Welcome to the Surgery Newsletter.

The Ministry of Health supports local health districts and health networks to develop and implement local improvement strategies, monitors performance against key indicators and shares knowledge regarding elective surgical services.

There is great work happening across NSW to improve on-time access to elective surgery.

Previous newsletters

In this edition

Message from the Executive Director, System Purchasing Branch

Executive Director, System Purchasing BranchIntroducing Kim McClymont, Executive Director System Purchasing Branch. Kim is in the role for 12 months while Elizabeth Wood is on secondment to Northern Sydney Local Health District.  Kim has an extensive background in service and capital planning in Nepean Blue Mountains, Western NSW and more recently at the state level in the Health System Planning and Investment Branch here at the Ministry........

Hi everyone,

NSW continues to deliver the best on time surgical performance in Australia while continuing to deliver higher volumes of elective surgery. Overall 97.4% of patients had their surgeries within the recommended time in in 2017-18.

The most recent Bureau of Health Information Healthcare Quarterly Report July to September 2018 highlights include:

There were 59,778 elective surgical procedures performed in NSW public hospitals during the quarter, an increase of 2.6% from the comparable period in 2017. Despite increases in volume, have the percentage of patients in hospitals across NSW who have their surgery completed on time is at or slightly below target for all three categories.

The July-September 2018 Elective Surgery Access Performance (ESAP) year to date results are:

  • Category 1: 99.8% (Target 100%)
  • Category 2: 97.6% (Target 97%)
  • Category 3: 96.4% (Target 97%)

The median wait days recorded for each category has increased from the same period in the previous year. 

  • Category 1: 11 days
  • Category 2: 44 days
  • Category 3: 228 days

At the end of October 2018, the total number of overdue elective surgery patients was 570, an increase from 483 overdue patients for the same period in 2017. The surgical specialties with the highest number of overdue patients were Orthopaedics 24, Urology 143 and ENT 99 patients.

The ESAP Performance Monitoring and Recovery Support Programs are assisting sites that have significant numbers of overdue patients. This includes weekly reporting and attendance at teleconferences to discuss the number of overdue patients and local strategies to address identified issues.

These results are an outstanding achievement and a credit to the ongoing hard work and dedication of the many staff in the Districts and Networks.

Congratulations! Keep up the excellent work.

Kim McClymont

Executive Director, System Purchasing.

Increasing Access to Cataract Surgery Forum

People writing ideas on butchers paper at Cataract Forum

The Increasing Access to Cataract Surgery forum was hosted by the NSW Minister for Health & Minister for Medical Research at Parliament House on 27 August 2018.

Attendees included representatives from the Royal Australian and New Zealand College of Ophthalmologists, the NSW Ministry of Health, the Ophthalmology Network - Agency for Clinical Innovation, Optometry NSW, Optometry Australia, the NSW Rural Doctors Network, The George Institute, the Look for Life Foundation, The Outback Eye Service, the Australian Government Department of Health, The Fred Hollows Foundation, the Agency for Clinical Innovation, the Centre for Eye Health, the Australian Commission for Safety and Quality in Healthcare and Local Health Districts. 

The Hon Brad Hazzard MP, the NSW Minister for Health & Minister for Medical Research, opened the forum, which was followed with a presentation by Dr Michael Hennessy, Co-Chair of the Ophthalmology Network – Agency for Clinical Innovation.  

During the forum, a skilled facilitator assisted the attendees to understand the common objectives and to reach consensus on the key priorities for cataract surgery. As the first step in this process, attendees worked together in pairs to identify what they believed was currently working well, what the blockers to improvement were and what should be accelerated across the system. 

Following the identification of the strengths, weaknesses and opportunities in the current system, the issues were grouped into common themes. 

