Opening statement by Dr Tony Holohan, Chief Medical Officer of the Department of Health & Children at the meeting of the Joint Committee on Health and Children on Tuesday 8th September 2009 I very much welcome the opportunity to meet with the Committee, to outline the details of our response to response to Pandemic (H1N1) 2009 and to address any questions you may have. I am joined this afternoon by Dr John Devlin Deputy Chief Medical Officer and Mr Brian Mullen Principal Officer from the Department of Health and Children and from the HSE by Dr Pat Doorley, National Director of Population Health, Dr Kevin Kelleher, Assistant National Director (Health Protection) and by Mr Gavin Maguire, Assistant National Director (Emergency Planning). Background I thought it would be useful Chairman to give an overall summary of the position since the commencement of this incident for your benefit and that of the members. A public health alert was received from the World Health Organisation (WHO) on Friday, 24th April 2009 indicating that human cases of influenza type A (H1N1) virus infection had been identified in the US and in Mexico. On 26th April, the WHO upgraded the WHO pandemic alert level from phase 3 to phase 4 and on 28th April to Phase 5. On Thursday, 11th June, following consideration by its Emergency Committee, the WHO raised the Influenza alert phase to Pandemic level 6 which officially declares a pandemic. 1 Pandemic means that an influenza virus, new to humans has appeared, is spreading and is causing disease in many parts of the world. Phase 6 means that there is increased and sustained transmission in human population in two or more regions of the WHO. This decision reflects the geographic spread of the virus and not its severity. The WHO categorised the severity of the pandemic as ‘moderate’. These changes in categorisation by the HSE were each anticipated as they occurred in the context of our national influenza preparedness. The Department and the Health Service Executive have been preparing for some years for the possibility of an influenza pandemic. These preparations reflect international developments and reflect the learning from SARS in 2003 and the possibility that there has been in recent years that a global pandemic might have occurred with the H5N1 virus- the so-called Avian Flu. On receipt of the initial alert in April from WHO, the Department activated the National Plan for pandemic influenza which was launched in January 2007. The plan was accompanied by a Guidance Report developed by the Pandemic Influenza Expert Group which was further updated in April 2009 and this guidance is currently being followed. In line with the national plan:• The National Public Health Emergency Team (NPHET), which manages the health system response to a public health emergency was convened and has met very regularly throughout this incident. It is chaired by the 2 Secretary General of the Department of Health and Children and the CEO of the HSE is a member. • The Pandemic Influenza Expert Group (PIEG) Chaired by Professor Bill Hall, Professor of Virology at UCD continues to provide public health and scientific advice on preparedness and control measures to the NPHET. • An Inter-Departmental Committee on Pandemic Planning which coordinates the intersectoral response to a potential pandemic has met on an approximately fortnightly basis. • HSE national and regional crisis management teams are meeting regularly to coordinate HSE preparedness and response measures. • The Department and the HSE participate in regular teleconferences and meetings with the European Centre for Disease Control, our colleagues inn Northern Ireland and public health officials in other European Member States and the WHO. • Regular press briefings to provide information and to convey important public health messages have taken place regularly since the outset. At present these take place every Thursday afternoon. • Information is updated regularly on the websites of the Department of Health and Children and the HSE. More recently, we have launched a Pandemic (H1N1) 2009 website at www.swineflu.ie. This advice covers travel, schools, care in the home, care in hospitals and other health care settings as well as general measures that people can take to limit their risk of transmitting or acquiring infection. 3 • The Minister for Health and Children has provided regular briefing of the Cabinet since the outset. Furthermore, Oireachtas Health spokespersons have also been briefed on preparations during the course of the incident. Arrangements were also put in place to secure a guaranteed access to 7.7 million doses of pandemic vaccine through two suppliers and we are just beginning to see initial doses beginning to arrive. The administration of these vaccines will not commence until after they are licensed which is not expected to be until into October. Advance arrangements were also in place which ensured that at the outset of this incident, Ireland had antiviral drugs for 47% of the population and some additional supplies have been procured since the beginning of this incident. The Pandemic in Ireland The first case of A (H1N1) influenza in Ireland was confirmed on 2nd May 2009 and we have had 2 deaths and 713 laboratory confirmed cases in Ireland. In line with our National Plan and with arrangements in other countries, we initially operated a containment strategy in Ireland. The rationale for this was to delay the development of the disease in Ireland to allow us to finalise preparations and to optimise our response to the Pandemic by identifying each individual case that occurred here and then actively identifying and treating each contact of that case. We said from the outset that this would be a time limited strategy. Therefore, we changed our response to one of mitigation in mid July- that is to say our response is now focused on trying to minimise the impact of the disease on the population and on the functioning of society generally. 4 As a result, patients are now diagnosed and managed clinically by their General Practitioner. Swab tests for the virus are no longer routinely taken from patients and sent for viral testing. The number of laboratory confirmed cases has, therefore, ceased to be a reliable indicator of the burden of infection. As of 29th July 2009, an estimated number of cases is provided each week based on information derived from the National Influenza Sentinel GP Surveillance Network. This gives a good estimate of the numbers of cases of influenza like illness being seen by GPs. This system shows that influenza like illness rates have been stable in recent weeks and with rates of between 30 and 40 per 100,000 population in the week. By way of context, the peak reported Influenza like illness rate during last winter was approximately 120 per 100,000 per week. Key Current Issues While we cannot predict with any certainty how the disease will progress, we are planning on the basis of certain assumptions which are broadly consistent with those being used for planning purposes in other countries. These assume that 25% of the population could become infected in the first wave, that up to 10% of the workforce may be absent from work during that time and that 1 to 2 percent of cases may require treatment in hospitals. In this scenario, an equivalent Influenza like illness rate could be as high as 1,000 to, 1,500 per 100,000 pre week. 5 It is indeed reassuring that in the great majority of cases, the infection will be mild and self-limiting and people will be able to care for themselves at home without the need to visit a GP or hospitals. Small numbers, especially those with underlying risks, will develop