Examination of Witnesses (Questions 180-199)
NORTHERN IRELAND
DEPARTMENT OF
HEALTH, SOCIAL
SERVICES AND
PUBLIC SAFETY
2 NOVEMBER 2004
Q180 Mr Steinberg: The other point
I would like to clear up is three times Mr Gowdy has mentioned
the fact that patients do not like to travel for operations and
they like to be near their relations, et cetera. Tell me,
if somebody needed an operation who lived in Enniskillen, let
us say, and there was a free bed in Coleraine, how far would that
be? I do not know Northern Ireland at all.
Mr Gowdy: 60-70 miles.
Q181 Mr Steinberg: How far is Enniskillen
to Belfast?
Mr Gowdy: 75-76 miles, something
like that.
Mr Steinberg: How can Enniskillen be
70-odd miles from Belfast and 70-odd miles from Coleraine?
Chairman: This is a very interesting
geography lesson.
Mr Bacon: Get a map!
Q182 Mr Steinberg: The point I am
trying to make is certainly we had a problem in the English health
service where family doctors were reluctant to send patients to
another hospital because it might be too far away. I can understand
that but if you have hospitals and theatres standing empty or
not doing any work in one area and another hospital is very, very
busy doing work in their own hospital, are people sent from one
area to another area for an operation? My experience of people
is that they would rather travel 30 or 40 miles to get their operation
over and done with than to wait around for 18 months to have an
operation ten miles away in their local hospital. That is the
point I am trying to make.
Mr Gowdy: Yes, we do make use
of other hospitals and we like to give people the choice. It is
not universally accepted by patients that that is what they want.
Some people are keener to be near their own home with their family
support around them, particularly in the post-operative phase.
Yes, we do it and we try to encourage people to do it and we offer
it to them. We have sent cardiac patients across to England, down
to Dublin and to Scotland. Yes, we have made use of that but not
everybody wants it.
Q183 Mr Jenkins: I shall not ask
you about the bed blockers. I did not like the answer I got but
I do not think I will get much farther than Mr Allan did on that
one. Have you had any costs done for the non-attenders? If we
can look at page 74, 4.32, the National Booked Admissions Programme
that we have in parts of England where there are pilot schemes.
Have you worked out how much you would be saving if you had a
booked system as to how much it is costing for the non-attenders?
If you have not got a figure, could you let us have a note on
it, please.[6]
Mr Hamilton: The non-attenders
do not automatically lead to a loss of funds because what we have
been practising up to now is overbooking, rather like the airlines,
so that if someone does not turn up there is someone there to
take their place. We are exploring partial booking which is increasingly
recommended by the Modernisation Agency. All of our trusts are
piloting some form of partial booking.
Q184 Mr Jenkins: You are sending
a message out to people who do not turn up, "Don't worry
it is not going to cost anything, we have double-booked you anyway".
Mr Hamilton: We have not sent
that message out.
Q185 Mr Jenkins: I would like a message
going out saying, "If you don't turn up you are going to
cost someone else the chance of being on that waiting list and
the actual cost to us as the health authority is X million pounds
per year that could be spent on other people".
Mr Gowdy: We have a service improvement
project looking at the booking arrangements because I think there
are some lessons that it is worth picking up here. If people are
contacted at a date close to their operation it actually reminds
them and encourages them to come.
Q186 Mr Jenkins: Have you estimated
what it has cost you to have these operating theatres standing
empty?
Mr Gowdy: We do not regard it
in those terms. As we have said a couple of times, we are getting
a very high percentage of the planned sessions, the ones we can
fund.
Q187 Mr Jenkins: Do not take me down
that line or I will get angry again. You can have 100% of your
booked time but only 40% of the time in theatre is available.
We have paid millions of pounds of taxpayers' money for a theatre
but it is standing there idle 50% of the time. That is a cost.
Mr Gowdy: The people of Northern
Ireland are getting a return out of this. We are increasing the
percentage use. We are trying our best to make sure we use our
money as effectively as possible.
Q188 Mr Jenkins: That is all I am
asking you to do, an estimate of what it costs to have these theatres
standing empty.
Mr Gowdy: As I said earlier, if
we could fund in entirety the 100% it would cost us another £48
million.
Q189 Mr Jenkins: How much does it
cost for theatres standing empty? Also, have you looked at how
many theatres you have got? When you say you do not do many operations,
you are inserting radioactive isotopes, have you got too many
theatres? Would it not be better to have a smaller number of theatres
that are more effectively used? Would you get an economy of scale
if you put more operations through that theatre? Have you done
the work on this?
Mr Gowdy: We have a strategy called
Developing Better Services which is designed to locate
hospital services in the right places in Northern Ireland and
change the use of some of our existing hospitals so that we are
not providing acute services in all of them and that will reflect
some of these issues around the use of theatres.
