1 The spare capacity in hospital operating
theatres that is not being utilised and its impact on patients
waiting for operations
1. We were surprised to learn that, in 2001-02, there
was sizeable spare physical weekday theatre capacity of 37% in
Northern Ireland, yet waiting lists and waiting times were the
worst in the United Kingdom. Theatres are scheduled to open seven
hours (for two sessions) each day for five days a week. In view
of the very high waiting lists, we are amazed that theatre sessions
are not planned for the evenings or weekends. Leaving aside the
fact that theatres are, for the most part, lying idle during these
periods, we find it incredible that, even within the potential
ten weekday sessions available each week, theatres are on average,
lying idle also for 37% of that scheduled time, and in many cases
more than this.[2]
2. The Department told us that, since the C&AG's
Report, there has been a modest improvement in theatre utilisation.
Spare week-day theatre capacity is currently 36%.[3]
However, whilst Northern Ireland's waiting list performance has
improved since 2001-02, it still remains the worst in the UK.[4]
3. The Department claimed that a benchmarking exercise,
which it commissioned in 2003-04, confirmed that the current utilisation
figure of 64% in Northern Ireland exactly matched a sample of
16 trusts in Great Britain.[5]
In the absence of knowing how representative this small sample
is for comparison with Northern Ireland, we asked the C&AG
to assemble a comparative chart. This information is provided
below.[6]
4. According to a national report by the Audit Commission
in 2003,[7] a well-used
theatre unit would average more than 40 hours use per theatre
per week, but very few units are actually this busy and the average
unit in Great Britain and Northern Ireland is used for only 25
hours work per theatre per week, but this varies between Trusts
from 9 to 47 hours. In Northern Ireland, the average unit is used
for only 21 hours per week but varies between hospitals from 10
to 38 hours.
Figure 3: Total Actual Operating Hours / Week per Commissioned Theatre
| NI only
Hours per week
| GB and NI
Hours per week
|
| Upper Quartile
| 24.6 |
29 |
| Mean |
21.2 | 25.2
|
| Lower Quartile
| 15 |
21.3 |
5. Only four of the sixteen Northern Ireland hospitals reviewed
were found to be on or above the Great Britain mean, with two
of them in the upper quartile. Twelve Northern Ireland hospitals
were found to be below the mean, with eight in the lower quartile.[8]
6. The Department wishes to increase the use of operating theatres
from their current 67% of capacity to around 70%.[9]
However, there remains in Northern Ireland, significant spare
theatre capacity during weekdays, in the evenings, and at the
weekends, that is currently not being used and could potentially
be used.
7. The Department told the Committee that operating theatres cannot
be used more than seven hours a day, five days a week because
of the difficulties of getting staff and having the resources
to fund them, and because patients do not really like to be treated
outside normal hours.[10]
We do not accept this. The funding in Northern Ireland is the
highest in the United Kingdom, with the exception of Scotland,
while waiting lists and waiting times are the longest. This, according
to the Department, is because Northern Ireland experiences higher
levels of deprivation, disability and morbidity — but so
do other regions in the United Kingdom, particularly areas in
large cities.[11] We
find it inexplicable that Northern Ireland still does not seem
to be able to get the return on its theatre assets (acquired at
a considerable cost) which is obtainable in other parts of the
United Kingdom at much lower levels of funding.[12]
8. More use should be made of theatres in the evenings and at
the weekends to reduce and maintain waiting lists and waiting
times that currently are at an unacceptably high level compared
to the rest of the United Kingdom. Patients can suffer and their
health can deteriorate while waiting for hospital treatment. No
doubt, extending operating hours into the evening and weekends
would require changes in staff working arrangements, but such
working patterns are happening in the NHS, and there is no real
reason it cannot be done in Northern Ireland.[13]
9. The cost of providing and staffing operating theatres
is very high. The Department and Trusts should, therefore, be
mindful of the waste of resources if those operating theatre assets
are underutilised, and the scope for the potential rationalisation
of theatre numbers.[14]
The Department, with Trusts, needs to keep theatre utilisation
patterns at individual hospitals under constant review, and negotiate
with consultants, within the terms of the new consultant's contract,
to work on weekday evenings and at the weekends.
2 C&AG's Report, paras 4.10, 4.13, 5.48, Figure
8; Qq 2, 30-43, 149-153 Back
3
Q 2 Back
4
Waiting for Treatment in Hospitals, C&AG's Report,
November 2004, NIA 132/03; Ev 20; Q 142 Back
5
Qq 2, 109, 121-123; Ev 19; Q 123 Back
6
Ev 20; Q 122 Back
7
Operating Theatres: Review of National Findings - Acute Hospital
Portfolio, Audit Commission 2003; Ev 20 Back
8
Ev 20 Back
9
Q 29 Back
10
Qq 63-69 Back
11
Qq 2, 108 Back
12
Q 167 Back
13
Qq 42-43, 193 Back
14
Qq 186-189 Back
|