significant complications and some more people will inevitably and unfortunately die. Therefore, an infection rate of 25% in a wave which would last 12-15 weeks would still have a significant impact on the health services and it is this that is the focus of our continued planning and preparations. Even as a mild disease, it should be understood that people- and we expect them to follow our advice-will be absent from workplaces and from school. This therefore means that the functioning of society as a whole would be impacted during such a wave of infection. It is for this reason that we have been working with other sectors through the interdepartmental committee and we have been saying for some time that businesses and organisations should develop business continuity plans based on the excellent guidance produced by Forfas on behalf of the Department of Enterprise and Employment on business continuity planning for an influenza pandemic. One key issue that is currently being addressed is the finalisation of arrangements to offer the pandemic vaccine to the whole population. This is an enormous and logistically complex undertaking for the health system. We will shortly launch this plan and announce the precise arrangements that will be put in place. I would particularly like to call on health professionals to come forward for vaccine once it is offered to them and to accept the responsibility they have to protect themselves in the first instance so that they will continue 6 Health Service Executive (HSE) Opening Statement Healthy Eating, Combating Obesity and Eating Disorders to Joint Committee on Health and Children 9th March 2010 1 Opening Statement to the Joint Committee on Health and Children 9th March 2010 - Healthy Eating, Combating Obesity and Eating Disorders Chairman, members of the Committee - thank you for the opportunity to make an opening statement this afternoon. I would like to comment briefly on the current situation regarding the proportion of our population that are overweight and obese and what we in the HSE are doing to address the issue. While today's invitation appears focused on treatment of severe obesity through the unit in St Columcille's, it is essential that this is put in the context of the HSE efforts around prevention of obesity and management of the full overweight and obesity spectrum, the vast majority of which will occur in an integrated public health and primary care setting, not a secondary care based setting Obesity is a major public health problem both for Ireland and for our European neighbours. It is estimated that over 300,000 children on the island of Ireland are overweight and obese. In 2005 The National Taskforce on Obesity (DOHC, 2005) published a report containing 93 recommendations to halt the rise in levels of overweight and obesity. The Taskforce recognised that a multi-sectoral approach is necessary, involving other state agencies and government departments and real engagement of the public and private sectors to implement all of the report's recommendations. Incidence of overweight and obesity Between 2001 and 2007, 38% of Irish adults were found to be overweight with obesity rising from 18% to 23%, (SLAN, 2007). Since 1990 the prevalence of overweight and obesity among 13-17year olds had increased from 6% to 19% in boys, and from 15% to 17% in girls (IUNA, 2007). Ireland's first national surveillance of 7 year olds revealed that 13% of boys and 19% of girls were overweight and 5% of boys and 8% of girls were obese (DOHC & HSE, 2008) 2 What is the HSE doing to address the issue? The HSE established a Working Group in 2006 to implement those recommendations of the Task Force on Obesity, for which the HSE has the lead responsibility. The group translated the recommendations of the Taskforce Report into a 5-year Action Plan. The priority areas are set out below: 1. To enhance effectiveness in surveillance, research, monitoring and evaluation of obesity. 2. To develop a quality uniform approach to the detection and management of obesity. 3. To develop our capacity in preventing overweight and obesity and to promote health. 4. To communicate our messages on obesity effectively, 5. To proactively engage and support the work of other sectors in addressing the determinants of obesity and the obesogenic environment. Phase 2 of the Action plan is currently being implemented. The HSE is keenly aware that to halt the growing trend towards obesity and to address the obesogenic environment requires engagement with external partners and multisectoral co-operation. To this end the HSE worked closely with the Health Promotion Policy Unit of the DOHC in the establishment of an interdepartmental and multisectoral group, which was set up in January 2009. The HSE has implemented a number of programmes in prevention and management in line with the priorities set out in the action plan. An overview of some of these programmes including the obesity management services in Loughlinstown is set out below. Childhood Surveillance: WHO - European Childhood Obesity Surveillance Initiative (Ireland) Surveillance of obesity is important so that progress can be monitored on an ongoing basis. 3 In 2008, in collaboration between the DOHC and the HSE, a national sample of 2420 seven-year-old school children from 163 Irish primary schools had their height, weight and waist circumference measured as part of surveillance and monitoring programme in the WHO European Region. 13% of boys and 19% of girls were found to be overweight and 5% of boys and 8% of girls were obese. Results have been sent to the WHO to be incorporated in a European report due out in Autumn 2010. These Irish results and other survey data available, will feed into the national database for height and weight for adults and children, which is currently being progressed which will enable us to monitor progress in addressing obesity. Management of obesity in Children ACE (Activity, Confidence & Eating) Obesity Management and Prevention Programme in Primary Care A number of programmes are in place for the management of overweight and obesity of children throughout the country. An example of good practice is the ACE programme, which is an interdisciplinary family based approach to the treatment of childhood obesity. It is a one-year programme targeting 5 - 12 year olds focusing on behavioural change, with an initial intensive weekly phase of education and physical activity for both children and their families and long term follow up that focuses on environmental determinants. In 2009 30 children plus siblings and parents participated in the programme. The ACE school programme promotes health and health awareness among pupils. In 2009, 3,344 pupils, parents and teachers have participated in Schools ACE. Treatment of severe obesity of adults in Loughlinstown From an adult perspective there is a need to provide support in the management of overweight and obesity at a number of different levels. The hospital system cannot alone manage obesity, and the HSE vision of integrated care will ideally fit the obesity treatment model - so that patients will receive their primary intervention in the primary care team setting and be referred onward to secondary care where appropriate for a higher intensity of intervention including surgery. 