Chair's Report - September 2023
Dear Colleagues
Prof Kelvin Kong is the NAIDOC Person of the Year for his work with Indigenous children at risk of hearing loss due to otitis media. RACS NSW supports Prof Kelvin Kong’s stance that surgeons have a role in promoting social health and the YES vote for the Voice to Parliament.
ASOHNS’ CEO and four OHNS surgeons (Dr Megan Hobson, Chair of ASOHNS NSW, Prof Kelvin Kong, Prof Stuart MacKay and A/Prof Payal Mukherjee) and Paediatrician, Prof Hasantha Gunasekera met with NSW Health to discuss proposed NSW Health eRFA forms. There was strong objection to inclusion of tonsillectomy, adenoidectomy and myringotomy / grommets labelled as possible low-value care. There was great concern that “value” terminology on the form will inadvertently further disadvantage already vulnerable populations.
Prof Kong stated that this would create another barrier to accessing treatment in the public health system, which already has formidable wait times for public ENT clinics, especially for Aboriginal and Torres Strait Islander children in NSW who already wait over 1,000 days for ENT surgery. Despite a much higher prevalence of otitis media (2.3 x burden of disease), Aboriginal children are less likely to receive grommet procedures than non-Aboriginal children. This carries the burden of neurocognitive deficits due to sleep disturbance for obstructive sleep apnoea and speech delay due to hearing loss.
I recently completed the chair’s rural visit and this year it was inland to Griffith, which is in the heart of Wiradjuri country – the largest nation within Australia. It is a seven-hour drive or a one-hour flight from Sydney. I chose to fly with a crowd of Italian Australians heading for A Taste of Italy celebrations and The Salami Festival. I was hosted by Dr Jaya (Dr Jayachandran) a general surgeon who is very much a part of the community, and it was impossible to go any place without people greeting him and telling their surgical stories or associations. He introduced me to his friends, family, and colleagues. Dr Warren Hargreaves is the second full-time surgeon at the hospital and their work is supplemented by regular and irregular locum surgeons rotating from other centres. Early career medical officers find it a valuable training hospital at the SET and non-accredited level due to the quality of teaching and the respectful, welcoming, encouraging behaviour. The town is multicultural and wealthy due to the wine growing and the area produces most of NSW’s wine. Around 30% of the surgery in Wagga Wagga, a two-hour drive, is for people from the Griffith area. The hospital is yet to develop an orthopaedic service.
Both in rural and metropolitan hospitals the use of locums can be utilised to maintain a surgical service and to enable new Fellows to work in multiple rural centres to enable an educated selection for permanent practice. However, locums can also be weaponised to prevent addition of patients to the surgical waiting list (adding to the hidden waiting list as a locum cannot complete an RFA) and to delay appointment of permanent surgeons thus leaving people in limbo. RACS NSW forwarded a survey from Dept Health and Aged Care about the use of locums on 1 September and completion of this survey or communicating your issues to our Committee will enable us to improve the workforce.
Several LHD’s have achieved significant reductions in their waiting list with action by clinician surgeons, “micromanagement” of the lists in the words of one. More surgeons are using ERAS principles and 23-hour hospital stays to reduce the use of hospital beds. At this stage there is no data collected on return to the Emergency Department and the burden on ambulance ramping of earlier discharge after surgery and RACS NSW intends to develop this with NSW Health.
85% of surgeons in NSW and 95% of NSW Health hospitals participate in CHASM and yet only 15% of private hospitals in NSW participate. In every other state it is 100% of private hospitals. Cosmetic surgery performed by non-surgeons is not included. Procedures performed by interventional gastroenterologists, cardiologists and radiologists are captured by the Anaesthetic audit only if death occurs within 24 hours of the procedure. The CHASM Program allows a surgeon completing a case form for their patient to reflect on the situation and consider what may be highlighted and discuss this during M&M meetings to share the education and if needed promote change in systems. It is not a question of performance but of perspective and experience. The program also provides the opportunity for peer review assessors to reflect when considering the surgical setting of the case under review.
RACS NSW Surgeons’ Evening is on 28 October at the RACS NSW Office and will celebrate our wonderful surgeons. Secretary Susan Pearce NSW Health will be on hand to present an award. Please join your colleagues and make the evening great!
Upcoming events
• 12 October 2023 - Work Life: How to thrive as a surgeon
• 28 October 2023 - Surgeons' Evening
• 9 November 2023 - Webinar: How to approach complaints to the regulator