Harney seeks plan for elective surgery

THE MINISTER for Health Mary Harney has told the HSE that she wants it to develop plans for all hospitals to comply with a set of national protocols around the admission, discharge and care of patients for elective procedures.

In a confidential letter to the chairman of the HSE, Liam Downey, setting out her priorities for 2010, Ms Harney said that it was unacceptable that there should be wide variations in the way common elective procedures are handled between different hospitals.

She said the Department of Health had recently analysed data for a 12-month period in 2008/09 regarding common elective procedures. She said that this had found, for example, that for hip replacements the average length of stay in hospitals that undertook significant numbers of such procedures ranged from seven to 18 days.

“For repair of inguinal hernia procedures, the proportion of cases treated on a day basis ranges from 84 to 0 per cent. Where the procedure is undertaken predominantly on an in-patient basis, average lengths of stay in excess of two days are common,” Ms Harney said.

“For cataract procedures, again there is substantial variation between hospitals in the proportion of such treatment provided on a day basis, with one hospital reporting 100 per cent. Where the treatment is carried out on an in-patient basis, lengths of stay of two or more days are not uncommon.”

Ms Harney said that, while the information concerned was relatively “high level in nature”, it suggested that there was much potential for increased efficiency in hospital processes and practices and that a strong focus on performance management was required.

Ms Harney told Mr Downey: “I am sure you agree that it is not acceptable that such wide variations in practice should occur, unless justified by the clinical circumstances of a particular case. I wish the HSE in 2010 to develop clear plans so that, consistent with the delivery of safe and effective care, admission, discharge and other elements of the care process for elective treatment are the subject of clear national protocols and procedures with which all hospitals are required to comply.”

Ms Harney said treatments widely accepted as suitable for performance on a day basis should be a particular focus.

The Minister also told Mr Downey that one of her main priorities for next year is the implementation of the Fair Deal nursing home support scheme.

She said it was essential that the HSE and individual hospitals maintained “a sharp focus” on ensuring compliance with the terms of the new consultants’ contract, especially in relation to the level of private practice activity permitted.

The Minister also said the HSE should give priority to the implementation of recommendations in the Ryan report.

Ms Harney maintained that urgent attention should be given to enhancing probity assurance measures under the various demand-led schemes.

“Questions relating to probity under the Dental Treatment Services Scheme (DTSS) have been aired in the media in recent times. I believe that there is a need to strengthen leadership and management of the DTSS and the Public Dental Service, perhaps through the appointment of a clinical lead,” she said.