4 The service in St Colmcille's was funded from the 2005 budget (200,000 Euros) allocation to support implementation of the obesity task force recommendations. It was anticipated at the time that there should be four treatment units developed incrementally for severe obesity in Ireland. While there are a number of treatment units in development phase, St Colmcille's Hospital in Loughlinstown, Co Dublin is the only unit staffed with the full Multidisciplinary team required to implement international best practice standards. A unit in Galway is currently being established and a unit in Cork is also to be established. A fourth unit between Beaumont and Connolly Hospitals has been proposed - so that there would be one unit in each of the four HSE regions - this is currently being explored. Treatment of severe obesity reduces mortality by 90% over 2 years and improves or cures sleep apnoea, diabetes and high blood pressure in 80-100% of cases. It also reduces the chance of getting cancer significantly and improves survival from cancer. It is one of the few medical interventions that provide cost savings in the long term. St Colmcille's sees 200 new patients per year from all over the country and has a waiting list of 860 patients for assessment and engagement with the weight management programme. Patients with life threatening obesity are prioritized. There are 92 people on the waiting list for surgery. The waiting list is continuously being reviewed and where appropriate clients are referred to weight management programme run by Primary Care Teams. The waiting list in Loughlinstown will be reduced by 20% when the other three units become operational. Weight management programmes are provided for adults that are overweight and obese through the Dietetic Services and the Primary Care Teams throughout the country. In keeping with best practice they combine nutrition and physical activity interventions. Examples include the GP Exercise Referral Programme, Farmers have Hearts and Brief Intervention. 5 Other programmes, which promote physical activity, are provided on our behalf, by the Local Sports Partnerships (32 Nationwide) via Irish Sports Council Funding. The Irish Heart Foundation provide, Healthy Hearts catering audits and awards as well as workplace physical activity programmes and community Sli na Slainte routes. . Weight Management Treatment Algorithm for Adults and Children Statistics support the widely held view that Irish adults and children are becoming heavier over time. Society is tending to normalize overweight and obesity with some, particularly parents, failing to see that, their own, or that of their child's weight, may be outside the normal range. Doctors have reported that in some cases normal weight individuals consider that they need to put on weight to be healthy. Many are unaware of their Body Mass Index (BMI) having had little opportunity to have their height and weight measured. The Weight Management Sub Group of the Intersectoral Group on Obesity are advocating for routine measurement at hospital admission and opportunistic screening in Primary Care Teams and GP surgeries. This group has developed a Weight Management Treatment Algorithm for both Adults and Children. This will provide national guidance for G.P.s, Practice Nurses, Public Health Nurses and Area Medical Officers in dealing with patients who seek help with their weight management. This is currently being finalised with the Irish College of General Practitioners and will be rolled out nationally. Public Health Awareness on Obesity National Media Campaign A key recommendation of the Task Force report was to implement on an annual basis a Cross Border campaign. The " Little Steps Go A Long Way" media campaign was launched in June 2008. The HSE and Safefood developed the campaign, in collaboration with the Health Promotion Agency of Northern Ireland. The emphasis of the campaign is on the crucial impact of parents and guardians as role models for their children. The campaign is now in year 2 (2009-'10) of a three-year programme. 6 During a post marketing survey carried out in 2009, 8 in 10 parents stated that they had already made changes to their child's eating habits. Traffic to the website has been considerable with 102,197 page views by 35,000 visitors. See www.littlesteps.eu Increasing Physical Activity in the Population National Physical Activity Guidelines Combating obesity requires both change in the population's eating habits and physical activity levels. Another key recommendation of the Task Force report was to develop national guidelines for physical activity. The HSE and the DOHC produced the National Guidelines on Physical Activity for Ireland " Get Ireland Active" in 2009. These guidelines highlight the recommendations for physical activity for children, young people, adults, older people and people with disabilities. See www.getirelandactive.ie . A National Policy on Physical Activity with an accompanying action plan is to be developed in 2010 by the proposed Physical Activity Sub Group of the Intersectoral Group. The GP Exercise Referral Programme The National GP Exercise referral programme is currently being rolled out throughout the country. Seventeen fitness centres are currently taking referrals from GPs throughout the country with 14 more centres receiving training prior to commencing the programme in 2010. Finally I would like to mention that the HSE has developed a number of other strategic alliances in our work to combat obesity. We are also engaged in many other national and regional projects in schools, communities, workplaces and in the Health Service to address the prevention and management of obesity. Thank you. 7 Combating Obesity Presentation to Joint Committee on Health and Children 9th March 2010 Professor Donal O Shea, Consultant Endosrinologist Loughlinstown & St. Vincent's Hospitals HSE Framework for Action on Obesity 2008 - 2012 HSE National Working Group on Obesity translated the recommendations of the Taskforce Report into a 5yr action plan with strategic priorities:1. 2. 3. 4. 5. To enhance the effectiviness in surveillance, research, monitoring and evaluation of obesity. To develop a quality uniform approach to the detection and management of obesity. To develop our capacity in preventing overweight and obesity and to promote health. To communicate our messages on obesity effectively. To proactively engage and support the work of other sectors in addressing the determinants of obesity and the obesogenic environment. Obesity Service Loughlinstown / St. Vincents { { Started in 2002 - funded December 2005 Multi Disciplinary Team (MDT) approach Dietician Physiotherapist Psychologist Nurse Surgeon Physicians { What is the intervention? { One to one high intensity (monthly) meetings with MDT for 9 months { Medication { Surgery (estimate 20-30% need) { Capacity is 200 new patients per year Age and BMI information for all patients Note: Of 325 patients studied only 12.3% were on no medication Total Male Female 1258 460 (30%) 798 (70%) age 46.5 (13.1) 46.8 (13.2) 46.4 (13.1) weight 131.4 (32.6) 148.8 (36.8) 123.9 (27.6) BMI 46.5 (10.4) 47.7 (10.5) 46.0 (10.4) BMI<30 (%) 2.3 0 3.3 BMI 30-35 (%) 9.3 6.8 10.4 BMI 36-40 (%) 14.1 19.1 12.0 BMI 40-50 (%) 40.3 38.6 41.0 33.6 35.5 33.3 n BMI>50 (%) Weight outcomes after 1 year Weight Weight Weight N0 Weight Weight Weight less less less change gain gain gain >100/o 5-100/0 1-50/0 1-50/0 5-100/0 >100/o Conservative All BMI 30-BMI 40-Gender Female Male Surgery A11 Health Service Executive (HSE) Opening Statement Healthy Eating, Combating Obesity and Eating Disorders to Joint Committee on Health and Children 9th March 2010 1 Opening Statement to the Joint Committee on Health and Children 9th March 2010 - Healthy Eating, Combating Obesity and Eating Disorders Chairman, members of the Committee - thank you for the opportunity to make an opening statement this afternoon. I would like to comment briefly on the current situation regarding the proportion of our population that are overweight and obese and what we in the HSE are doing