Select Committee on Public Accounts Seventh Report


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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Prepared 29 September 2005