Croakey is closed for summer holidays and will resume publishing in the week of 9 January 2023. In the meantime, we are re-publishing some of our top articles from 2022.
This article was first published on Wednesday, January 19, 2022.
Prime Minister Scott Morrison today continued to urge Australians to “keep pushing through” the Omicron wave.
But as journalist Marie McInerney reports below, it’s not only her Mum who is suffering as a result of the wave’s devastating impact upon health and other services.
Marie McInerney writes:
Amid the daily count of COVID-19 deaths and ICU admissions are many hidden casualties of this pandemic and how it’s been handled by our political leaders.
My 82-year-old mother is now one of them, proof that we cannot, as the Prime Minister would have it, just “push through”.
She is among many Australians now waiting for surgery that has been delayed indefinitely. Like so many, she has been left in pain, immobilised, bedridden and house-bound, her life on hold while our hospitals swell with COVID-19 patients as we learn to “live with it”.
Following months of increasingly severe shoulder and arm pain, Mum was scheduled to have a right reverse total shoulder replacement in Adelaide on January 6.
The surgery itself was not something she was looking forward to.
It’s a big operation for someone who has previously suffered a stroke and COVID had had already added layers of anxiety. She worried if COVID restrictions meant no one could go with her to the hospital or visit afterwards, to explain any issues or help her deal with pain or discomfort.
But even that, she said, was better than living with the pain.
Then, just two days before her surgery was scheduled, it was cancelled under South Australia’s Emergency Management (Appropriate Surgery During COVID-19 Pandemic No 6) Direction 2022, to ensure “that healthcare resources are available to respond to the immediate needs of persons infected with COVID-19”.
Collateral damage
The news barely generated a headline here in South Australia. As a family, we pored over reports and the nightly TV bulletins for details. But like so much harm that is rippling across the community as we ‘let it rip’, the indefinite delay of surgical procedures across the state appeared to be mostly unremarked collateral damage.
It may be that many people see elective surgery as being less serious, a choice, not a necessity. Officially, it is any procedure that can be delayed for “at least 24 hours”.
“It doesn’t include things like major trauma or absolute emergencies, like appendicitis, where you’ve got to have it out straightaway,” Michael Roff, CEO of the Australian Private Hospitals Association (APHA), told Croakey.
What it does include is an array of other major, urgent procedures, including joint replacements and cataract surgery – the types of surgery that dramatically improve a person’s ability to move around or to see. As well as others that most of us wouldn’t think for a moment could be ‘elective’: like cancer surgery and cardiac procedures, including heart valve replacements.
In its report card on Australian hospitals published last November, the Australian Medical Association said that only 75 percent of Category 2 elective surgery cases had been treated within the recommended timeframe.
“In reality, what this means is that 25 percent of people will wait longer than 90 days for surgeries, which in this category can include treatment for an unruptured brain aneurism, decompression of a spinal cord and treatment for ovarian cysts or unhealed fractures,” the AMA said.
It’s hard to get the figures on how many people like Mum are affected by the current suspension of elective surgery in SA, Victoria, New South Wales and, to a lesser extent in Queensland, Tasmania and the Northern Territory.
Federal Health Minister Greg Hunt’s office did not respond to a request for these numbers. But a spokesperson said the Minister spoke in detail about the issue yesterday in his press conference that announced the activation of an agreement for private hospital staff to come into the public hospital system – though it’s worth noting there was no specific mention of elective surgery. The APHA has also queried the significance of this announcement on ABC radio today.
SA Health couldn’t have been less forthcoming. Asked in detail how many surgeries had been cancelled, what that toll might mean for patients, and what the plan was to resume elective surgery and address the backlog, the office of Minister for Health and Wellbeing Stephen Wade responded:
In order to keep South Australians safe as we experience more COVID-19 in our community, changes were made effective January 4 to what surgeries are considered appropriate during the pandemic.