to address the issue. While today's invitation appears focused on treatment of severe obesity through the unit in St Columcille's, it is essential that this is put in the context of the HSE efforts around prevention of obesity and management of the full overweight and obesity spectrum, the vast majority of which will occur in an integrated public health and primary care setting, not a secondary care based setting Obesity is a major public health problem both for Ireland and for our European neighbours. It is estimated that over 300,000 children on the island of Ireland are overweight and obese. In 2005 The National Taskforce on Obesity (DOHC, 2005) published a report containing 93 recommendations to halt the rise in levels of overweight and obesity. The Taskforce recognised that a multi-sectoral approach is necessary, involving other state agencies and government departments and real engagement of the public and private sectors to implement all of the report's recommendations. Incidence of overweight and obesity Between 2001 and 2007, 38% of Irish adults were found to be overweight with obesity rising from 18% to 23%, (SLAN, 2007). Since 1990 the prevalence of overweight and obesity among 13-17year olds had increased from 6% to 19% in boys, and from 15% to 17% in girls (IUNA, 2007). Ireland's first national surveillance of 7 year olds revealed that 13% of boys and 19% of girls were overweight and 5% of boys and 8% of girls were obese (DOHC & HSE, 2008) 2 What is the HSE doing to address the issue? The HSE established a Working Group in 2006 to implement those recommendations of the Task Force on Obesity, for which the HSE has the lead responsibility. The group translated the recommendations of the Taskforce Report into a 5-year Action Plan. The priority areas are set out below: 1. To enhance effectiveness in surveillance, research, monitoring and evaluation of obesity. 2. To develop a quality uniform approach to the detection and management of obesity. 3. To develop our capacity in preventing overweight and obesity and to promote health. 4. To communicate our messages on obesity effectively, 5. To proactively engage and support the work of other sectors in addressing the determinants of obesity and the obesogenic environment. Phase 2 of the Action plan is currently being implemented. The HSE is keenly aware that to halt the growing trend towards obesity and to address the obesogenic environment requires engagement with external partners and multisectoral co-operation. To this end the HSE worked closely with the Health Promotion Policy Unit of the DOHC in the establishment of an interdepartmental and multisectoral group, which was set up in January 2009. The HSE has implemented a number of programmes in prevention and management in line with the priorities set out in the action plan. An overview of some of these programmes including the obesity management services in Loughlinstown is set out below. Childhood Surveillance: WHO - European Childhood Obesity Surveillance Initiative (Ireland) Surveillance of obesity is important so that progress can be monitored on an ongoing basis. 3 In 2008, in collaboration between the DOHC and the HSE, a national sample of 2420 seven-year-old school children from 163 Irish primary schools had their height, weight and waist circumference measured as part of surveillance and monitoring programme in the WHO European Region. 13% of boys and 19% of girls were found to be overweight and 5% of boys and 8% of girls were obese. Results have been sent to the WHO to be incorporated in a European report due out in Autumn 2010. These Irish results and other survey data available, will feed into the national database for height and weight for adults and children, which is currently being progressed which will enable us to monitor progress in addressing obesity. Management of obesity in Children ACE (Activity, Confidence & Eating) Obesity Management and Prevention Programme in Primary Care A number of programmes are in place for the management of overweight and obesity of children throughout the country. An example of good practice is the ACE programme, which is an interdisciplinary family based approach to the treatment of childhood obesity. It is a one-year programme targeting 5 - 12 year olds focusing on behavioural change, with an initial intensive weekly phase of education and physical activity for both children and their families and long term follow up that focuses on environmental determinants. In 2009 30 children plus siblings and parents participated in the programme. The ACE school programme promotes health and health awareness among pupils. In 2009, 3,344 pupils, parents and teachers have participated in Schools ACE. Treatment of severe obesity of adults in Loughlinstown From an adult perspective there is a need to provide support in the management of overweight and obesity at a number of different levels. The hospital system cannot alone manage obesity, and the HSE vision of integrated care will ideally fit the obesity treatment model - so that patients will receive their primary intervention in the primary care team setting and be referred onward to secondary care where appropriate for a higher intensity of intervention including surgery. 4 The service in St Colmcille's was funded from the 2005 budget (200,000 Euros) allocation to support implementation of the obesity task force recommendations. It was anticipated at the time that there should be four treatment units developed incrementally for severe obesity in Ireland. While there are a number of treatment units in development phase, St Colmcille's Hospital in Loughlinstown, Co Dublin is the only unit staffed with the full Multidisciplinary team required to implement international best practice standards. A unit in Galway is currently being established and a unit in Cork is also to be established. A fourth unit between Beaumont and Connolly Hospitals has been proposed - so that there would be one unit in each of the four HSE regions - this is currently being explored. Treatment of severe obesity reduces mortality by 90% over 2 years and improves or cures sleep apnoea, diabetes and high blood pressure in 80-100% of cases. It also reduces the chance of getting cancer significantly and improves survival from cancer. It is one of the few medical interventions that provide cost savings in the long term. St Colmcille's sees 200 new patients per year from all over the country and has a waiting list of 860 patients for assessment and engagement with the weight management programme. Patients with life threatening obesity are prioritized. There are 92 people on the waiting list for surgery. The waiting list is continuously being reviewed and where appropriate clients are referred to weight management programme run by Primary Care Teams. The waiting list in Loughlinstown will be reduced by 20% when the other three units become operational. Weight management programmes are provided for adults that are overweight and obese through the Dietetic Services and the Primary Care Teams throughout the country. In keeping with best practice they combine nutrition and physical activity interventions. Examples include the GP Exercise Referral Programme, Farmers have Hearts and Brief Intervention. 