The ‘hidden wait list’ you should know about if you're planning elective surgery

By Nathan Schmook

3 minutes

09 November 2018

Stonemason Michael Harcourt has lived with severe exostosis of the ear for two years, patiently waiting to undergo surgery as his ear canal slowly closes over.

The father of two saw his GP about the condition long ago, and was referred to Fiona Stanley Hospital so he could be booked in for surgery.

But what caught Harcourt and his family by surprise was the ‘hidden wait list’ he has found himself on as he waits for a first specialist appointment.

The hidden wait list, also referred to by doctors as the ‘wait-to-wait’, is a significant part of the patient journey in the public system that is not accounted for in the 38-day national median waiting time for elective surgery.

It is the time a patient waits between first presenting to a GP and their first visit with a specialist.

For Harcourt, whose ear canal has almost fully closed over, it has been a two-year wait-to-wait.

“It is quite hard to believe that it takes two years and more to even get to see a specialist and then the real wait begins,” his wife Kristy said.

“I don’t think people really understand that when they hear about waiting lists. What no one tells you is that you have to wait a really long time to even get onto the waiting list.”

HBF has pieced together data from the public and private systems to provide the first ever comparison between public and private hospital wait times.

Private system data has been attained from WA’s two largest private hospital networks, St John of God and Ramsay Health Care.  

Patient journey diagram

For patients like Harcourt, the ‘hidden wait list’ can be a surprise hurdle on the path to getting healthy again.  

According to the Australian Medical Association, people can wait longer for a first appointment with a specialist than they do between placement on the Elective Surgery Waiting List and receiving surgery. 

The ‘wait-to-wait’ in WA is recorded in the Referrals to Public Outpatient Surgical Clinics report, with figures from December 2017 showing there were 79,517 people still waiting for a first appointment with a specialist.

Of those, 50 per cent had been waiting more than eight months.

The Referrals to Public Outpatient Surgical Clinics report also indicated that the time people waited for a first appointment was on the rise, from a median of 7.5 months in December 2016 to 8.78 months in December 2017.

There are no targets in place for the time it should take between a GP referral to surgical care. The WA state government is currently working with providers to develop targets for wait-to-wait.

‘Wait-to-wait’ data limitations – what the stats don’t tell you

It is important to note that the Referrals to Public Outpatient Surgical Clinics report only presents half the picture, using the median (50 per cent of cases) to report the amount of time it takes to see a specialist.

Without other reporting measures, like the 90th percentile used in the Elective Surgery Waiting Times report, it is difficult to determine the length of time most people can expect to wait.

A median can also disguise the amount of time patients with different assigned urgency categories wait to be seen.

It is acceptable for category three patients to wait up to a year for their surgery, while patients in category one and two must be seen within 30 and 90 days respectively.

There is also no data for ‘wait-to-wait’ broken down by procedure and surgical specialty, making it impossible to get an accurate picture of how long the ‘wait to wait’ will be for a specific situation (for example a tonsillectomy).

Does wait-to-wait exist in the private system?

The short answer is: yes. But the wait-to-wait in the private system is generally much shorter.

Ramsay Health Care and St John of God estimate the average ‘wait-to-wait’ in the private system is two to three weeks, compared to 8.78 months in the public system.  

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Read more about public & private waiting times in our full report.

HBF releases public & private wait times report
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