Elective surgeries are now limited to Category 1 and Urgent Category 2 to increase capacity across our public and private hospitals for both patients and staff.”
Roff said the APHA had estimated about 340,000 “missing episodes of care”, mostly surgeries, in private hospitals in 2020 as a result of COVID-19. That figure had come back to around 275,000 by September last year but has been “confounded by what’s happened in the beginning of the year here”, he said.
Behind the statistics
But the term ‘missing episodes of care’ of course does not even begin to tell the stories lying behind these statistics.
Mum’s procedure is classified under Category 3, defined by National Cabinet as: “Needing treatment at some point in the next year. Their condition causes pain, dysfunction or disability. Unlikely to deteriorate quickly.”
In fact, Mum has been essentially bed-ridden with the pain from her shoulder for the past five to six weeks. My sister and I have moved in with her to provide full-time care with meals, medications, showering, shopping and cleaning, backed up by other siblings.
Her deterioration has been a shock to us all.
Right up until the pain hit so sharply, Mum was fiercely independent, shopping and cooking for herself, playing piano, welcoming droves of visitors (pre-Omicron), lovingly tending a bountiful vegetable garden that is currently bearing tomatoes, spinach, herbs and corn that towers above me. Last year she passed her driving test once again. Before her shoulder got worse, she gave Victor Borge a run for his money, miming a performance on the keyboard as a mock tribute for our brother’s 50th birthday.
As a family, we have followed up every treatment option. In recent days, thankfully, the strapping applied by an attentive physiotherapist has immobilised her shoulder joint and given her relief. That means she has been able to reduce some pain medications that caused nasty side effects and worries about long-term use.
But she still can barely walk around or sit up for long. She can’t drive or cook. She urgently needs surgery but there is no telling when it will be rescheduled. The only “anecdotal” advice her surgeon had received was that it might be two months.
That of course means continuing worries for both her physical and mental health.
In the meantime, like so many in Australia, we are living in a shadow lockdown. Already cautious, we do not want to put her or her surgery at risk by bringing COVID-19 into the house so, after six lockdowns in Melbourne, I’m back in a ‘bubble’.
It’s far from being in an ICU ward with COVID, of course. But it makes us think about those who don’t have family who can move in with them to provide care. Those who can’t work from home, for whom English is not their first language. Those whose families who don’t have the healthcare experience to identify looming issues, navigate the health system, and advocate on their loved ones’ behalf.
Burnout
“Omicron is a gear change and we have to push through,” Scott Morrison told us last week, as total infections surpassed one million, more than half in the previous week alone, putting intense pressure on hospitals and supply chains.
Chief Medical Officer Professor Paul Kelly joined him at the press conference, speaking about how Australia had now “caught up” to the rest of the world in terms of outbreak pressures – something we had previously tried to avoid, we might remember. Then he declared: “We have had plans in place since the beginning of the pandemic and re-planned last year exactly for this sort of event.”
THIS was the plan for hospitals and healthcare?
For the first time ever, a Code Brown has beeen declared in Victoria across every public metropolitan hospital and major regional public hospitals, allowing staff leave to be cancelled and “less urgent treatments, like outpatient care” to be shut down, not for days but for weeks.
Health and hospital staff are exhausted and depleted in many states, but notably Victoria and NSW.
And, barely mentioned, there are thousands of people like my mother.
Elective surgery has been cancelled or limited, in Australia and internationally, at various points during the pandemic.
Adjunct Professor Alison Verhoeven, former Chief Executive of the Australian Healthcare and Hospitals Association, says this has been necessary due to the demands placed on the health system, including the available workforce, beds, ICU capacity and the need to safely manage care. Another factor though has been the speed at which governments have let the virus rip.
As the COVID-driven demand for healthcare reduces, hopefully in the coming weeks, public hospitals must be ready and sufficiently funded to be able to address the backlog in elective surgery, she said.