5 Other programmes, which promote physical activity, are provided on our behalf, by the Local Sports Partnerships (32 Nationwide) via Irish Sports Council Funding. The Irish Heart Foundation provide, Healthy Hearts catering audits and awards as well as workplace physical activity programmes and community Sli na Slainte routes. . Weight Management Treatment Algorithm for Adults and Children Statistics support the widely held view that Irish adults and children are becoming heavier over time. Society is tending to normalize overweight and obesity with some, particularly parents, failing to see that, their own, or that of their child's weight, may be outside the normal range. Doctors have reported that in some cases normal weight individuals consider that they need to put on weight to be healthy. Many are unaware of their Body Mass Index (BMI) having had little opportunity to have their height and weight measured. The Weight Management Sub Group of the Intersectoral Group on Obesity are advocating for routine measurement at hospital admission and opportunistic screening in Primary Care Teams and GP surgeries. This group has developed a Weight Management Treatment Algorithm for both Adults and Children. This will provide national guidance for G.P.s, Practice Nurses, Public Health Nurses and Area Medical Officers in dealing with patients who seek help with their weight management. This is currently being finalised with the Irish College of General Practitioners and will be rolled out nationally. Public Health Awareness on Obesity National Media Campaign A key recommendation of the Task Force report was to implement on an annual basis a Cross Border campaign. The " Little Steps Go A Long Way" media campaign was launched in June 2008. The HSE and Safefood developed the campaign, in collaboration with the Health Promotion Agency of Northern Ireland. The emphasis of the campaign is on the crucial impact of parents and guardians as role models for their children. The campaign is now in year 2 (2009-'10) of a three-year programme. 6 During a post marketing survey carried out in 2009, 8 in 10 parents stated that they had already made changes to their child's eating habits. Traffic to the website has been considerable with 102,197 page views by 35,000 visitors. See www.littlesteps.eu Increasing Physical Activity in the Population National Physical Activity Guidelines Combating obesity requires both change in the population's eating habits and physical activity levels. Another key recommendation of the Task Force report was to develop national guidelines for physical activity. The HSE and the DOHC produced the National Guidelines on Physical Activity for Ireland " Get Ireland Active" in 2009. These guidelines highlight the recommendations for physical activity for children, young people, adults, older people and people with disabilities. See www.getirelandactive.ie . A National Policy on Physical Activity with an accompanying action plan is to be developed in 2010 by the proposed Physical Activity Sub Group of the Intersectoral Group. The GP Exercise Referral Programme The National GP Exercise referral programme is currently being rolled out throughout the country. Seventeen fitness centres are currently taking referrals from GPs throughout the country with 14 more centres receiving training prior to commencing the programme in 2010. Finally I would like to mention that the HSE has developed a number of other strategic alliances in our work to combat obesity. We are also engaged in many other national and regional projects in schools, communities, workplaces and in the Health Service to address the prevention and management of obesity. Thank you. 7 Combating Obesity Presentation to Joint Committee on Health and Children 9th March 2010 Professor Donal O Shea, Consultant Endosrinologist Loughlinstown & St. Vincent's Hospitals HSE Framework for Action on Obesity 2008 - 2012 HSE National Working Group on Obesity translated the recommendations of the Taskforce Report into a 5yr action plan with strategic priorities:1. 2. 3. 4. 5. To enhance the effectiviness in surveillance, research, monitoring and evaluation of obesity. To develop a quality uniform approach to the detection and management of obesity. To develop our capacity in preventing overweight and obesity and to promote health. To communicate our messages on obesity effectively. To proactively engage and support the work of other sectors in addressing the determinants of obesity and the obesogenic environment. Obesity Service Loughlinstown / St. Vincents { { Started in 2002 - funded December 2005 Multi Disciplinary Team (MDT) approach Dietician Physiotherapist Psychologist Nurse Surgeon Physicians { What is the intervention? { One to one high intensity (monthly) meetings with MDT for 9 months { Medication { Surgery (estimate 20-30% need) { Capacity is 200 new patients per year Age and BMI information for all patients Note: Of 325 patients studied only 12.3% were on no medication Total Male Female 1258 460 (30%) 798 (70%) age 46.5 (13.1) 46.8 (13.2) 46.4 (13.1) weight 131.4 (32.6) 148.8 (36.8) 123.9 (27.6) BMI 46.5 (10.4) 47.7 (10.5) 46.0 (10.4) BMI<30 (%) 2.3 0 3.3 BMI 30-35 (%) 9.3 6.8 10.4 BMI 36-40 (%) 14.1 19.1 12.0 BMI 40-50 (%) 40.3 38.6 41.0 33.6 35.5 33.3 n BMI>50 (%) Weight outcomes after 1 year Weight Weight Weight N0 Weight Weight Weight less less less change gain gain gain >100/o 5-100/0 1-50/0 1-50/0 5-100/0 >100/o Conservative All BMI 30-BMI 40-Gender Female Male Surgery A11 1 HSE Opening Statement for PAC Meeting Thursday 17th December, 2009 The HSE welcomes the opportunity to update the PAC on issues raised in the C&AG Report No 64 and subsequently when the HSE appeared before the PAC in July. o Case Management/Key Working in Addiction Services;The National Rehabilitation Co-ordinator has undertaken an analysis in the 4 Regions of the HSE, Dublin Mid Leinster; Dublin North East; HSE South and HSE West to identify where formal Case Management/Key Working approaches are in place in the addiction services. The analysis showed that a key working system is in place in the majority of addiction services in 3 out of the 4 regions. Formal Case Management systems are not a commonly utilised tool in the health services. This is a useful baseline for the National Rehabilitation Coordinator who as part of and chair of the National Rehabilitation Implementation Committee is due to deliver a National Framework for Rehabilitation early in 2010 which will address the issue of case management and key working in the addiction services. o Suboxone ;An Expert Group set up by the Department of Health and Children to examine the use of Buprenorphine/Naloxone (Suboxone) recommended the introduction, in the short term and as a feasibility study, of the prescribing and dispensing of Buprenorphine/Naloxone (Suboxone) in specialist addiction clinics with pharmacies and supervised dispensing on site and in a selected number of community settings (Level II GPs and community pharmacists). The study would run for a year and prescribing/dispensing at the study sites would be evaluated before a decision was made on whether to extend prescribing/dispensing to the entire community. Pharmacists and GP's have been recruited to be part of the study spread across different addiction services. The Study will be evaluated in February/March 2010. The numbers of clients active in the study currently is 43. o Needle Exchange Services;The Report of the NACD/NDST working group on Needle Exchange provision in Ireland [November 2008] assessed the role of needle exchange in harm reduction and the extent of provision in Ireland. The Report stated that worldwide 'A substantial number of drug injectors have been attracted to these programmes and have been provided with a range of services which cannot be suitably offered by other health services ' [p22]. It showed how Needle Exchange provision in Ireland reflected the areas where most injecting took place and estimated 44,663 exchanges in 2007 predominately in Dublin. The Report also pointed out the lack of Needle Exchange services 2 in the North East, the South