Summary
The extent to which hospital operating theatres are
used and managed efficiently and effectively is a key issue in
the overall use of hospital resources in Northern Ireland. Decisions
relating to the use of operating theatres are directly related
to the availability of hospital staff and beds, and to the volume
and nature of emergency cases. Some 36% of available weekday theatre
capacity is not being used, with little use of theatres in the
evenings and weekends. This has to be viewed in the context of
Northern Ireland's waiting lists and waiting times for treatment,
which are currently the worst in the United Kingdom, and the spending
in Northern Ireland on acute health services, which has been higher
than any other region in the UK, apart from Scotland. Better use
of operating theatres would contribute to reducing the length
of time which patients have to wait for treatment.
Figure 1: Comparative Inpatient Waiting Lists, June 2004
| Waiting List Measure
| Northern Ireland |
Wales |
England |
Scotland |
| Inpatients waiting for treatment per 1,000 population |
30.04 | 25.87 |
22.23
| 17.87 |
| Inpatients waiting 12 months or more per 1,000 population
|
4.041 | 3.063 |
0.011
| 0.00 |
Source: Waiting for Treatment in Hospitals, Northern
Ireland Audit Office, November 2004, NIA 132/03
Figure 2: Per Capita Acute Service Expenditure by a Sample of Regions,
1999-2000
| Region
| Acute £ / head |
| Scotland |
336 |
| Northern Ireland |
329 |
| Wales |
326 |
| North East England |
321 |
| Republic of Ireland |
315
|
| South West England | 288 |
| Mersey
| 254 |
North West England |
239 |
Source: DHSSPS Acute Hospitals Review Group Report,
June 2001
On the basis of a Report by the Comptroller and Auditor
General for Northern Ireland,[1]
the Committee took evidence from the Department on four main issues:
- the spare capacity in hospital
operating theatres that is not being utilised and its impact on
patients waiting for operations;
- the scope for better theatre
management and control;
- the scope for improving the
planning and organisation of theatre sessions and the need to
improve the measurement and monitoring of theatre utilisation;
- the shortage of theatre staff
and the limited availability of beds.
As a result of our examination, we drew the following
main conclusions:
There is significant spare operating theatre capacity
to accommodate initiatives to reduce the unacceptably high waiting
lists and waiting times in Northern Ireland
- There is no convincing explanation
as to why Northern Ireland, with the highest level funding in
the UK (apart from Scotland) does not get the return on the use
of its theatres which is obtainable in other parts of the UK.
Relatively high per capita funding, significant idle theatre capacity
and deprivation and morbidity levels that are no higher than some
other areas in the UK are hard to reconcile with waiting list
and waiting time performance that is the worst in the UK. This
is even more inexplicable given the Department's assertion that
the current pattern of use of theatres in Northern Ireland matches
the pattern of use in the rest of the UK.
There is scope for better theatre management and
control
- A major element in improving
operating theatre efficiency is the development of an effective
theatre services management structure, and the establishment of
a theatre policy and guidelines, together with computerised data
collection systems. It is clear to this Committee that there were
deficiencies in the management and control of operating theatres
in Northern Ireland and that there is considerable scope for improvements
and restructuring of operating theatre management in hospitals.
The need for better planning and organisation
of theatre sessions and the measurement and monitoring of theatre
utilisation must be addressed
- We are alarmed at the incidence
of operations cancelled at the last minute for a variety of reasons,
for example, patients failing to attend for surgery, patients
unfit for surgery, session overruns, delayed discharge from hospital.
Some of these are perfectly avoidable. Reasons given for some
others are inexcusable (for example, the persistent taking of
annual leave at the last minute by consultants). They result in
an unnecessary waste of theatre resources, which is totally unacceptable,
given that Northern Ireland has the worst waiting list performance
in the United Kingdom. We expect the Department, with Trust co-operation,
to measure and monitor the rate and reasons for last minute cancellations,
set targets for their reduction, and invoke sanctions on staff
when necessary. Proper theatre management systems must be introduced
throughout the HPSS to facilitate this.
There is a shortage of theatre staff and the availability
of beds is limited
- The current level of consultant
and theatre nursing under-staffing and the limited availability
of beds in Northern Ireland's acute hospitals is a matter of great
concern to the Committee.
Action taken since the C&AG's Report has produced
measurable improvements
- The Department of Health, Social
Services and Public Safety has accepted and told us that it has
implemented all of the C&AG's 43 recommendations. Measures
are being taken to improve the management of theatres, including
the creation of more effective theatre utilisation committees,
the deployment of theatre managers with appropriate authority,
and the introduction of a new theatre management information system,
which will be a common computerised system across all trusts.
The Department is monitoring the theatre utilisation performance
of each and every trust and their implementation of the C&AG's
recommendations. While the actual use of theatre capacity has
increased slightly since the C&AG's Report, from 63% to 64%,
the Department would see improving that ratio to 70% as a reasonable
intermediate aspiration. We welcome this positive response but
we expect the Department to ensure that more progress is made
and maintained. We will be monitoring progress closely.
1 The use of operating theatres in the Northern
Ireland Health and Personal Social Services, Northern Ireland
Audit Office, April 2003, HC 552, NIA 111/02. Back
|
