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.
| 
