Examination of Witnesses (Questions 60-79)
NORTHERN IRELAND
DEPARTMENT OF
HEALTH, SOCIAL
SERVICES AND
PUBLIC SAFETY
2 NOVEMBER 2004
Q60 Mr Steinberg: I do not know about
that. I know there are not many surgeons in England earning £40,000
a month, whether it is a big one or a little one.
Dr Carson: The vast majority of
that private sector work takes place outwith the health service
facilities in the private independent sector.
Q61 Mr Steinberg: But you did say
some of it was taking place?
Dr Carson: Some of it takes place,
yes.
Q62 Mr Steinberg: We will leave that
to the imagination.
Mr Gowdy: The point is it is not
displacing NHS, HPSS activity.
Q63 Mr Steinberg: Let us change the
subject. Why are the theatres not utilised at weekends?
Mr Gowdy: There are a couple of
reasons for that. One is that patients do not really like to be
treated outside—
Q64 Mr Steinberg: Oh, come on, it
is absolute poppycock that patients do not like to be treated
on a Saturday.
Mr Gowdy: We could not run our
theatres as intensively as you are suggesting outside normal hours.
Q65 Mr Steinberg: Why not?
Mr Gowdy: The difficulties are—
Q66 Mr Steinberg: Tell the truth.
Mr Gowdy: The difficulties are
getting staff and having the resources to fund them. As we said
earlier, we are getting a very high utilisation—
Q67 Mr Steinberg: Because the consultants
will not come in and do the work.
Mr Gowdy: May I put this point
first because it is an important point to make. We are getting
a very high utilisation out of the sessions that we are able to
fund so that our trusts are delivering for us very close to 100%
of all of the sessions that we have asked them to put in place.
Q68 Mr Steinberg: If that is the
case then you are at fault because you should be asking them to
do more quite frankly, Mr Gowdy.
Mr Gowdy: We are trying to stretch
them to do that. As I was saying earlier, we have actually seen
some progress made in the couple of years since this Report was
published and we are trying to stretch beyond that.
Q69 Mr Steinberg: Your theatres are
being used for seven hours a day, five days a week. There is a
huge capacity there that could be used but is not being used.
Mr Gowdy: Because we cannot fund
it and we cannot staff it.
Mr Steinberg: Let me just move on. Can
you turn to page 104, please. I see here the annual leave of consultants
stops a considerable number of operations taking place. I find
that remarkable because when I take my summer holidays I usually
organise them at least eight or nine months before we go. My wife—she
has not quite mastered the Internet yet—goes to the travel
agent and she books a holiday. It seems to me what happens in
Northern Ireland is the consultant goes down to his breakfast
one morning and the wife says, "We are off to Benidorm",
is that right?
Chairman: He could probably afford to
go to somewhere better than Benidorm.
Q70 Mr Steinberg: You are right.
"Just ring in and tell the lads that we will not be in today
because we are off to Benidorm", that is what seems to happen
here.
Dr Carson: Leave entitlement for
an NHS consultant here is no different from what it is elsewhere
in the UK.
Q71 Mr Steinberg: I am not saying
it is.
Dr Carson: This document, when
it looked at availability of operating theatres, considered that
48 weeks was a normal average. In fact, a consultant—
Q72 Mr Steinberg: I have got no problem
with that.
Dr Carson: A consultant is only
available for 42 weeks of the year.
Q73 Mr Steinberg: I have got no problem
with that. The problem I have is that if it is done properly it
is managed properly. If eight months beforehand, or seven months,
six months, five months or four months beforehand, the surgeon
says to the manager of the hospital, "I am off to Benidorm
for a fortnight", therefore the cover will be brought in.
I get the impression here that about 24 hours before the operation
is supposed to take place, he rings in to say, "I am off
for a fortnight's holiday".
Dr Carson: I would want to assure
you that through the new arrangements in regard to theatre management
such an opportunity should not and could not arise, and would
be penalised within effective theatre management arrangements
currently.
Q74 Mr Steinberg: I am running out
of time but I wanted to make the point that I was very, very cross
when I read that. I understand that but if an operation is cancelled
in the UK, in England, at the last minute, and they are regularly,
which is a disgrace because people get hyped up for their operation
and go in and an hour beforehand are told "On your bike,
go home, we have not got this, that or the other to do the operation",
they are guaranteed within 28 days to have that operation but
in Northern Ireland they are not. That is quite outrageous. Why
does that happen?
