Thread by @jilltomlinson

Today is the 120th consecutive day of #electivesurgery restrictions in Victoria. How did we get here?

🧵

On 25 March 2020 National Cabinet halted non urgent elective surgery on the advice of AHPPC

pm.gov.au/media/elective… 
 
Emergency & category 1 surgeries could continue.

NB. Elective category 2 & 3 surgery is essential surgery. It diagnoses & it cures cancer. It treats disability, so people can return to walking, working, running & living. It is not optional surgery.

The March 2020 #electivesurgery restrictions birthed a curious category: category 2A surgery. This is defined as “surgery in CAT 2 that is, you know, like, more urgent than other CAT 2s”. 🤷‍♀️ 

It was the first arbitrary inclusion, but it wouldn’t be the last. More on that soon.

After a month, Government announced that elective surgery would slowly be allowed to recommence, at an estimated 25% of usual surgery capacity.

abc.net.au/news/2020-04-2…

The 2020 restrictions stopped elective surgery, thereby preventing the use of PPE that is routinely used in surgery. There were global PPE shortages & #electivesurgery restrictions allowed us to increase crucial PPE stockpiles.

The 2020 fears that COVID would overwhelm the Australian health system were thankfully not realised.

But the idea “restrict elective surgery every time COVID admissions rise” is now locked into the thinking of Health Ministers & political decision makers.

On the arbitrary nature of restrictions, inclusions & exclusions have so far involved 
•category 2 & 3 cases 
•category 2A (🤷‍♀️) 
•paediatric surgery 
•metropolitan 
•regional  
•public 
•private

•IVF 
•cancer screening 
•day surgery cases 
•COVID streaming hospitals 
And percentage caps – 50%, 75%. 
 
It was only yesterday South Australia added paediatric surgery to the list; the list of arbitrary opt ins & outs has further growth potential.

Under 50% caps in 2021 Victorian surgeons were advised they could operate for 135 mins rather than the 270 mins of a standard list 🙄

I “negotiated” a more efficient special arrangement – I cancelled half my lists & booked 270 minutes on every 2nd scheduled list.

Arbitrary restrictions preclude efficient resource use. Pythonesque situations have surgeons concluding that the Victorian Government doesn’t understand how the surgical system works in public and private, at a macro or micro level.

Victoria’s official plan appears to be pausing or shifting elective surgery unless COVID admissions reach negative figures (<0).

There’s no roadmap for building future capacity, dealing with growing waiting lists in public & private, addressing training shortfalls or maintaining the surgical workforce. Victorian surgeons have been placed in lockdown.

Did you know that Victorian patients have flown to Queensland in 2022 to have category 3 elective surgery performed there?

Surgeons can currently perform category 3 elective surgery in private in Queensland.

https://twitter.com/drdavidoehme/status/1487163514913316867?s=21

https://twitter.com/jilltomlinson/status/1487157069853913088?s=21

In 2020-21 other states ramped up elective surgery to help people whose essential surgery had been delayed by the National Cabinet’s March 2020 decision.
 
ACT, NSW, TAS ⬆️ by 20% 
WA & QLD ⬆️ by 10% 
 
But in VIC ⬇️ by 6% 
 
Source: AIHW

Victorian surgery waiting lists were growing pre-pandemic, but the problem is now escalating rapidly.

The Victorian Cancer Registry report last month showed cancer diagnoses ⬇️ by 7% in 2020, which equates to >2400 Victorians with cancer needing diagnosis & treatment.

The broad brush approach #SpringSt is taking to elective surgery in public & private exacerbates problems for patients (who wait with pain & disability & cancer with no idea when their surgery will be permitted) & the surgery workforce.

Surgical trainees are entering the 3rd year of pandemic related surgery restrictions. They aren’t seeing & doing a desirable number of elective cases because those are banned in public & private.

Surgeons can stop operating for months & retain their skills*, but as with airline pilots we may see some initial performance challenges after long layoffs.

Some surgeries will now be more difficult technically because of the delays.

*see: maternity leave

While we wait for elective surgery to resume, cancers grow larger, necessitating changes to the planned surgery. Joints become stiffer & won’t regain the range of movement they otherwise would have. Patients are delayed in returning to work, & have poorer quality of life.

We’ve all been affected by this global pandemic, but Victoria’s #electivesurgery settings are consistently harsher and less nuanced than those in other states & we must ask: why?

Is the Victorian public healthcare system more chronically underfunded? Do we have fewer healthcare workers?

Do we have a different philosophical approach to permitting surgery to continue in facilities that have capacity to do so while others lack capacity (but not actually sharing those resources)?

Or do the current restrictions lack nuance because for no good reason?

Inexplicably @martinfoleymp, the VIC events team & public health take a nuanced approach to events, but not surgery restrictions in public & private hospitals & day surgery centres.

#EventsCapitalOfAustralia

The broad brush elective surgery lockdowns mean small business owners (surgeons) who usually perform 70% of Victoria’s elective surgery in the private sector cannot cure cancers & painful conditions that their patients present with.

Despite 120 consecutive days of restrictions the Victorian Government hasn’t provided a roadmap for these small business operators (surgeons) who they have placed in lockdown.

This might be understandable if these were expendable industries or if elective surgery was optional.

But elective surgery is essential surgery.

It diagnoses & cures cancer.

It allows Victorians to return to walking, working, running & living.

Victoria has had unnecessarily longer & harsher restrictions than other states & territories in 2021 & 2022, & it appears as though @MartinFoleyMP & @DanielAndrewsMP are set to continue on this path.

The Victorian Government must

▶️ apply nuance to #electivesurgery restrictions, 
▶️ provide an elective surgery roadmap, &
▶️ immediately allow the resumption of elective surgery in Victorian facilities that have the capacity to provide it.

Show us the plan, Dan.