At the start of the pandemic, Australians were told lockdown was a vital measure to protect the healthcare system. Outpatient specialist clinic appointments were at first deferred, and then moved to telehealth. Mask mandates, working from home, curfews, movement restrictions and border closures all promptly came into force. All to protect the health system, right?
Yet last week, footage showed 24 ambulances ramped at Royal Adelaide Hospital, with patients waiting hours on stretchers to be triaged. South Australia currently has a grand total of 15 cases of COVID-19.
Western Australia had 1700 hours of ambulance ramping in August 2020, compared to 500 hours in August 2015. WA also has 15 active cases of COVID-19. And in mid-December, Ambulance Victoria called a code red, with over 100 people waiting for ambulances. In July 2020, two people had fatal cardiac arrests in ambulances ramped outside Victorian hospitals. Victoria currently has 38 active cases of COVID-19.
ERs aren't clogged because of COVID-19 patients - they are overflowing because of chronically ill people who can't access timely, quality, affordable treatment in the public outpatient specialist clinic system. And while lockdown has exacerbated the problems plaguing outpatient systems across the country, the issues were there long before the pandemic.
Australia has a world-class healthcare system when it comes to what can be obtusely classed as "cuts and cancer": there are relatively straightforward diagnostic and treatment pathways when it comes to caring for people with a certain narrow set of well-known issues with common treatments.
Yet the public outpatient specialist system is falling apart at the seams when it comes to biopsychosocially complex care. As AMA ACT President Dr Di Dio pointed out in October, wait times for elective surgery waitlists are far worse than the official data suggests, "because they do not include the time that patients wait to see an outpatient specialist".
Patients with complex and comorbid conditions - such as autoimmune, musculoskeletal and mental health issues - wait months and sometimes years to get an initial first appointment. In Canberra, "urgent" rheumatology patients were waiting more than 16 months for an appointment before the pandemic. The 90th percentile waiting time for a first rheumatology consult in Victoria is approximately 449 days, according to the Victorian Agency for Health Information, but the actual wait time is in reality likely much higher, especially considering the published health data for Victoria's specialist clinic wait times is incomplete: the VAHI website hasn't posted any Victorian Integrated Non-Admitted Health (VINAH) data from Alfred Health, Mildura Base Hospital, Djerriwarrh Health Services, the Royal Children's Hospital and the Bairnsdale Regional Health Service. In some parts of NSW, patients are waiting up to 500 days for a routine colonoscopy.
Specialists regularly fail to communicate with each other, and multidisciplinary care is often unco-ordinated. GPs are overstretched and are underfunded when it comes to managing patients with complex and multidisciplinary conditions. Referrals go "missing", faxes fail to arrive. Public patients don't know their referral was never received until an appointment fails to materialise months down the track.
Rural and remote patients are regularly forced to travel huge distances to large cities to seek care. Funding for allied health appointments is restricted to five sessions a year and the gap between the rebate and the cost of appointments makes allied health unaffordable for people on low incomes.
Patients without advocates or the ability to advocate for themselves or co-ordinate their own care often miss out on appropriate healthcare entirely until their conditions are acute and require emergency care. Follow-up specialist appointments are often scheduled too far down the line from initial appointments, with patients having to go months or years without seeing their treating doctor, all the while getting sicker.
Emergency rooms and ambulance services are not meant to be the front line for treating chronic and complex conditions. But Australia's outpatient specialist system has been so abysmally neglected over multiple decades it is now placing strain on every part of public healthcare.
While ever more money pours into emergency rooms, new hospital beds and elective surgery wait list reduction, the wait lists for access to outpatient specialist clinics burgeon. Ensuring better funding for outpatient healthcare is the key to keeping chronically ill patients out of emergency rooms.
When it comes to COVID-19, Australia is in an enviable situation compared to most of the world: most cases are contained. We have not lost hundreds of thousands of people to the virus.
But we shouldn't lose sight of the cherished reason given for lockdowns and preventing the spread of COVID-19 in the first place: the necessity to protect our public health system. Australia urgently needs to prop up its flailing public outpatient specialist system, before the bottleneck that is the lack of timely care for chronically ill patients crushes all parts of the public healthcare system.
- Asher Wolf is a freelance journalist and digital rights activist.