The final report of the Inquiry into ACT Health System Data, Demand and Processes, has found the number of people on the ACT elective surgery waiting list rose from about 5500 in 2020-21 to about 6800 in 2024-25.

The inquiry made 49 recommendations, with the ACT Government undertaking to respond with a “detailed implementation plan” by the end of the year.

The report, chaired by Michael Walsh and tabled in the ACT Legislative Assembly on Wednesday, puts waiting-list transparency at the centre of its reform agenda, warning that patients, clinicians and policymakers need a clearer view of who is waiting, how long they are waiting, how urgency is assessed and how people move through outpatient, elective surgery and planned-procedure pathways.

Elective surgery waits have worsened in the ACT while national waits have eased. The inquiry found the ACT median wait for elective surgery reached 54 days in 2024-25, compared with 45 days nationally. National AIHW data shows the median elective surgery wait across Australia was 45 days in 2024-25, and 6 per cent of patients waited more than a year for surgery.

Orthopedics emerged as one of the sharpest pressure points. In 2024-25, ACT orthopaedic patients waited a median 169 days for surgery, while 26.8 per cent waited more than a year. The report said orthopedic waits were much longer than the average for all ACT specialties and longer than national orthopedic benchmarks. Nationally, orthopedic surgery was one of the specialties with the highest share of patients waiting more than 365 days.

The inquiry also found an equity gap for indigenous patients. In 2024-25, indigenous patients in the ACT waited a median 73 days for elective surgery, compared with 53 days for non-indigenous patients in the territory. National AIHW data also shows First Nations patients waited longer than other Australians for elective surgery in 2024-25.

A key problem identified by the inquiry is that the ACT does not have adequate public reporting on outpatient waiting times. The report says outpatient data “needs to be collected and reported”, because outpatient delays affect how quickly patients can be assessed and then placed on elective surgery or planned procedure lists.

The report recommends Canberra Health Services create clearer rules to ensure people on outpatient, elective surgery and planned procedure waiting lists are consistently assessed for clinical urgency and then seen in order of waiting time within each specialty and urgency category.

It also calls for Central Health Intake to be strengthened so it can co-ordinate outpatient referrals, support communication with patients and give Canberra Health Services a whole-of-system view of elective surgery and planned procedure waiting lists.

To increase capacity, the inquiry recommends more virtual outpatient appointments, greater use of nurses, allied health workers and GPs with special interests for initial assessments, contracting private specialists to help with outpatient assessments, and reviewing space at Canberra Hospital and North Canberra Hospital so more public outpatient clinics can operate.

Patients waiting for outpatient appointments should also receive quarterly clinical reviews, the report says, so their circumstances can be checked and their urgency adjusted if needed. The inquiry also recommends more electronic communication with patients through outpatient and elective surgery pathways, including use of the Digital Health Record.

The ACT Government’s own elective surgery dashboard says waiting times depend on demand, hospital resources and the urgency category assigned to patients, and that median wait-time data is captured only after surgery is performed, meaning it does not show the live position of people still waiting.

The report says the Digital Health Record and e-referral systems should be further developed so the health system can properly analyse how patients enter and move through outpatient, elective surgery and planned procedure lists. It also says the system should examine whether patients who see private specialists are reaching public surgery lists faster than those waiting first for public outpatient appointments.

While the inquiry acknowledges work already under way in planned care, it says the reforms were introduced quickly and, in some areas, without enough consultation with clinicians. It recommends a more open, transparent and clinically led process to redesign planned care.