Victoria spent over $1b on a surgery catch-up plan. The financial watchdog can’t say if rapid clinics worked

Victoria’s billion-dollar COVID catch-up plan for elective surgery fell short of its targets, and the effect of rapid surgical hubs on the health system remains unclear.

The government program delivered 30,000 fewer catch-up operations than originally hoped, and this shortfall was driven by issues between the Health Department and the private hospitals tasked with carrying out extra public procedures, the Victorian Auditor-General’s Office has found.

In a report on its investigation, tabled in state parliament on Wednesday, the Auditor-General’s Office determined that 209,925 elective procedures had been conducted in the 12 months to July last year – below the catch-up program’s target of 240,000 procedures.

The watchdog also heard that, as of May this year, there were 583 long-wait patients on the surgery waiting list. This group was on the waiting list and overdue for surgery as of March 2022.

The Auditor-General’s Office heard from the department that the surgery shortfall was because private hospitals were either grappling with their own backlogs and infrastructure issues or asking for too much money as part of public-private surgery partnerships. It also heard from one health service that the modelling that helped shape the department’s targets was flawed.

The Andrews government allocated $1.5 billion to a surgery catch-up plan in April 2022, given the pandemic had triggered a backlog in elective procedures.

As part of this program, which ran from April 2022 until June 30 last year, public health services were tasked with increasing their partnerships with private hospitals to deliver extra operations. These kinds of operations are called public-in-private surgeries.

In the case of Frankston Private Hospital, one of the institutions to add a public surgical centre under the catch-up program, just over 6000 planned procedures were delivered in the 2023-24 financial year. The department’s target was 9000 procedures.

Peninsula Health, the public health service that ran the surgical centre, told the Auditor-General’s Office that the Health Department’s modelling did not adequately consider workforce factors, some patients having more than one procedure per session, and patients cancelling surgery at short notice.

Blackburn Public Surgical Centre, which was established at Bellbird Private Hospital, aimed to deliver 5760 procedures a year until June 2024. But it delivered just 877 in 2022-23, and 642 in 2023-24. This was due to closures related to flood damage and construction.

The Health Department attributed the shortfall in public-in-private contracts to private hospitals having their own surgery backlogs, quoting costs that were too high, and requesting low-complexity patients.

Aside from the Frankston and Blackburn surgical centres, the COVID catch-up plan also delivered 12 “rapid access” surgery hubs for low-risk and on-the-spot procedures. But the Auditor-General’s Office report found the department could not directly report on the performance of those hubs.

“Their impact on the system’s performance is unclear,” the report said.

It found that, while the catch-up program had reduced Victoria’s surgery waiting list by 30,958 patients, there were still 2000 more people on the waiting list by June 2024 than originally hoped. Eighty-three per cent of patients treated as part of the catch-up program were seen within clinically approved timelines, against a target of 95 per cent. And while the plan came in $356.4 million under budget, this was because fewer private hospitals partnered with public health services than originally budgeted for.

Health Minister Mary-Anne Thomas said on Wednesday the report showed the catch-up plan had boosted the number of planned procedures and reduced waiting lists.

“Over the past three years, we have reformed how we deliver surgery, and in the past year, our dedicated healthcare workers delivered a record 212,000 surgeries – the most in Victoria’s history,” Thomas said. “Nationally, we are the only state or territory to treat 100 per cent of the most urgent category one patients on time.”

Coalition health spokeswoman Georgie Crozier said the unclear impact of the rapid access hubs was concerning.

While the COVID catch-up plan has wrapped up, these medical centres will remain.

“This is a damning report that exposes not just a failure of Labor to deliver, but also a deliberate refusal to be transparent about the true state of our surgery waiting lists,” Crozier said. “Victorians deserve a government that puts patients first, not more political spin.”

A Health Department spokesperson said they welcomed the report and knew there was more work to be done.

“The Department of Health has continued to work with health services to improve how their planned surgery lists are managed, through a range of programs including VicKey, expanding the Elective Surgery Information System, more Patient Support Units and Rapid Access Hubs.”

In the 2024-25 budget, the Allan government scaled back the overall 240,000 surgeries target to 200,000, the same target as before the pandemic.

When it announced the ambitious target, it promised to reform the health system to provide enduring improvements. This included changes to take pressure off the system such as expanding virtual care and treatment outside of surgery.

In Wednesday’s report, the Auditor-General’s Office recommended the Health Department ensure all public planned surgeries are captured in the state’s central monitoring system. The department accepted this recommendation in principle.

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