OPINION: With the commencement of elective cataract surgery on 27 April, thousands on waiting lists can now to look forward again to their upcoming surgery. Two Indigenous leaders in the eye health sector, Dr Kris Rallah-Baker and Mr Shaun Tatipata, have called for equity when working through the cataract surgery waiting lists [i] [ii].
It is important that this advice is heeded, as there is also a risk of Indigenous (Aboriginal and Torres Strait Islander) Peoples’ access to care slipping further backwards without specific attention and sector-wide support.
Managing the resumption of cataract surgery will not be an easy task. Without careful planning and collaboration, there is a real risk of unwinding some of the significant achievements made by a range of stakeholders who have worked cooperatively over the past decade to improve access to cataract surgery for Indigenous Australians. At the same time there is an opportunity to ensure that equity is better embedded in the surgical priority and waiting list systems than before.
Expectedly, backlogs for elective surgery and specialist appointments will have swollen and placed large pressures on health systems to increase throughput of services being delivered. Without careful consideration, the inequity in access, which persisted before the pandemic and despite significant improvements, is at risk of increasing.
The gains made in recent years are underpinned by collaboration of stakeholders all working together towards the shared goal of improving the eye health of Indigenous Australians. These include regional, state/territory and national networks, bringing various stakeholders together and all working under shared frameworks: the Roadmap to Close the Gap for Vision (2012) [iii], which is approaching complete implementation [iv], and Strong Eyes, Strong Communities (2019) [v], which provides sector-wide future guidance with the leadership of Indigenous People and organisations in the sector.
Significant improvements in outcomes have been measured in Australia-wide surveys (2008, 2015) and annual benchmark data reports by the Australian Institute of Health and Welfare (2017 onwards). At the same time, inequity in the eye care system persists, including in the public system. In 2018-19, cataract surgery median waiting times in public hospitals for Indigenous Australians was 113 days, significantly longer than the median waiting time for non-Indigenous Australians (83 days). [i] This inequity is made worse by the limited access to and utilisation of private ophthalmology, which makes it even more important to ensure appropriate access through the public system. [ii]
In different regions and states/territories, integrating considerations of equity may look different. In some parts of Australia for example, clinical prioritisation for Indigenous patients (meaning, allowing Indigenous status to increase clinical priority of elective cataract patient from category 3 to category 2) is already employed to improve equity in access. Elsewhere, ensuring spots on clinical lists for patients referred via Indigenous primary health services is also successfully used to improve equity of outcomes.
Specific consideration should also be given to regional and remote communities. The ongoing concern regarding transmission of the virus to communities may effectively mean that, for some, the lack of access will continue for now, thus increasing the backlogs even further. While ensuring that the risk of transmission is reduced as much as possible, this further delay should be recognised so that plans can ensure timely access when appropriate.
The return of cataract surgery is not a return to ‘business as usual’. The goal of achieving equitable access to surgery is now at risk of going backwards if we do not heed the calls for equity of leaders in the sector. However, let us make sure we never go back to ‘business as usual’ with inequity in access to timely cataract surgery. Ongoing commitment to collaboration on all levels is necessary to ensure we can keep improving eye health access and outcomes, towards the elimination of avoidable vision loss for all Aboriginal and Torres Strait Islander peoples across Australia.
ABOUT THE AUTHORS: Guy Gillor, Rosamond Gilden, Nick Schubert and Mitchell Anjou – Indigenous Eye Health, University of Melbourne.
[i] Myles Hume. ‘’Don’t forget’ Indigenous eye health in elective surgery return, advocates warn.’ Insight. 24 April 2020.
[ii] Shaun Tatipata. ‘Don’t forget First Peoples when elective surgery returns.’ Croaky. 29 April 2020.
[iv] Indigenous Eye Health, University of Melbourne. 2019 Annual Update of the Implementation of the Roadmap to Close the Gap for Vision.