But the challenge to catching up on the ballooning waiting list is not just money but available staff, “particularly when a lot of staff may be in isolation or have COVID or be burnt out from long periods of overtime and no leave, and many being reassigned to other work including caring for COVID patients, testing, vaccination clinics etc”.
Michael Roff agrees that the “key capacity constraint” going forward is the workforce, where already, prior to COVID, there have been shortages, particularly in specialty areas like theatre nurses.
To some extent, he says, the Australian nursing workforce, both public and private, “has been propped up by skilled migration”, in recent years by United Kingdom nurses who had left the National Health Service (NHS) because of severe budget cuts.
“So that workforce supply has dried up in the last two years, plus we’ve got people who are exhausted. And you know, this whole exercise will probably lead to them exiting the profession earlier than they otherwise would have,” he said, urging a serious government effort focusing on building the health workforce.
At this stage, he says, there’s no telling how long people whose surgeries have been cancelled will have to wait. It will depend on “the type of surgery, the urgency category, the state they live in and, to some extent, even the city or regional area they’re in”.
Health workforce shortage and burnout is a global issue in the pandemic. George Washington University’s Fitzhugh Mullan Institute for Health Workforce Equity was last week awarded a $US6 million grant to help health institutions strengthen their workforces, amid widespread physical and emotional exhaustion” and “a feeling of betrayal by the system”.
Avoidable suffering
Leanne Wells, CEO of the Consumers Health Forum of Australia, wants public and private hospitals to have learned from the previous elective surgery shutdowns to mitigate the adverse repercussions for patients.
“We would hope the state governments and the Commonwealth have factored in not only additional funding to meet the extraordinary demands facing hospitals, but are also providing for recruitment and training of more staff as a medium to long term strategy,” she said, emphasising the need for more nurses and concerns about the frequent imbalance in supply and demand for hospital specialists and GPs.
For now, Wells said, we have news of the Commonwealth’s agreement with private hospitals being re-activated to assist with the elective surgery backlog. But, she said, that is “still cold comfort for many patients who will need to live with pain, disruption, anxiety and risk of condition escalation as we are told by the Australian Private Hospitals Association that people will still need to wait for lengthy periods.”
As one of my sisters told me, these are the sorts of issues that get swept aside in such a huge crisis. It’s not simply a matter of a patient finally having their operation and then everything is fine.
Like so many others, Mum will now be a bigger risk for problems during surgery and afterwards simply because her condition has deteriorated, she is more frail, and her muscles have weakened through lack of use. Mentally, she won’t be as strong either, worn down by the pain and worry of it all.
The situation of my mother, and of thousands like her, poses big questions for health and healthcare in the months ahead, including the risks of higher mortality and morbidity.
As well, those who get through the surgery will likely need more at-home care and support. Not to mention, my sister adds, the social and economic impact on families in providing ongoing extended care. We won’t be counting those costs, but governments should.
Where is the plan?
After our communication online, Verhoeven sends an article published this week in the BMJ by Professor Dominic Harrison, Director of Public Health, Blackburn with Darwen Council in North West England.
Titled What is driving all cause excess mortality?, it warns that Omicron is likely to generate more avoidable deaths from non-COVID causes than from COVID in England, amid “a double jeopardy of simultaneous high demand and reduced capacity due to staff shortages”.
Echoing public health concerns here, Harrison writes that yet again England has acted “with too little control, too late” with Omicron, squandering hopes about its relative mildness through the sheer number of infections which are overwhelming hospitals.
“Despite two years of pandemic impacts and three variants of concern of SARS-CoV-2 in the last 12 months, we have yet to see any strategic plan emerge defining what we might need to do to ‘live with the virus’. Whatever that is going to look like, it cannot look like the current situation,” he says.
My family would have to agree. Governments must face the reality of the health crisis we are now experiencing. ‘Pushing through’ leaves too many behind. Our Mum included.
Correction: The original story misspelt Michael Roff’s name but is now updated.
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See Croakey’s archive of stories on health workforce matters.
