Committee of Public Accounts

Press Notice No. 7 of Session 2005-06, dated 4 October 2005


Mr Edward Leigh MP, Chairman of the Committee of Public Accounts has today criticised the Health Service in Northern Ireland for not making more use of its hospital operating theatres to reduce and maintain waiting lists and waiting times that are the worst in the United Kingdom. He also drew attention to deficiencies in the way Northern Ireland's hospital operating theatres are run and managed, and their use measured and monitored. He also expressed great concern at the shortage of medical consultants and theatre staff and the limited availability of beds in Northern Ireland's hospitals.

Mr Leigh was speaking as the Committee published its 7th Report of Session 2005-06 which examined: the significant 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, and for improving the planning, organisation and the measurement and monitoring of theatre utilisation; the shortage of consultant and theatre nursing staff; and the limited availability of hospital beds.

The Committee was concerned to find that operating theatres are scheduled to open only seven hours (ie two sessions) each day for five days a week with little use being made of them in the evenings and weekends. There is, therefore, significant spare unused physical capacity in the evenings and at the weekends. Even within the scheduled weekday use, theatres are, on average, idle almost 40% of the time and, in some case more than this. Yet Northern Ireland's waiting lists and waiting times for treatment are currently the worst in the United Kingdom, while spending in Northern Ireland on acute health services has been higher than any other region in the United Kingdom (apart from Scotland).

The Committee found it inexplicable that, with this generous level of health funding, Northern Ireland still does not seem to be able to get the return on its considerable theatre assets (acquired at some considerable cost) which is obtained in other parts of the United Kingdom at much lower levels of funding. More use should be made of theatres during weekdays, in the evenings, and at the weekends to reduce and maintain waiting lists and waiting times. Extending operating hours into the evenings and weekends may well require changes in staff working arrangements, but such working patterns are happening in the NHS, and there is no real reason why it cannot be done in Northern Ireland. The Department of Health, Social Services, and Public Safety should be mindful of the cost of its operating theatre assets standing idle. It needs to keep theatre utilisation patterns at individual hospitals under constant review and negotiate with consultants, within their health service contracts, to work on weekday evenings and at the weekends, when it is necessary.

The Committee also found many of the reasons given for the last minute cancellation of operations to be inexcusable and indicators of poor management, resulting in an unnecessary waste of theatre resources and nugatory cost. These reasons include the persistent taking of annual leave at the last minute by some 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. With appropriate planning, organisation, and proper management, many cancellations should be avoidable.

The Committee found the levels of consultant and theatre nursing under-staffing and the limited availability of hospital beds a matter of great concern. There is clearly scope for improved workforce planning and management, and better bed management. It seems to the Committee that the numbers of medical and nursing staff in training in recent years have been insufficient to meet the needs of the Health Services in Northern Ireland. The Department needs to monitor the rate of medical and nursing students that withdraw from training each year, and determine the reasons for withdrawal; and the rate of, and the reasons for those who, on completion of their training, do not take up post in Northern Ireland. 

The Department accepts that there needs to be improvement in the use of its hospital theatres. It has told the Committee that it is taking measures to improve the management and use of theatres and that it has implemented all of the 43 recommendations made by the Comptroller and Auditor General in his Report. We expect the Department to ensure that more progress is made and that it is maintained. We intend to monitor this closely.

Mr Leigh said today:

"There is no convincing explanation as to why Northern Ireland, with one of the highest levels of funding in the United Kingdom, does not get the same return on the use of its operating theatres as other parts of the United Kingdom. Relatively high per capita funding, and significant idle theatre capacity are hard to reconcile with the worst waiting list and waiting time performance in the United Kingdom. The Department must address this."

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