East, the West, the South and the North West. The C&AG report had also identified the North East and South East as two areas which had no Needle Exchange services. The NACD/NDST Report recommended piloting the provision of needle exchange services through Community based Pharmacists. Following discussions between the HSE and the Irish Pharmacy Union 65 Needle Exchange services will be put in place in rural towns in 24 Counties through a pathway of Rural Pharmacists, coordinated and led by a National Liaison Pharmacist. This initiative has secured part funding from the Elton John AIDS Foundation which has been active in Ireland for several years with small projects to prevent the spread of blood borne illnesses. The Pharmacists will be trained in February 2010 and the programme will be rolled out during the course of 2010. Pharmacists will advise injectors on their general health needs and the health consequences of injecting and they will encourage injectors to take up treatment. This will be done on a one to one basis. o Providing additional treatment services to respond to the increase in heroin use outside of Dublin;Additional facilities and clinics are required in the South East, South, North East and Midlands and reconfiguration of the facilities in the Mid West is also needed. The provision of additional clinics requires new facilities /upgrading existing facilities, recruiting additional Level 2 GPs with back up of nursing and counselling staff and pro active engagement with local communities. It is a significant challenge to put in place additional services through reframing of existing services and resources, nevertheless, plans are in place to develop service capacity in Gorey, Wexford, Waterford, Cork, Tralee; Limerick; Dundalk; Drogheda throughout 2010. We also intend to develop capacity in Mullingar and Portlaoise which may require capital funding. o National Overdose Prevention Strategy;A group is currently meeting and is finalising it's recommendations on best practice in relation to overdose prevention. This will draw upon International literature and using the reports of the National Drug Related Deaths Index as background materials. Once the recommendations are agreed and published, engagement will take place with wider stakeholder groups such as HSE drugs services, community and voluntary sectors, local and regional drugs task forces, an Garda Siochana, Ambulance services, the Family Support Network and representatives of services users. This engagement will take place with a view to maximising the chances of the recommendations being implemented. PUBLIC ACCOUNTS COMMITTEE Statement by Ms Laverne McGuinness, National Director: Integrated Services Directorate - Finance and Performance Management, HSE, 10th June 2010. Chairman and members of the Committee. A public statement was issued on 3rd June which stated that I personally had provided "wrong, untrue and inaccurate information" to the Committee. I believe that this statement was unfair as I did not knowingly or intentionally provide inaccurate information to the Committee. I am please to attend today to clarify to the Committee why the information I provided at its meeting on 4th March was different to the information provided on Friday 28th May and on Friday 4th June to the Minister for Children and Youth Affairs, Barry Andrews T.D. and the Independent Review Group, established by the Minister. Firstly, I would like to emphasise that behind the numbers I will be referring to today are children, families, friends and carers and again place on the record our very sincere sympathy to these families and friends of the young people who died. Since 2008 we have been working on a strategy to fundamentally modernise childcare and family services in Ireland within the resources available and the industrial relations environment we operate in. I am confident that if we stick with this strategy, it will provide safe and highly professional service in the years ahead. In the interim we are very focused on managing the risks which are inherent in this area of social care. 1 The figure of 20 children who died while In Care notified to the Committee on 4th March originates from a response to a request from HIQA, the Health Information and Quality Authority, in February 2009 which we responded to the following month. In March 2009 we advised HIQA that 21 children had died in the care of the former health boards and HSE since 2000. This figure was later revised to 20 when it was established that one of the cases identified referred to a young adult. This was the most up to date and accurate information available at the time of the Committee's meeting on 4th March 2010. Six days after the Committee meeting, on 10th March 2010, HIQA published the Guidance for the HSE for the Review of Serious Incidents including Deaths of Children in Care. The same day, 10th March, Minister Andrews requested that we provide information on: 1. Children who died In Care; 2. Young adults up to 21 years who had died and had previously been In Care; and 3. Children who died who were known to the child protection services. Taking account of the clarity in the Guidance from HIQA, the request from Minister Andrews and discussions with the Independent Review Group last month we went back out to our social services around the country with far more precise definitions of the information now required. 2 We applied these new definitions to records going back over 10 years from January 1st 2000 to April 30th 2010. During this period there would have been over 200,000 referrals to child protection/social services and child protection concerns in relation to over 20,000 of these children. The compilation of this new information was a manual process as the records do not exist in one central location or data base. Notwithstanding this, this exercise was not completed as quickly as we would have wished and this delay has reflected badly on our child and family services. Friday, 28th May On 28th May we provided the first set of information requested to the Minister for Children and Youth Affairs and the Independent Review Group. This related to children up to 18 years who died, of natural and unnatural causes, while In Care. For children In Care, the former health boards and subsequently the HSE act as loco parentis in accordance with the provision of the Child Care Act 1991 by court order or voluntary consent. Within this group 18 children died of unnatural causes while In Care during the 10 year period. A further 19 children died from natural causes and health related conditions during the 10 year period; a total of 37 children. The difference between the figure of 20 provided to the Committee on 4th March and this figure of 37 is because: 1. There have unfortunately been additional deaths between the time of the initial request to our social services in early 2009 and the extended review period which is April 2010; 3 2. All children who died from natural causes, in accordance with the HIQA guidance have now been included whereas before only some were included; and 3. Two accidental deaths and 1 drug related death have been identified following further validation of files and the new more precise definitions. Friday, 4th June On 4th June we provided the information with respect to the two additional groups. 1. The first group consisted of young adults between 18 and 21 years who had previously been In Care but who were no longer In Care when they died. If any such young person was no longer engaging with aftercare services or had moved to another jurisdiction the HSE may not have had the details of their death. From the information available 27 young adults within this group died during this 10 year period, 4 of natural causes and 23 of unnatural causes. 