Private and non-private surgical operations

WQ.277/2020

WRITTEN QUESTION TO THE MINISTER FOR HEALTH AND SOCIAL SERVICES

BY DEPUTY I. GARDINER OF ST. HELIER

ANSWER TO BE TABLED ON MONDAY 13th JULY 2020

Question

 “Will the Minister –

1. provide monthly figures of all the private and non-private medical operations, listed by type of operation, carried out on Jersey residents during the 12-month period from June 2019 to June 2020, with the same data provided for the previous 12-month period (June 2018 to June 2019) for comparison;
2. state how many elective operations have been cancelled or postponed because of the Covid-19 crisis;
3. provide figures detailing the current backlog of operations, including day surgery and repeat appointments;
4. state what policy, if any, is used in determining and administering waiting lists and advise how the waiting list for elective surgery has been monitored and how it has changed since this time last year; and
5. advise whether any dedicated resources will be allocated to catch up on elective surgery procedures and how long he anticipates it will take to catch up and return to the situation in respect of such procedures as it stood this time last year?”

Answer

1. Please see the appendix.
2. Routine procedures were postponed due to COVID-19, rather than cancelled. ‘Urgent’ and ‘soon’ procedures continued to take place. Approximately 470 ‘routine’ elective procedures were postponed. Routine elective day surgery procedures re-started in June 2020 and routine elective main theatre procedures re-started in July 2020.
3. (i) There are currently 2,693 patients* awaiting inpatient procedures, treatment or diagnostic tests on the elective inpatient waiting list. Prior to COVID-19, there were 2,359 patients on this waiting list.
   2. We assume that repeat appointments relate to outpatient activity. There are currently 7,894 patients* awaiting a new outpatient appointment. This is lower than pre-COVID-19 and is due to fewer GP referrals and a gradual reduction due to ‘urgent’ and ‘soon’ appointments continuing to be held.
4. Patients are selected for outpatient appointments and inpatient procedures, treatment or diagnostic tests according to clinical priority (categorised as ‘urgent’, ‘soon’ or ‘routine’). Patients of the same clinical priority are appointed in chronological order i.e. the patients who have been waiting longest will be seen first.

As part of the waiting list initiatives that have been developed over the last nine months, a new Access Policy is currently in draft status. This policy details the methodology and tools used to administer the waiting lists, including the use of the new Patient Tracking List (PTL). It also includes the principles used to prioritise patients for outpatient or inpatient treatment/assessment. The intention is that this policy will be approved by 27th July 2020. In addition, monthly waiting list data should be published on the Government of Jersey website on 20th July 2020.

5. A new theatre timetable has been created to addresses an imbalance between demand and capacity. There is a particular focus on general surgery where we see some of our longest waits and highest number of patients waiting. This will allow us to address the impact of COVID-19 as quickly as possible and will result in an overall more efficient use of theatre time.

The timetable will be reviewed again in six months using demand and capacity modelling to assess whether further changes are required.

In order to support the new timetable, a 4th general surgeon and a 3rd gastroenterologist are to be recruited.

*An individual patient may be counted more than once if they are on the waiting list for multiple specialties. Therefore, this number does not equate to unique people.

Appendix

Public procedures by specialty and month for the last 12 months (01/07/2019 – 30/06/2020)

PUBLIC

Procedure Specialty Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Anaesthetics 1 1 1 0 1 1 0 1 1 1 3 2 Cardiology 14 7 16 11 16 8 16 15 6 5 7 17 Community Health Services Dental 10 2 8 9 4 4 4 8 14 0 0 1 ENT 66 54 81 84 67 62 73 65 49 14 32 55 Endoscopy 43 36 37 55 39 33 36 30 35 0 0 53 General Surgery 103 75 77 89 90 76 84 86 74 33 35 72 Gynaecology 65 42 46 71 57 44 58 58 44 12 9 44 Nephrology 0 0 0 3 0 0 0 5 0 0 0 0 Obstetrics 2 0 1 4 2 2 0 3 4 24 28 23 Ophthalmology 65 24 69 90 56 48 78 59 40 3 7 30 Oral Surgery 26 10 5 16 0 3 2 2 0 0 1 0 Pain Management 42 28 36 37 35 33 49 37 24 0 5 18 Trauma & Orthopaedics 135 86 124 153 123 110 129 105 78 21 19 57 Urology 32 34 38 46 38 25 41 35 26 12 11 41 Breast Surgery 0 0 0 0 0 0 0 0 0 0 0 0 Accident & Emergency 0 0 0 0 0 0 0 0 0 0 0 0 MaxilloFacial Surgery 33 29 38 52 46 40 49 49 33 1 4 35 Paediatric Trauma & Orthopaedics 0 0 0 0 0 1 0 0 1 0 0 0 Cardiac Surgery 1 0 0 0 0 0 0 0 0 1 0 0 Paediatric Urology 4 0 0 0 3 0 0 0 0 0 0 0 Radiology 0 0 0 0 0 1 0 0 0 0 0 0 TOTAL 642 428 577 720 577 491 619 558 429 127 161 448

Public procedures by specialty and month for the previous 12-month period (01/07/2018 – 30/06/2019)

