker's patients as at November 2003 was 1.5 years. This compares to the PMBH clearance rate for all orthopaedic surgeons of one year and the Area total of 6.7 months.
In July 2001, Dr Baker had 259 patients on his list, of whom 75 waited longer than 12 months for surgery. As at November 2003, the number of patients on Dr Baker's list had reduced to 178 and 28 waited longer than 12 months for surgery.
The waiting time for Dr Baker's patients on the elective surgery list at PMBH was 10.62 months in July 2001, 6.15 months in July 2002, 7.4 months in July 2003 and 8.35 months in December 2003. This compares to the average waiting times at PMBH of 8 months in July 2001, 5.14 in July 2002, 6.29 in July 2003 and 7.33 in December 2003. The equivalent waiting times across the Area were 6.95, 5.28, 4.85 and 5.5 months.
Across the Area at July 2001 there were 1590 patients waiting longer than 12 months for elective surgery. Because of the extra funds provided to undertake more surgery each year, by July 2003, this figure had reduced to 371 and at December 2003 was 467.
At PMBH at July 2001, there were 796 patients waiting longer than 12 months for elective surgery. By July 2003 this reduced to 340 and at December 2003 was 421.
Across the Area Health Service at July 2001 there were 191 orthopaedic patients waiting longer than 12 months for elective surgery. By July 2003 this reduced to 67 and at December 2003 was 108. At PMBH at July 2001 there were 92 orthopaedic patients waiting for elective surgery. By July 2003 this figure reduced to 62 and as of December 2003 this was 95.
Since July 2001, PMBH has averaged four orthopaedic surgeons. Two orthopaedic surgeons have resigned in the last three years but the hospital has been successful in recruiting an additional two.
Contrary to Dr Baker's comments, patient classifications are undertaken strictly in accordance with the classification criteria applied universally across NSW which do not allow spurious reclassification to "not ready for care".
Public patients are patients of the hospital and do not have choice of doctor. Those who choose to wait for a particular doctor have made the choice to wait longer for their operation.
The number of doctors performing orthopaedic surgery at PMBH does not dilute the amount of funds available. Funding does not change depending on the number of doctors: what is important is the number of operations performed, not how many doctors are performing them.
To only provide services depending on how many doctors are working within the Area Health Service at a given time as opposed to looking at the size of health need would be irresponsible. If this was the case, it would follow that given the shortage of psychiatrists, we would not fund mental health or given the shortage of radiation oncologists, we would never have radiotherapy services.
The statement that the MNCAHS Board and Chief Executive Officer makes projections of need and budget predictions and decides where available funding will be spent on which services is absolutely correct. This is done in consultation with the Department of Health and three clinical councils (medical, nursing and allied health). Waiting time is the most relevant measure that we monitor. What we require of hospital managements, including PMBH management, is to use the money to perform the services for which funding has been made available.
Within these parameters, all procedures are assessed on clinical need. The majority of our orthopaedic growth funding has been allocated to expensive joint procedures to ensure patients will not be required to wait more than 12 months for surgery. It is important to reiterate that the decisions around volume, range and mix of services is a decision made by the AHS and the CEO in consultation and advice of managers of each of the hospitals, including PMBH, and the three clinical councils. I am prepared to accept those decisions as being appropriate. These decisions have been endorsed by all three clinical councils in each of the last three years.
We are working very hard to achieve a situation where patients are treated locally and this is one of the tenets of our strategic plan.
Over the past three years, the Mid North Coast Area Health Service has developed a comprehensive community consultation process, which was mentioned in the NSW Independent Pricing and Regulatory Tribunal (IPART) report into patient care on being a best-practice model. This consultation process assists me obtain first-hand knowledge of the community's needs, which is passed on to the Board, the Department of Health and to the community.
As a measure of how we are continuing to develop our relationship with the community, a values and expectations forum will be held in Port Macquarie in early February. The aim of this forum is to assess community expectations and to clarify the values or criteria the community would like the MNCAHS to adopt when having to make the important decisions about health service delivery with finite resources.
Notwithstanding the above comments, I accept, as does the Board, that we need to continue to improve on the range of services available to the community on the Mid North Coast, on the waiting times for elective surgery and on the provision of an increasing proportion of those services locally.
MID NORTH COAST AREA HEALTH SERVICE CHIEF EXECUTIVE OFFICER,
TERRY CLOUT