The top five priority areas identified by the group for further consideration were:

  1. Improving referral processes for patients who may need cataract surgery 
  2. The use of day surgery to increase the number of surgeries able to be performed 
  3. Streamline the process for patients to get access to cataract surgery for their second eye surgery if required 
  4. Outpatient ophthalmology clinics 
  5. Research

Cataract Surgery at Shellharbour District Memorial Hospital

Congratulations are well deserved for the staff of Shellharbour District Memorial Hospital (SDMH) who undertook an extra 223 cataract surgeries over a 4 month period up to the end of June 2018. The additional surgeries were funded as part of the Increasing Access to Elective Surgery initiative.

Shellharbour booking office teamShellharbour booking office team
Shellharbour Theatres teamShellharbour Theatres team


SDMH Nurse Unit Manager for Perioperative Services, Angela Jones, reports that she was very proud of the effort from all involved from the surgical booking office, to the day surgery team, to the Sterilising Services Department, Theatres, Post Anaesthetic Care Unit and the Operations Assistants for ensuring that all of the cases were done and the team still had a smile on at the end of a very busy 4 months.

For further inquiries please contact

Angela Jones, Nurse Unit Manager, Perioperative Services, Shellharbour Hospital

Update from the EDWARD Business Implementation Program (EBI) 

The EDWARD Business Implementation program is engaging across NSW Districts & Networks and the Ministry of Health, to enable the use of data from EDWARD. As part of this process the Ministry of Health is bringing greater focus to OPERA. A number of current and future releases will improve the stability and timeliness of wait list reporting. These releases are concentrating on addressing some outstanding issues and fine tuning the Wait List Data Marts to provide earlier access to wait list data and provide quicker report response. The January 2019 release user acceptance testing process is currently being planned with testing representation from the OPERA User Advisory Group (OUAG).

Other OPERA capabilities will be enabled as we move forward including admitted patient, emergency department and data quality.  The OUAG meets monthly and although currently has a wait list focus, it will expand to cover these other data areas. Currently the group is mainly IPM Wait List sites, however we are actively engaging with Cerner sites in the preparation of the provision of an extract solution for Cerner Wait List. 

A new addition to the program is Mr Kieron McGlone as the EBI Program Director.  Kieron has over 25 years’ experience in health, his previous position was Associate Director InforMH where he worked across the state with mental health data and reporting. 

For further inquiries please contact

Mr Kieron McGlone, EBI Program Director
 

Agency for Clinical Innovation (ACI) Update

Integrated Surgical Care for Older People

The Guide: Integrated Surgical Care for Older People​ aims to improve outcomes and experience of older people having surgery in NSW. For an older person with complex health care needs and multiple co-morbidities, many challenges arise. These are not only from surgical care itself, but from the way in which individual patient care pathways are planned and coordinated across health care teams, with patients, carers and families. 

The project resulted in the development of a comprehensive Integrated Surgical Care for Older People guide, highlighting common challenges experienced across the NSW health system, informed by health professionals and health service executives from metropolitan and regional health services in NS​W. The resources aim to support clinicians to develop and improve local perioperative services, as well as to guide health service managers in the development of service and district strategy. They provide a foundation to reflect on current care models and an opportunity to identify how services could be enhanced to improve care delivery and patient outcomes in the future.

The Guide was launched at the Australian and New Zealand College of Anaesthetists Perioperative Medicine Special Interest Group on 25-27 October 2018, where an information and discussion session was hosted as part of conference proceedings. It is also now available on the ACI website​.

NSW National Surgical Quality Improvement Program

The National Surgical Quality Improvement Program (NSQIP) has been active in NSW for three years under the sponsorship of the ACI Surgical Services Taskforce. NSQIP is a risk adjusted, internationally benchmarked and peer-controlled program that measures and improves the quality of surgical care. The program allows hospitals to collect and compare 30-day patient outcomes following surgery and to benchmark performance with local and international peer facilities. 

