Hospitals have different reasons for cancelling surgery

Analysis: Each hospital will need to work out its own solution, writes Eithne DonnellanCancelled operations 2004: by the numbers

Most patients requiring surgery will be nervously counting down the days to their operation. They will be arranging time off work, somebody maybe to mind the children or, if they are getting on in years and their family are away from home, they may well be asking them to take time out to spend it with them in the days following their operation or discharge from hospital.

To get news the day before or even on the morning the operation is scheduled to take place that is has been cancelled is a terrible blow to all concerned, not least the patient who has been psyched up for the operating theatre.

It is also a major inconvenience for the patient and his or her family. There is also the possibility that for some whose operations are cancelled, it will mean enduring pain for longer. This would certainly be the case for many awaiting hip operations.

Tragically there have also been cases where operations that were cancelled had unthinkable consequences, as in the case of Róisín Ruddle, a Limerick toddler who died after being sent home from Our Lady's Hospital for Sick Children in Crumlin in 2003.

She was scheduled to have a heart operation but, due to a shortage of intensive care nurses, her surgery was put off for another day. She was dead before her surgery could be rescheduled. Later her parents spoke of their anguish at having to wait three months for an appointment for the operation, only for it to then have been cancelled. The news that thousands of patients had operations cancelled last year, sometimes for what appear to have been avoidable reasons, is nothing short of scandalous.

We have known for years that operations regularly have to be cancelled by hospitals, particularly when a backlog of patients end up on trolleys in A&E and the beds into which surgical patients might otherwise be booked have to be handed over to them, but the extent of the problem has never been quantified over a full year.

Data is not routinely published on how many operations are cancelled every year, so it is impossible to say if the situation is improving or getting worse.

In fact some hospitals admit they don't even keep this type of data and among those who do, it took some of them from last September until now to collate the figures in order to reply to a Freedom of Information request from this newspaper.

A month ago, the Health Service Executive said about 10,000 operations were cancelled during the first six months of this year. It was the first time such figures were released, but the figures published by The Irish Times today reveal how many operations are cancelled by individual hospitals over a full 12-month period. They also reveal the reasons for those cancellations.

While many hospitals blamed a shortage of beds, a significant number also blamed patients themselves for cancelling their surgery or for failing to turn up at the appointed time.

What the figures clearly show is that the reasons behind cancelled operations vary from hospital to hospital. Therefore, if the problem is to be tackled, each hospital will need to work out its own solution.

There seems to be a major problem at Cork University Hospital, for example, with theatre lists being overbooked.

Among those hospitals such as Letterkenny General Hospital, where pressure on beds was the major reason for operations being cancelled in 2004, presumably more beds may be needed.

It will be of concern to staff in this hospital and others in a similar predicament to hear the head of the Health Service Executive, Prof Brendan Drumm, claim recently that the State was "massively equipped with hospital beds".

The figures also indicate innovative solutions will have to be found for dealing with patients who fail to turn up. It is one thing if patients have a good reason for not showing, but those who just don't bother turning up are denying other patients a slot in theatre. Perhaps they should be penalised in the same way as motorists who fail to turn up for their NCT at the appointed time effectively have to pay a fine.

These statistics for surgical cancellations come just weeks after a survey was published showing one in five patients surveyed across 26 hospitals had an operation/procedure cancelled and rescheduled by the hospital on at least one occasion. Some 3.6 per cent said their operation had been cancelled twice and 1.7 per cent that it had been cancelled three times or more.

Those in authority in the HSE, the Department of Health or the Minister for Health's office cannot now claim to be unaware of the major problem that exists with operations being cancelled by our hospitals every year.

To put the problem in perspective, there were significantly more operations cancelled last year than patients treated by the National Treatment Purchase Fund, which arranges to have public patients more than three months on waiting lists for surgery to be treated privately. It arranged treatment for 13,627 patients in 2004 on a budget of €44 million.

Unless swift action is taken to curb the numbers of patients who are having their operations cancelled, more and more patients who could have been treated in the public system will be knocking on the door of the treatment fund - and taxpayers will be paying twice for something they should have to pay for once.

Cancelled operations 2004: by the numbers

Tallaght Hospital 2,264

Beaumont Hospital 1,852

St James's Hospital 1,927

St Vincent's Hospital data not available *

The Mater Hospital 805

Sligo General Hospital 76

Letterkenny General Hospital 1,352

University College Hospital Galway and

Merlin Park Regional Hospital, Galway 4,308

Mayo General Hospital 15

Portiuncula hospital, Ballinasloe 3

Roscommon County Hospital 147

Our Lady of Lourdes Hospital, Drogheda 819

Louth County Hospital, Dundalk 12

Our Lady's Hospital, Navan 294

Cavan/Monaghan Hospital Group 143

Midland Regional Hospital, Tullamore 1,326

Midland Regional Hospital, Mullingar data not available **

Midland Regional Hospital, Portlaoise data not available **

Limerick Regional Hospital 126

Mid-Western Regional Orthopaedic Hospital, Limerick 11

Ennis Regional Hospital 56

Nenagh General Hospital 0

Cork University Hospital 1,586

Mallow General Hospital 0

Bantry General Hospital 0

Kerry General Hospital 305

St Mary's Orthopaedic Hospital, Cork 0

St Joseph's Hospital, Clonmel 24

Our Lady's Hospital, Cashel data not available **

Waterford Regional Hospital 1,009

St Luke's Hospital, Kilkenny 208

Wexford General Hospital 700

Kilcreene Orthopaedic Hospital, Kilkenny 51

Children's University Hospital, Temple Street 82

Our Lady's Hospital for Sick Children, Crumlin data not available **

Connolly Hospital, Blanchardstown 702

St Columcille's Hospital, Loughlinstown 165

Naas General Hospital 60

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TOTAL 20,428

* St Vincent's said no operations were cancelled but operations may have been postponed and this data is not collated.

** The hospitals said "such details are not available".