Select Committee on Public Accounts Minutes of Evidence


Examination of Witnesses (Questions 20-39)

NORTHERN IRELAND DEPARTMENT OF HEALTH, SOCIAL SERVICES AND PUBLIC SAFETY

2 NOVEMBER 2004

  Q20  Mr Curry: This was a sort of dip there, a dip where management and technology just so happened to create a problem?

  Mr Gowdy: Yes. It is an advance in medicine in that we are now able to treat, through cardiac surgery, frailer, older patients than might have been the case before so there is a benefit to this patient group as a result of this.

  Q21  Mr Curry: Let me move on. You state, I think, and I am sure the Auditor General would agree, that you cannot use capacity fully without more staff and more beds, is that right?

  Mr Gowdy: Yes.

  Q22  Mr Curry: Would you then take me up from 63% in, let us say, 5% steps and tell me how much more in terms of beds and staff and what the private sector call resources, and I call money, you need in order to keep moving up that step? What would be a good rate of utilisation? At what figure would you say you had got to where one could practically sustain it?

  Mr Gowdy: If we could get to the 100% figure we would need something in the order of £48 million additional in our budget. That is in theatres alone predominantly paying for the staff and some of the consumables that are used. The predominant factor in it is staff. In addition to that—

  Q23  Mr Curry: Present spend is what, just short of a billion, is that right?

  Mr Gowdy: On theatres?

  Q24  Mr Curry: A comparable figure.

  Mr Gowdy: On our total acute services it is £800 million.

  Q25  Mr Curry: You have just quoted, what, £50 million. What is the comparable figure already being spent?

  Mr Gowdy: That is multiplying up the number of sessions. £2,500 per session is the cost, roughly, that we have worked out. We could do a quick calculation.

  Q26  Mr Curry: An increase in terms of cost?

  Mr Hamilton: The pro rata increase, if we are operating around 63% of our total capacity and the additional one-third, would cost £48 million. On a pro rata basis we are spending approximately £100 million at the moment on theatres.

  Mr Gowdy: In addition, you would need to have in place the beds for recovery and they are quite expensive. An intensive care unit bed costs on average £500,000 per bed. For a high dependency unit bed it is about £300,000. It is very expensive to put in place the post-operative care arrangements that are needed, particularly when you are dealing with older, frailer patients.

  Q27  Mr Curry: Okay, that is 100%. Give me one point between 63% and 100% that you think is a reasonable intermediate goal and the cost that goes with it and the time frame for getting there.

  Mr Gowdy: Certainly we would want to increase by a couple of per cent each year if we could. We can very quickly work out what those figures are. It is not just simply putting in the money, it is recruiting the staff. We can let you—

  Q28  Mr Curry: Where you are trying to get to is what I am anxious to get from you.

  Mr Gowdy: I would certainly like to—

  Q29  Mr Curry: Not aspirationally but reasonably.

  Mr Gowdy: I would certainly like to see us get up as close to around 70%. I think that is a reasonable aspiration. It depends on getting the staff in place. It is not simply us putting the extra money in, it is needing the physical capacity to put the beds in place and having the nursing and medical staff to support that. There are some limits in terms of the fact that this is a small province, it is difficult for us to recruit and so on. An aspiration that is realistic is 70% for us, I think.

  Chairman: Thank you very much for that. Mr Steinberg?

  Q30  Mr Steinberg: Thank you, Chairman. Mr Gowdy, 37% is quite a remarkable figure really when you consider that theatres are standing empty almost 40% of the time, in fact it could be 40%, could it not, because this 37% could be a lot worse, could it not?

  Mr Gowdy: It is a point I was making at the start, that there are variations in terms of the nature of hospitals.

  Q31  Mr Steinberg: It could be more than 37%.

  Mr Gowdy: In some cases it is definitely more than 37%.

  Q32  Mr Steinberg: I cannot believe that.

  Mr Gowdy: What you need to appreciate is that some of the theatres are used for emergency use exclusively.

  Q33  Mr Steinberg: You have explained that. Tell us some basic facts. Tell us, how long are the theatres open each day?

  Mr Gowdy: Primarily they are open two sessions each day for five days a week. That is a morning session and—

  Q34  Mr Steinberg: How long is a session?

  Dr Carson: Three and a half hours was the traditional scheduled sessional commitment for a hospital consultant, a notional half day.

  Q35  Mr Steinberg: Ah, here they come, the hospital consultants. So after three and a half hours, "Stitch him up lads, we are finished. We will go home for the day".

  Mr Gowdy: There are a couple of points that need to be made here. One is that operations can be estimated but not predicted. There is a range of circumstances. A patient may need a more difficult operation.

  Q36  Mr Steinberg: I understand. So it is open three and a half hours in the morning and three and a half hours in the afternoon, seven hours a day. How many hours are there in a day?

  Dr Carson: I could illustrate a normal working day for myself when I was a consultant anaesthetist in the cardiac surgical unit, if that would help.

  Q37  Mr Steinberg: No, I would only lose my temper because you would probably substantiate what I think. How many days a week are they open?

  Mr Gowdy: What we are dealing with here is—

  Q38  Mr Steinberg: How many days a week are they open?

  Mr Gowdy: Five days a week. There are also sessions used at the weekends and in the evenings for emergency sessions.

  Q39  Mr Steinberg: We are going to get on to that.

  Mr Gowdy: Or where we have been able to put in additional resources to allow that to happen.



 
previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2005
Prepared 29 September 2005