PUBLIC

Procedure Specialty Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Anaesthetics 0 0 0 0 0 0 0 0 4 1 0 1 Cardiology 13 6 13 15 16 7 13 14 9 8 22 11 Community Health Services Dental 3 5 1 8 2 8 0 2 8 5 8 0 ENT 58 71 78 65 76 61 62 64 89 67 66 86 Endoscopy 40 33 35 65 45 28 44 26 42 49 51 29 General Surgery 102 72 81 97 102 72 77 91 88 82 93 96 Gynaecology 53 34 48 50 47 31 69 47 50 51 58 49 Nephrology 0 3 0 4 0 0 0 3 0 0 0 3 Obstetrics 13 12 14 8 19 8 10 3 2 2 1 0 Ophthalmology 40 81 73 97 69 61 81 66 58 58 54 70 Oral Surgery 42 32 34 40 44 27 57 43 30 10 19 16 Pain Management 30 39 34 41 38 24 35 32 40 21 31 31 Trauma & Orthopaedics 135 100 126 161 129 99 141 133 134 129 139 130 Urology 25 42 31 32 52 22 33 28 33 34 38 29 Breast Surgery 1 0 0 0 0 0 0 0 0 0 0 0 Accident & Emergency 0 0 0 0 0 0 0 0 0 0 0 0 MaxilloFacial Surgery 0 0 1 2 0 1 5 11 32 22 23 37 Paediatric Trauma & Orthopaedics 0 0 0 0 0 1 0 0 0 1 1 1 Cardiac Surgery 0 0 0 0 0 0 0 1 0 0 0 0 Paediatric Urology 0 0 0 0 0 0 0 3 0 3 0 0 Radiology 0 0 0 0 0 0 0 0 0 1 0 0 TOTAL 555 530 569 685 639 450 627 567 619 544 604 589

Private procedures by specialty and month for the last 12 months (01/07/2019 – 30/06/2020)

PRIVATE

Procedure Specialty Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Anaesthetics 0 0 0 0 0 1 1 0 0 0 0 0 Cardiology 0 1 1 2 1 0 1 1 1 0 2 0 Community Health Services Dental 0 0 0 0 0 0 0 0 0 0 0 0 ENT 16 26 15 22 29 12 22 19 13 2 3 3 Endoscopy 0 0 1 0 0 1 0 2 8 0 0 1 General Surgery 35 18 28 40 41 21 32 22 20 0 4 14 Gynaecology 23 14 15 21 15 23 28 29 18 1 5 9 Nephrology 0 0 0 0 0 0 0 0 0 0 0 0 Obstetrics 0 0 0 0 0 0 0 0 1 0 0 2 Ophthalmology 29 12 29 25 38 24 30 24 12 0 0 0 Oral Surgery 0 1 1 0 0 2 1 0 2 0 0 0 Pain Management 19 10 17 21 13 15 16 17 13 1 0 2 Trauma & Orthopaedics 38 20 30 37 33 36 43 31 28 0 4 12 Urology 17 3 11 3 11 5 18 8 5 0 0 5 Breast Surgery 0 3 1 1 1 0 0 0 0 0 0 0 Accident & Emergency 0 0 0 0 0 0 0 0 0 0 0 0 MaxilloFacial Surgery 2 5 9 9 6 6 9 8 8 0 0 2 Paediatric Trauma & Orthopaedics 0 0 0 0 0 0 1 0 3 0 0 0 Cardiac Surgery 0 0 0 0 0 0 0 0 0 0 0 0 Paediatric Urology 0 0 0 0 0 0 0 0 0 0 0 0 Radiology 0 0 0 0 0 0 0 0 0 0 0 0 TOTAL 179 113 158 181 188 146 202 161 132 4 18 50

Private procedures by specialty and month for the previous 12-month period (01/07/2018 – 30/06/2019)

PRIVATE

Procedure Specialty Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Anaesthetics 0 0 0 0 0 0 0 0 0 0 0 0 Cardiology 2 2 2 4 1 0 0 1 1 3 1 3 Community Health Services Dental 0 0 0 0 0 0 0 0 0 0 0 0 ENT 15 16 8 22 14 17 28 10 28 19 23 19 Endoscopy 0 0 0 0 0 0 0 0 0 0 0 1 General Surgery 29 29 36 48 54 24 49 30 36 25 33 35 Gynaecology 17 22 26 24 22 17 24 24 21 33 27 18 Nephrology 0 0 0 0 0 0 0 0 0 0 0 0 Obstetrics 0 1 0 0 1 0 0 0 0 0 0 0 Ophthalmology 12 16 25 19 24 20 37 23 20 28 23 19 Oral Surgery 3 10 4 8 7 7 7 7 0 2 1 3 Pain Management 8 22 14 21 24 14 12 18 18 23 18 13 Trauma & Orthopaedics 54 17 47 51 31 36 49 31 41 30 29 30 Urology 6 3 3 11 10 6 7 10 6 2 8 6 Breast Surgery 0 1 1 0 0 0 0 0 0 0 0 0 Accident & Emergency 0 0 1 0 0 0 0 0 0 0 0 0 MaxilloFacial Surgery 0 0 0 0 0 0 0 1 7 7 7 6 Paediatric Trauma & Orthopaedics 0 0 0 0 0 0 0 0 0 4 1 1 Cardiac Surgery 0 0 0 0 0 0 0 0 0 0 0 0 Paediatric Urology 0 0 0 0 0 0 0 1 0 1 0 0 Radiology 0 0 0 0 0 0 0 0 0 0 0 0 TOTAL 146 139 167 208 188 141 213 156 178 177 171 154