2. The second group consisted of children who would have had ongoing contact with child protection services at the time of their death and also children who died up to two years after their case had been closed. This review involved a very wide analysis of our records which identified that 124 children who were known to social services died during the 10 year period, 63 of natural causes and 61 of unnatural causes. Independent Review Group There has been public commentary saying that the HSE has been refusing to provide information to the Independent Review Group. I would like to clarify again we are very willing to provide the Independent Review Group with as much 4 information as we are lawfully permitted to provide. What we have refused to do is provide information that would cause us to break the law. It would be helpful if this point could be acknowledged. We continue to work with the Independent Review Group and explore ways by which information can be provided to it and await further developments regarding the legislative amendment which may facilitate the provision of information. We have established a HSE Child Deaths and Serious Incidents Review Group Chaired by Dr. Helen Buckley (TCD) which will monitor and oversee the review of all future child deaths in accordance with the HIQA Guidance. We are maintaining an open register for the period, January 1st 2000 to April 30th 2010, and in the event that further deaths are identified over the next 3 months, they will be added to the list and notified to the Independent Review Group and the Minister for Children and Youth Affairs. I hope that this information will be of assistance to the Committee. Thank you ******************* 5 Mental Health Capital Programme Update for Joint Committee on Health Children Tuesday 20th April 2010 Capital Expenditure on Mental Health 2005-2009 - Mental Health Expenditure ?140m approx Capital Expenditure on Mental Health 2005?2009 St Lukes Acute MH Unit Kilkenny Bloom?eld Hospital Our Lady?s Hospital Cashel Residential Units, Cork Dublin Cope Foundation Cork Day Hospitals eg Clonmel, Gorey, BIackrock,Flng|as Residential Units. Blanchardstown. Carndonagh, Newcastlewest. Primary Care Facilities, Ballymun, Tallaght, etc Current Mental Health Projects - Residential Units Cork, Galway, Dublin I MH Residential Units. Bailinasloe, Clonmel, Mullingar - Acute MH Unit Letterkenny - Primary Care Centres, lnchicore, Ballyfermot, Letterkenny I Grangegorman Redevelopment St lta?s Portrane A for Change Framework for Mental Health Service Development 2006 Adopted by HSE Management Team Working Group Modernisation of MH infrastructure Working Group Report December 2008 Mental Health Development Programme developed. Submissions to 2009 Department of Finance agreement Mental Health Capital Group Prioritisation of Developments Extra Exchequer Returns All proceeds from sale of HSE Assets must be returned to the Exchequer Unless (in accordance with the Health Act) I Approval has been received in advance of the sale from the Department - The proceeds are to be invested in Priority Projects Dublin North East Priorities 1. Beaumont Acute MH Unit 2. Grangegomian Redevelopment 3. Louth Acute MH Unit Also Upgrade of existing beds Mater Hospital Additional Residential Beds (Fairview) Residential Units Portrane Navan Behaviour Unit Dublin Mid-Leinster Priorities 1. St Lomans Redevelopment (Baiyfermot, Lucan 8t Crumlin) 2. Unit Cherry Orchard Warrinstown 3. Residential Unit Mullingar Also Beds Tallaght Residential Units Portlaois 8: Newcastle High Support Hostels West Priorities 1. Letterkenny Acute MH Unit 2. Limerick Acute MH Unit 3. Residential Beds Bailinasloe, Mid West Also Rown?eld. Donegal Upgrade Dementia Unit, St Joseph?s Ennis Upgrade existing Admission Units High Support Hosteis South Priorities 1. South Tipp Developments Residential Community based 2. Wexford Developments Residential and Community based 3. Kerry Developments Residential Unit and upgrade of existing Acute Unit. Also Waterford Residential Unit and High Support Hostels Waterford CMHC Day Hospital Primary Care Centres - Being procured by Lease agreement I 187 Approved by Board - 82 Letters of intent issued - 20 Agreements to Lease signed - 7 now in Operation - 30 in operation by end of 2010 I Another 40 in operation by end of 2011 Approx 50 inciude CMH facilities First one now in operation in Letterkenny I Central Mental Health - CMH Project Team - Brief includes provision of New Central Mental Hospital 120 beds 4 Intensive Care Regional Unit ID ICRU - Site Selection and Optiona Appraisal - Procurement based on funding provision from value of existing site National Project for Radiation Oncology As part of Enabling Works I CUH Acute MH Unit - UCH Galway Acute MH Unit Dear Professor Drumm, I wish to inform you that the Committee has set aside Thursday 5th November, 2009 (commencing 10.00 a.m.) for examination of the following matters:2008 Annual Report of the Comptroller and Auditor General and Appropriation Accounts: Chapter 39 ?- Implementation of Medical Consultants Contract Please note Mr. Michael Scanlan, Secretary General from the Department of Health and Children has also been invited to this meeting. The Committee has directed me to invite you to attend this meeting to assist the Committee in its examination of these matters. In addition to yourself, as Accounting Officer, you may have up to three supporting officials attend with you. Observers are also permitted but will be required to attend in the public gallery with no communication with those being examined. You may make an opening statement to the Committee on the matters under examination and you are asked to keep the statement to not more than 5 minutes in length. I would appreciate if the definitive list of all attending (indicating their title and area of responsibility), the opening statement and any other documentation is provided, in electronic format, to public.accounts.committee@oireachtas.ie by 12.30 p.m. on the Tuesday preceding the meeting. A transcript of the Committee proceedings will be posted on the Committee web page at www.oireachtas.ie usually within a week. Any minor factual corrections you wish to make to your own contribution should be submitted to the Editor?'s Office (carl.lombard@oireachtas.ie) within a week of the posting of the transcript on the website. Any information, which cannot be supplied to the Committee on the day of the meeting, can be forwarded within two weeks of the date of the meeting. The Committee will meet at 10.00 a.m. in Committee Room 1, Leinster House 2000, Leinster House on Thursday 5th November, 2009. I have enclosed a copy of the Witness brief which deals with rights of witnesses and I would ask that you bring its contents to all support staff who are attending the meeting. If you have any queries do please contact either the undersigned, or Ted Mc Enery, Clerk to the Committee at Tel. 618 3867, who will be happy to go over any aspects of the examination with you. Yours sincerely, __________________ Treasa Carroll, Senior Clerk, Committee Secretariat (Tel. 618 3790) An Coiste um Chuntais Phoibli ComMittee of Public Accounts Teach Laighean Leinster House . . Dublin 2 Bails Atha Chath 2 (01) 618 3790/3074/3867 Lo-Call 1890 337 889 Fax (01) 618 4124 email: Public_Accounts_Committee @Oireachtas.ie 23rd October 2009 Prof. Brendan Drumm, Chief Executive, Health Service Executive, Dr. Steeven?s Hospital, Dublin 8. Dear Professor Drumm, As per telephone conversation last week I wish to con?rm that in addition to Chapter 39 the Implementation Medical Consultants? Contracts