The NSW NSQIP Collaborative met on 1st November 2018 to share progress to date in their hospital and surgical quality improvement initiatives. Participants have implemented positive changes in their workplace to improved surgical services for their staff and patients, including:

  • Reduction of surgical site infections at Mid North Coast Local Health District
  • Improvements surgical site infection and urinary tract infection at Westmead Hospital
  • Improvements surgical site infection, urinary tract infection and pre-operative optimisation at Nepean Hospital
  • Strategies for successfully introducing a network-based surgical quality improvement initiative at Sydney Children’s Hospitals Network.

Further details, including site contacts for the program, are available on the ACI website​.

For further inquiries please contact
Crystal Burgess, Manager, Surgical Services Taskforce
Phone: (04) 10 550 359

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New Face in System Purchasing Branch

Vincent Salomon has joined the System Purchasing Branch surgery team at the Ministry of Health. 

Vincent will be working on various projects within the System Purchasing Branch over the next 12 months including managing the Surgery Access Line, revising the Waiting Time and Elective Surgery Policy, creating a Waitlist Managers Toolkit to assist with the role functions, reporting and auditing requirements and assisting with frequently asked questions.

Vincent has a clinical background in operating theatres and more recently as the Admissions and Waitlist Manager at Sutherland Hospital. He brings a wealth of experience and knowledge to the role and we look forward to what he achieves in his time at the Ministry.

For further inquiries please contact

Vincent Salomon, Senior Policy Officer, Surgery
Phone:(02) 9462 7835​

Frequently asked questions​

​A patient was offered a date with an alt​ernate surgeon and declined, can they be made NRFC (Not ready for care)?

A patient remains ready for care unless they meet the criteria set out in section 5.5 of the Waiting Time and Elective Surgery Policy.

Section 5.9.1 outlines the requirements for transfer of patients to doctors with a shorter waiting time. The offer to the patient has to be considered "reasonable”. This needs to be determined for each individual and the following considered:

  • The circumstances of the patient (e.g., age, available support, public transport, physical condition and the required procedure).
  • The offer must be specific. The name of the clinician, hospital, and planned admission date or an estimate of the likely waiting period must be given.
  • The offer must be a credible alternative and be available if the patient decides to accept the offer.
  • Where the patient declines two genuine offers of treatment with another doctor or at another hospital, then the patient should be advised that they may be removed from the elective surgery list. The Local Health District Program Director of Surgery should review the patient’s status on the list in consultation with the original treating doctor prior to the patient being removed from the elective surgery list.

The new doctor will determine the requirement to review the patient.

The patient's listing date and history must be that of the original booking. In this way an accurate record of time to surgery is maintained. Where there is a delay in listing the patient on the shorter list, the patient must remain on the original list, pending confirmation of the patient's acceptance by the second doctor. The patient’s current clinical priority category must be maintained, unless altered after clinical review by the new treating doctor.

For how long is the patient’s consent valid?

The general rule is that consent will remain valid until it is withdrawn by the patient or until the patient’s circumstances change in a material respect.

Hospitals and practitioners should bear in mind, however, that a change in patient’s circumstances could encompass a number of situations. This would include a change in the patient’s condition which would affect treatment, the development of alternative treatments to the recommended procedure or the identification of new risks or side effects associated with the recommended procedure.

It is suggested, therefore, that a new consent form be obtained or the patient be asked to affirm their previous consent if a significant period of time has lapsed since the original consent was obtained. What constitutes a “significant amount of time” will depend on the individual circumstances of the case.

NSW Health Consent to Medical Treatment – Patient Information policy provides additional detailed information.

For further inquiries please contact

Vincent Salomon, Senior Policy Officer, Surgery 
Phone: (02) 9462 7835​
Email: Vincent.Salomon@health.nsw.gov.au​

Tell us what you think​

What did you think of this newsletter? What would you like to see included next time? We are always looking for feedback to give you the most from this publication. If you have any suggestions or would like any further information please contact us.

Email the Editor
Melinda Pascoe, Principal Policy Officer, Surgery
Phone: (02) 9391 9557
Email: MOH-SPB@health.nsw.gov.au

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Page Updated: Thursday 20 December 2018
Contact page owner: System Purchasing