Conclusions and recommendations
The sizeable spare capacity in hospital operating
theatres that is not being utilised and its impact on patients
waiting for operations
1. Theatres
are scheduled to open seven hours (ie two sessions) each day for
five days a week. There is, therefore, significant spare capacity
in the evenings and at the weekends that could potentially be
used, but for the most part is not. Even within the scheduled
weekday use, theatres are, on average, idle almost 40% of the
time.
2. More
use should be made of theatres during weekdays, in the evenings
and at the weekends to reduce waiting lists and waiting times
that currently are at an unacceptably high level compared to the
rest of the UK. Patients can suffer and their health can deteriorate
while waiting for hospital treatment.
3. We
recommend that the Department review current theatre utilisation
patterns at individual hospitals with a view to their maximisation,
and negotiate with consultants, within the terms of the new consultant's
contract, to work on weekday evenings and at the weekends.
The scope for better theatre management and control
4. The
Department has told us that it has implemented all 43 recommendations
made in the C&AG's Report, including those on theatre management
and control. It has been working with Trusts to ensure that they
take all the recommended measures that are needed. This is commendable,
but it is important that action is sustained and we have asked
the NIAO to keep progress under review.
5. A
new common computerised theatre management information system,
to be introduced in 2005 throughout the HPSS, will facilitate
improved theatre management and control, giving a common, consistent
information base on which to compare the performance of each and
every Trust. The Department needs to ensure that the existing
computerised theatre management systems developed within some
Trusts are compatible with this new system and that consultants
co-operate fully in managing and using the new system.
The scope for improving the planning and organisation
of theatre sessions and the need to improve the measurement and
monitoring of theatre utilisation
6. Many
of the reasons given for the last minute cancellation of operations
are indicators of poor management, where the planning and organisation
of theatre sessions could be improved. They include annual leave
taken at the last minute by consultants; patients not turning
up for surgery; patients found to be unfit for surgery; constant
overruns of theatre lists by individual surgeons, and beds becoming
unavailable due to the delayed discharge of patients from hospital.
7. With
appropriate management such cancellations are avoidable. The Department
must view the consequences of last minute cancellation of operations,
in terms of a waste of resources and nugatory cost. The rate and
reasons for cancelled operations need to be systematically measured
and monitored by Trusts and the Department, and remedial action
taken to reduce the incidence of cancellations, particularly those
which are avoidable. The Department needs to set targets for reducing
cancellation rates, and performance against these targets must
be measured and closely monitored.
8. There
was evidence of incorrect and inconsistent disclosure of utilisation
data by Trusts, raising concerns about the validity of the annually
published theatre utilisation data. Trusts must have timely and
reliable data to compare their performance against that of other
Trusts, and theatre utilisation data has to be reliable if the
Department is to fulfil its monitoring and planning roles. The
new common computerised theatre management systems to be introduced
in 2005 throughout the acute hospital sector should facilitate
this.
The shortage of theatre staff and the limited
availability of beds
9. The level of consultant
and theatre nursing under-staffing and the limited availability
of beds is a matter of great concern and it is clear to this Committee
that workforce planning and management, and better bed management
is needed by both Department and Trusts. The Department told us
it has now set out a definitive strategy for meeting its overall
future workforce commitments, but pressure needs to be maintained
by the Department to prevent slippage. It also needs to look to
best practice on bed management, and to increase the volume and
range of day surgery procedures to release hard-pressed inpatient
surgical beds.
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