Department of Human Services, Victoria
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Exploring Solutions to Better Meet Demand for Foot and Ankle Surgical Services Report for the Department of Human Services, Victoria Project Team (on behalf of The Australian Health Workforce Institute) Catherine Jones and Fiona Landgren – Project Health and Vin Massaro and Lorraine Perry – Massaro Consulting June 2009 Contact: Mr. Brendan Moloney The Australian Health Workforce Institute Level 3, 766 Elizabeth Street University of Melbourne Parkville 3010 Tel: + 61 3 8344 9659 Fax: + 61 3 9347 8939 Email: [email protected] This study was funded by the Department of Human Services. The opinions presented in this document are those of the authors and not the Department of Human Services and have been provided for general information to guide discussions of future policy initiatives. The Australian Health Workforce Institute is a joint initiative between The University of Melbourne and The University of Queensland Contents 1. Executive Summary........................................................................................5 2. Introduction...................................................................................................10 2.1 Background.....................................................................................................10 2.2 Project purpose ...............................................................................................11 2.3 Methodology....................................................................................................11 2.3.1 Phase 1 – Literature Review .............................................................11 2.3.2 Phase 2 – Mapping of Current Service .............................................13 2.3.3 Phase 3 – Key stakeholder consultations: exploring solutions..........18 2.3 4 Limitations of the Report ...................................................................23 2.4 Context............................................................................................................23 2.4.1 Surgical services in Victoria ..............................................................23 2.4.2 Other workforce initiatives.................................................................24 2.4.3 Providers of foot and ankle elective surgery .....................................24 3. Demand for foot and ankle surgery.............................................................26 3.1 Foot and ankle surgery in Australia – procedure profile and trends................27 3.2 Foot and ankle surgery in Victorian hospitals – procedure profile and trends..............................................................................................................30 3.3 Waiting times for foot and ankle elective surgery............................................37 3.4 Number of people waiting for elective foot and ankle surgery ........................42 3.5 Waiting times for an outpatient appointment...................................................42 3.6 Factors influencing demand for foot and ankle elective surgery .....................43 3.6.1 Increasing patient expectations.........................................................43 3.6.2 Availability of and access to conservative management options ......44 3.6.3 Population level influences................................................................45 4. Supply of foot and ankle surgery – current service model and workforce.......................................................................................................46 4.1 Current service delivery in Victorian public hospitals – an overview...............46 4.2 Current workforce............................................................................................49 4.3 Other factors influencing the supply of foot and ankle surgical services.........51 4.3.1 Theatre availability and competing priorities .....................................52 4.3.2 Other system factors .........................................................................53 5. Initiatives to address demand for foot and ankle surgery ........................54 5.1 Outpatient workforce reform initiatives............................................................55 5.2 System redesign initiatives..............................................................................59 6. The role of podiatric surgeons ....................................................................60 6.1 Background.....................................................................................................61 Exploring Solutions to Better Meet Demand for Foot and Ankle Surgical Services (May 2009) 2 6.2 Current podiatric surgeon workforce and service model.................................61 6.3 Qualifications...................................................................................................63 6.4 Scope of practice and funding.........................................................................65 6.5 Safety and effectiveness of podiatric surgeons...............................................66 6.6 Cost effectiveness of podiatric surgeons ........................................................66 6.7 A possible workforce initiative - creating a multidisciplinary team (employing podiatric surgeons in public hospitals) .........................................67 7. Roadmap for implementation of possible solutions..................................69 8. Conclusion ....................................................................................................72 9. Bibliography..................................................................................................73 Appendices ..............................................................................................................75 Appendix 1. Literature Review .................................................................................75 Appendix 2. Membership and Terms of Reference of the Reference Group ...........76 Appendix 3. Data request sent to Victorian public hospitals for data pertaining to foot and ankle elective surgery and outpatient services...................78 Appendix 4. Foot and ankle procedures Victorian hospitals 2007 /2008 .................80 Appendix 5. The economic impact of podiatric surgery - Access Economics Report, September 2008 – an analysis ................................................87 Figures Figure 1. Drivers of supply and demand for elective foot and ankle surgery in Victorian public hospitals ................................................................................14 Figure 2. Number of emergency* and non-emergency^ foot and ankle procedures for Victorian private and public hospitals by financial year (July 03 - June 08)...................................................................................................................31 Figure 3. Average time to treatment for elective orthopaedic surgery in Victorian public hospitals, July 2007 to June 2008 ........................................................38 Figure 4. Median time to treatment for category 2 elective orthopaedic surgery in Victorian public hospitals, July 2003 to June 2008 .........................................39 Figure 5. Median time to treatment for category 3 elective orthopaedic surgery in Victorian public hospitals, July 2003 to June 2008 .........................................40 Figure 6. Average waiting time for category 2 elective orthopaedic surgery. Snap shot of Victorian public hospitals* ...................................................................41 Figure 7. Average waiting time for category 3 elective orthopaedic surgery. Snapshot of Victorian public hospitals*...........................................................41 Figure 8. Number of cases waiting for elective orthopaedic surgery and elective foot and ankle surgery. Snap shot of Victorian public hospitals* ....................42 Figure 9. Victorian population and numbers of patients on elective surgery waiting lists by age group (Surgical Services Strategy, DHS) ....................................45 Figure 10. Common public hospital service delivery model.............................................47 Exploring Solutions to Better Meet Demand for Foot and Ankle Surgical Services (May 2009) 3 Figure 11. Factors influencing the demand for and supply of elective foot and ankle surgery in Victorian public hospitals ...............................................................52 Figure 12. Workforce innovation – Allied health foot and ankle clinic (Barwon Health)...56 Figure 13. Service model – Podiatric surgery, Repatriation General Hospital, Daw Park, South Australia ......................................................................................63 Tables Table 1. Summary of proposed solutions and implementation strategies ......................8 Table 2. Breakdown of literature included in the review ...............................................13 Table 3. Hospitals consulted during mapping exercise ................................................16 Table 4. Summary of data collected .............................................................................17 Table 5. Consultation strategy ......................................................................................19 Table 6. Projected number and percentage of foot and ankle surgery procedures, showing hospital breakdown (public / private) by procedure type, Australia, 2008................................................................................................28 Table 7. Projected number and percentage of