Around 20% of Mater Dei patients still waiting for surgery one year on

A new performance audit from the Auditor General into the management of elective surgery waiting lists has reported that prolonged intervention are coming in at a cost for both the patient and Mater Dei Hospital (MDH).

Although no specific amounts are so far available - the National Audit Office's report will be published on Wednesday - a statement from the NAO said that excessive waiting times may in the near future, increase government's financial liability in terms of the European Union's Cross Border Health Directive.

While the report acknowledges high levels of patient satisfaction with the services provided, despite the increase in the number of elective operations carried out at MDH over recent years, around one fifth of patients have been waiting for their intervention for over one year.

"The rise in the demand for elective surgery is mainly brought about by the increasing healthcare requirements of an ageing population, the constant introduction of new operative technology dealing with previously untreated conditions, as well as the extent of facilities available at MDH," the NAO said.

"The demand for operations was alleviated by the increase in the number of interventions carried out at MDH and outsourcing initiatives.  However, a number of strategic and operational issues are limiting MDH from increasing further its intervention throughput."

The report said that patient demand in the private sector coupled with the attraction of better remuneration packages make it more difficult for MDH to encourage its pool of consultants and other professionals to extend their working hours at the hospital,

Furthermore, MDH's obligation to conform to the centralised public service recruitment procedures tends to prolong the engagement process of staff.

Mater Dei Hospital is also still in the process of computerising its waiting lists in a centralised system. This project, which statred three years ago, has focused on the Cardiology, Ophthalmic, Orthopaedics and Surgical Departments.  The system is a prerequisite to effective waiting lists management since it transfers the ownership of waiting lists to the hospital's management.

The report found that the management of elective surgery waiting lists was being hampered by the lack of a centralised database of all the departments' waiting lists. "The resultant data fragmentation impinges on the administrative and management aspects of elective surgery.  Despite the importance of integrating the various datasets, efforts to determine the feasibility of the Integrated Health Management System 2 (IHIS2) appear to have stalled.  This state of affairs is prohibiting MDH from evaluating and investing in other IT alternatives. " 

In July 2012, the 18 main operating theatres and five Endoscopy theatres reviewed showed that, on average, each operating theatre is used for 31 and 27 hours per week respectively.  The utilisation of the operating theatres is affected, amongst others, by bed-turnover limitations, especially due to a 12% occupancy of the hospital's bed-stock by patients awaiting to be transferred to other healthcare institutions.

"This situation is limiting the daily number of operations carried out at MDH.  At the operational level, a number of process inefficiencies were noted.  In some cases interventions started later than scheduled, operation turnaround times were prolonged, and in some instances under-running surgery lists led to early session finishes.

"The lack of a central authority within the Operating Theatres Department to assume full responsibility for this function weakens management control over this critical and most valued asset within the hospital."

The NAO said that the increase in interventions was down to identifying and addressing specific areas of inefficiencies.  But these efforts need to be complemented with the adoption of integrated information systems.