Mr Jenkins: Mr Hamilton, when you said
that you have got 100% of booked time, we are so used to people
coming before us and giving figures that we will spot it immediately.
I am not interested in the booked time, I am interested in the
total amount of time that the theatre could be available. Do not
think that you got away with that one because you did not.
Q190 Chairman: Thank you, Mr Jenkins.
Just a couple of brief questions from me to end this session.
I want to deal with a specific point. If you turn, please, to
page 55, can we look at Royal Victoria Hospital. "The Cardiac
Surgery Planning Group meets each Thursday . . . Planned leave
by medical and nursing staff is notified at these meetings. However,
we noted that there were no cross-over arrangements for consultant
surgeons' leave. The trust explained that there are currently
insufficient resources to cover elective sessions when a surgeon
is on leave." What I want to know from you or one of your
colleagues, Mr Gowdy, is actually dealing with this unit, since
this Report was published what improvements have actually been
made in the planning and organisation of theatre sessions at this
unit?
Mr Gowdy: I will let Dr Carson
expand on that.
Dr Carson: The operating theatre
sister has been given management responsibility for the cardiac
surgical theatres and a week in advance the operations are scheduled
and all leave is made available to the theatre sister to enable
those operating theatres to be used to maximum efficiency. We
are continuing through our review group to monitor very carefully
the additional investment that has been put into the cardiac surgical
unit to make sure that the performance of the unit, given the
investment in critical care nursing and beds and in theatre equipment,
is used to maximum effect. That work is continuing.
Q191 Chairman: You have accepted
in full all of the recommendations made by the Comptroller and
Auditor General in his Report, have you not?
Mr Gowdy: Yes.
Q192 Chairman: Have all the recommendations
now been implemented?
Mr Gowdy: There were 43 recommendations
and 37 of those have been fully implemented, the remainder are
due to be implemented by the end of December this year.
Chairman: Thank you. Mr Bacon would like
to ask one question.
Q193 Mr Bacon: Mr Gowdy, you said
that patients do not like to be treated outside normal weekday
hours when you were saying people wanted to be treated between
Monday and Friday. Are you seriously saying that a patient with
a painful hernia offered the chance to be treated at four o'clock
on a Saturday afternoon would say, "No, I am sorry, it is
not a weekday"?
Mr Gowdy: No, I am not suggesting
that. It was in response to the question about extending the hours
considerably and making much greater use of the evening sessions
as well as the weekend. No, I am not saying that, people in pain
will want to be treated as quickly as possible and if that means
a weekend they will do it.
Q194 Mr Bacon: Dr Carson, you were
in the process of saying that doctors who went on leave at short
notice without giving enough notice were in breach of contract
and they could face disciplinary procedures and you are going
to send me a note of how many doctors have been disciplined. Are
you aware of any doctors being disciplined?
Dr Carson: I am not aware.
Q195 Mr Bacon: You are the Deputy
Chief Medical Officer for Northern Ireland, are you not?
Dr Carson: Yes.
Q196 Mr Bacon: So you would be likely
to be aware.
Dr Carson: I would be informed
if a doctor was suspended for breach of contract, yes.
Q197 Mr Bacon: Do you think it just
does not happen because administrators are reluctant to take on
consultants even if they do suddenly say at the last minute, "I
will go off to the golf course"?
Dr Carson: No. I think the introduction
of consultant appraisal from 2001 has made the interface between
a clinical manager and the individual consultant much closer and
the knowledge and awareness of what doctors are doing is now fully
appreciated, not only by their clinical managers but their general
managers as well. I do not know a surgeon who does not want to
operate, I have to say. Certainly I am not aware of anybody who
has been in breach of contract for failure to fulfil their contractual
commitments. I believe that commitment from our consultants is
very full.
Q198 Mr Bacon: This persistent non-compliance
that is referred to on page 55, what is it and who is it who is
doing it? Have you read page 55, paragraph 3.11: "Persistent
non-compliance by some consultant surgeons has resulted in anaesthetic
cover being scheduled for sessions that subsequently could not
be held because of surgeons taking leave . . ." without giving
proper notice. That was the whole point of my earlier question.
Dr Carson: I know that examples
of that would now be fully addressed by our Theatre User Committees.
Remember, the information that comes from theatre management systems,
whether they are paper based or IT based, those are the sorts
of issues that get discussed by all the theatre users, including
that surgeon who is persistently failing to comply with the requests
from the theatre managers. If they do that, the theatre managers
that we have now put in place in every hospital have powers, through
to the chief executive of that organisation, to take whatever
action is appropriate. Some of these surgeons do lose operating
time as a consequence and it is given to somebody else. That flexibility
and those powers are given to Theatre User Committees.
Mr Bacon: Thank you very much.
Q199 Chairman: It might have been
easier to give that answer before instead of just denying Mr Bacon's
question.
Mr Gowdy: Can I respond to an
earlier question Mr Bacon asked?
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