In December, Heather Jacobs was told she would be seen by a specialist cardiology clinic within three months.
She's still waiting.
"I have got heart failure, and I've got angina … and the ischaemic heart," she said.
"All that sounds terrible, but I'm still going.
"They want to investigate, because palpitations have started happening, so they'll investigate the valves and so forth.
"I've gone from [category] one, to two, to one again, then back to two.
"I guess if it was a situation that was incredibly acute, I would get into an ambulance and go to hospital.
"The trouble is they're so full."
Heather is one of hundreds of thousands of people waiting for an initial appointment at one of Queensland Health's specialist outpatient clinics, which provide services that don't require someone to be admitted to hospital.
There are 167,181 surgical patients and another 100,061 medical patients on the list.
It's sometimes called "the waitlist for the waitlist" because it can include the care people receive before being booked for an elective surgery.
At times during the pandemic, many of those services were put on pause.
Scores of elective surgeries have also been cancelled or rescheduled during the past two-and-a-half years.
Few can confidently say what the total impact will be on the system.
Even before the pandemic hit, in July 2019, there were 212,247 people in Queensland waiting for a first appointment with an specialist outpatient clinic.
What are the waitlists like now?
At the end of June, there were 57,914 people waiting for elective surgery in Queensland, and 7,560 of them have been waiting longer than clinically recommended.
Of those, 266 were Category 1, having a condition that may get worse quickly, to the point that it's an emergency. They're meant to be seen within 30 days.
A further 3,145 were Category 2 patients, meaning their conditions are causing some pain, dysfunction or disability and they should have surgery within 90 days.
4,149 patients were Category 3, who are meant to have surgery within a year but have been waiting for longer than recommended.
While patients wait for their specialist treatments, monitoring their condition often falls back on their general practitioner.
Royal Australian College of General Practitioners vice-president Bruce Willett said there had been a significant increase in the delay that it was taking for people to get appointments as outpatients.
"It is still an increased burden to continue to look after, manage those patients, both in terms of the workload — and of course we share our patient's stress about the waiting, and that's an additional psychological burden for both patients and GPs," he said.
"I do understand that Queensland Health will be working really hard to try and cut back on those waiting times.
"Unfortunately, I think it's going to take six to 12 months to actually get through those waiting times."
Blow-outs in the south-east and north
The Queensland chair of the Royal Australasian College of Surgeons, Sanjeev Naidu, said the proportion of emergency surgery and urgent surgery — heart surgeries, cancer operations and treating traumas such as car crashes — has been increasing over at least the last five years, which is putting pressure on hospitals and the state's elective surgery program.
"Especially in south-east Queensland and up in Cairns, the volumes have increased because of our population increase," Dr Naidu said.
"It's steadily increasing but there was a bit of a spike from 2020 onwards.
"When you look at the big picture, 7,500-odd [long waits], it's a small percentage.
"However, those numbers of long waits are people, and we do need to look after them to the best of our ability."
Dr Naidu said Australia used to rely on UK nurses to fill vacancies but said there were 100,000 staff needed there now too.
"We might have beds but we do not have staff. That is a big problem in the hospital system as well as in primary healthcare," Dr Naidu said.
"Now staff, they are tired, they are burnt out.
"We have to care about our staff … look after them because we are unable to recruit readily like we used to before."
Funnelling patients to the private hospitals
One of Queensland Health's tools to keep on top of waiting lists is a program called Surgery Connect, which funnels public patients into the private system for their procedures.
In the last financial year, 9,650 procedures were done through Surgery Connect, the highest in the previous three years.
Between mid-2018 and last month, more than 30,000 surgeries were carried out through Surgery Connect.
UnitingCare Queensland group executive Michael Krieg said there were waitlists across the board, with the biggest challenge being available staff.
"The ability for us to ramp up to higher levels is really challenged because of the workforce constraints," he said.
The number of UnitingCare staff off sick has been running somewhere between 8 and 10 per cent this year, similar numbers to Queensland Health's sick leave at the height of the most recent third wave of COVID-19.
UnitingCare's hospitals did about 10 per cent less work than they'd usually expect over the past two-and-a-half years.
Mr Krieg said many burned-out staff were not willing or able to take on extra work.
"It's hugely challenging because most private hospitals have not made money at all in the last two years. We need activity to be viable," he said.
"Being able to balance staff welfare, our ability to pay for things, the challenges on the whole system, is really difficult at the moment.
"The pressure on our staff in particular has been huge."
The national body representing private hospitals, Australian Private Hospitals Association (APHA) said internal surveys from private hospitals showed about 8,000 nurses were needed to fill positions around the country.
'Sickest patients will always be seen first'
Queensland Health said this year's state budget included $15 million to support the delivery of long-term planned care and to tackle waiting lists.
The agency admitted it was facing increased pressure, driven by a growing and ageing population, COVID, a lack of aged, disability and primary care and declining private health cover.
Queensland Health managed to increase the number of elective surgeries in the June quarter by 40 per cent from the quarter before, completing 32,362 elective procedures.
"Queensland has experienced three COVID-19 peaks this year, which has also increased pressure on our health system due to high hospitalisations as well as a large number of furloughed staff," a spokesperson said.
Each regional health and hospital service manages their planned care and elective surgeries depending on their specific circumstances.
"The sickest patients will always be seen first," a Queensland Health spokesperson said.
Another elective surgery blitz?
After a months-long, nationwide pause on elective surgery in early 2020, the Queensland government spent $250 million on a "blitz" on non-urgent procedures.
By August that year the then-Health Minister Steven Miles said the long wait list had dropped to 2,774 patients, despite predictions that year's cancellation would see the number around 7,000.
With more than 7,000 long wait patients now, Health Minister Yvette D'Ath didn't say whether another blitz was planned.
She pointed to the government's $23.6 billion spend on health in this year's state budget, which included hospital expansions and thousands of new beds.
"To complete 32,362 surgeries in a quarter so heavily impacted by COVID and flu is an outstanding effort," Ms D'Ath said.
Outpatient waiting lists were the target of significant funding when the state government came to power in 2015 — an effort the Auditor-General examined in a report released late last year.
That report found the funding halved the waitlist for specialist outpatient appointments at first, but they've been steadily increasing again since 2017.
Between July, 2017 and July, 2020, the number of patients waiting longer than recommended increased by 72 per cent, and while 36 per cent more first appointments were offered in the five years to June, 2021, the number of referrals increased by 53 per cent.
The increase in referrals was vastly higher than Queensland's population growth, which was just over 8 per cent, in roughly the same period.
"This is making it more difficult to match supply and demand and actively manage patients to ensure they are on the right pathway at the right time," the Auditor-General's report said.