Mr Gowdy: We cannot fund that
given the waiting list problems that we have got. The way to attack
it is exactly the point you are making. What we need to do is
to make sure that the management of leave arrangements is sharper.
I think this is one of the virtues of this Report. It has certainly
drawn out for us a very clear need to get those arrangements in
place. Some hospitals are now doing that, Craigavon Hospital tries
to arrange evening summer leave to minimise the impact on theatre
sessions.
Q75 Mr Steinberg: They should all
be doing it.
Mr Gowdy: People will take leave
for all sorts of reasons that come up at fairly short notice.
What we need to do is to make sure we manage the totality of that
and get the majority of leave notified sufficiently so that it
does not affect the running of the sessions. I very much take
your point on that.
Q76 Chairman: I want to be entirely
fair to you, Dr Carson, you are obviously itching to tell Mr Steinberg
your typical day. If you remember, there was not time to answer
that question. Please give us, not the hardest working day or
the least working day but an average day for you or your colleagues.
Dr Carson: When I was working
in the cardiac surgical unit on a normal scheduled operating session
I would be in the anaesthetic room seeing the first patient in
the morning at 7.30. The patient would be anaesthetised and in
the operating theatre at eight o'clock. The operation would last
five hours, which would take you through to one o'clock. The second
patient would arrive in the operating theatre at about half past
one. I would quite often work on through with a minimal stop for
lunch, if any at all. The patient would be anaesthetised and on
the operating table at two o'clock. The operation would last for
five hours and finish at seven o'clock. The patient would end
up in the intensive care unit where I would discharge that patient
over to the care of my intensive care colleagues at about seven
o'clock in the evening. I would then go and see my patient for
the next day and do all the other additional things that—
Q77 Mr Steinberg: It is a great pity
that the rest of your colleagues are not doing the same, I have
to say.
Dr Carson: I would be the first
person to defend those colleagues who I know work very hard throughout
the health service. We are on record as saying that consultants
work over and above what they are by and large contracted to do.
In England, where you are trying to introduce the new consultant
contract, the Department is being challenged by consultants who
are looking for 12, 13 and 14 programmed activities to cover the
work they are currently doing. We are trying to introduce a consultant
contract here within a financial envelope for a consultant that
will deliver only 10 programmed activities a week.
Mr Steinberg: I wish you success.
Chairman: We will stop there. We will
let Mr Allan take over the questioning.
Q78 Mr Allan: Thank you, Chairman.
I was struck by figure four on page 31 which tells us that the
management information systems that we need to demonstrate how
hard or otherwise consultants are working are largely manual still.
This was a report in 2003 about the modern managed health service.
We see that 10 of the units covered have only a manual system,
two have none whatsoever, five have a mixed manual and computerised
one and only four are fully computerised. The Report tells us
in paragraph 2.17 on pages 29 and 30 that a business case has
to be made for investing in computerised management systems. Can
we take it that case has been made, Mr Gowdy? I think you said
earlier that the systems are now going ahead.
Mr Gowdy: We have an outline business
case from one of our hospitals which we have asked to take the
lead in specifying what the nature of the system should be, that
is the Belfast City Hospital. They have given us the outline business
case and we are in discussion with them. We expect, and certainly
hope, that will be cleared so the full business case can be with
us at the start of 2005. We have to go through the tendering process
and our aim is to have the system coming on stream by the autumn
of 2005.
Q79 Mr Allan: Can you help me to
understand how this works in the Northern Ireland context. Are
you saying that one unit takes the lead and draws up a business
case for all the units?
Mr Gowdy: We have asked them to
do that because we are very conscious that we have got to get
a consistent system in place that is going to give us and the
trusts the sort of information that we, and they, need to manage
and monitor this system. We are asking them, as the ones who are
furthest advanced in their development of computer modelling,
to take the lead. What we are doing is getting all the other trusts
to feed in their needs so we ensure that we cover the totality
of the needs. Obviously that would be in terms of the scheduling
of theatre sessions, preparing lists and having the necessary
costing information that we want to see from the system. The Belfast
City Hospital presented that outline business case to us, they
did that a couple of months ago, and we are discussing with them
and the other trusts whether the needs are now entirely specified.
We need to get approval from our Department of Finance and Personnel,
which is the usual approval mechanism, and we will proceed to
full business case, we hope, at the start of the year to allow
us to put this out to tender.
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