the Committee will also examine Chapter 37 the Management of Private Patient Income at the meeting of the 5m November 2009. Should you require any further information, please do not hesitate to contact me. Yours sincerely, 312W Treasa Carroll. Senior Clerk, Committee Secretariat (Tel. 6l8 3790) ?orR is\0l - Bodies\2009\lnvite\Health Service Executive? Revised Invite PAC 05l 12009.doc PUBLIC ACCOUNTS COMMITTEE Chapters 37 & 39 of the 2008 Report of the Comptroller and Auditor General on Vote 40 for the HSE OPENING STATEMENT BY PROFESSOR BRENDAN DRUMM CHIEF EXECUTIVE OFFICER HEALTH SERVICE EXECUTIVE 5th November 2009 1 Chairman, Members of the Committee - thank you for the opportunity to make an opening statement this morning. I would like to comment briefly on the collection of costs from health insurers for treating private patients in public hospitals and implementation of the 2008 consultant contract. Private Patient Income Before setting out the specifics in relation to recouping private patient accommodation costs, I would like to highlight that: o We are not yet satisfied with the time it is taking to recover accommodation costs from health insurers for patients treated privately in HSE hospitals and voluntary hospitals; o The delays in processing claims creates primarily cash flow issues but does not affect the amount of money eventually recovered by hospitals from insurers; and o In general HSE and voluntary hospitals recover 97% of private patient accommodation costs from insurers. A number of initiatives have been introduced to address this situation and they include the following: A high level group from the HSE and Voluntary Hospitals has been working with health insurers to streamline the claims processes. At the moment each private patient insurance claim has essentially two parts; there is the private accommodation costs which is payable to the HSE hospital or voluntary hospital and the cost for providing private clinical services which is payable to the consultant or consultants. Claims for hospital accommodation costs are not accepted by insurers unless they are signed off by the primary Consultant. This administrative requirement causes major logjams. 2 Ideally we would like insurers to remove this requirement. This would mean that hospitals would not be dependent on Consultants signing off on claims forms to recover private patient accommodation costs from insurers. Insurers have now agreed to process claims signed off by a secondary Consultant where there has been a significant delay in sign off by the primary Consultant. VHI has also agreed to introduce an improved payment arrangement. A payment on account of ?EUR50 million has been agreed in lieu of payments due. We anticipate receiving this payment shortly. We are exploring the possibility of having similar arrangements with other insurers. In addition, we are now beginning to centralise the HSE?'s entire billing system which will be based in Kilkenny. This centralised approach will streamline all insurance claims and debt collection processes. The most up to date position in relation to insurance claims is that there are claims for private accommodation cost of approximately ?EUR51 million currently being processed by insurers. This includes claims which are the subject of further information requests from insurers (?EUR11 million). Outstanding claim forms which include private inpatient and day care accommodation costs of approximately ?EUR94 million await sign off by Consultants. We have now introduced a major drive to have all outstanding claim forms signed off by Consultants, submitted and paid by the end of the year. This is a very ambitions undertaking and each hospital has been issued with a target they must meet. Achieving this target will treble our current weekly cost recovery from insurers until the end of the year to over ?EUR20 million a week. A major factor determining the ability of hospitals to meet this target will be for Consultants to sign off on all insurance claims in a timely fashion. I would encourage them to co-operate fully with their local colleagues in achieving this. The insurance companies are co-operating with us in this endeavour. Hospitals can now submit claims as they are ready rather than once a month. 3 Our drive to recoup costs from health insurers this year could result in a decrease in cash flow from this source early next year. To try and address this, next year hospitals will have specific debt recovery targets and hospitals who fail to reach their target will be subject to budget sanctions. Our target is to recover all outstanding debts within 30 days. Consultant Contract 2008 The Consultant Contract 2008 introduces reforms which will benefit patients, move towards a consultant-provided service and maximise the return from tax payer investment in existing and additional consultant posts. These include a longer working week (37 instead of 33 scheduled hours), a longer working day (8am to 8pm instead of 9am to 5pm), greater equity for public patients through a public-only contract type, limits on private practice and a common waiting list in diagnostic services, measures to ensure high quality services and patient safety, the introduction of Clinical Directors to manage Consultants and ensure clinicians have a senior role in planning and managing services. 1,688 of the 1,888 consultants employed by the HSE in August 2008 (90%) signed up to new contract. In addition, we have since created 218 new consultant posts and approved 195 replacement consultant posts under the new contract. This represented a 10% increase in the overall number of Consultant posts and means that the new contract applies to 86% of Consultants (2,025 of the 2,350 Consultant posts). A unique and significant feature of the new contract is the creation of the post of Clinical Director. Clinical Directors are key members of local corporate management teams. They plan how clinical services are delivered and how resources are employed. They contribute to deploying and managing Consultants, strategic planning and achieving local priorities. Consultants report to their assigned Clinical Director who monitors and manages the public/private mix of their work where relevant and develop and manage rosters. The current emphasis is on introducing rosters so that there is on site Consultant cover 12 hours a day (8am ?- 8pm) and maximising the value of the additional 4 hours per week Consultants now work. Clinical Directors also deal with a range of other quality, safety and organisational issues. 4 In early 2009 a process started to verify that the new contract was being implemented as planned. A key element of the contract is the regulation of each Consultant?'s public and private practice and in September 2008 we introduced new measurement systems to do this. The measurement system has been rolled out to the 49 acute hospitals and captures inpatient and day case activity carried out by each consultant (weighted for case mix) and reports on the level of private practice on a monthly basis. Details of on-site private Outpatient activity and certain diagnostic activity are being collected manually by hospitals as an interim measure pending the development of automated data collection systems. Consultants employed by the public health service ?- irrespective of whether they are employed under Consultant Contract 2008 or not, are now issued with a public/private mix measurement report every month. This documents their activity in relation to inpatient, day case and outpatient activity during the previous three months. This measurement system is essential and when combined with the performance data we are collecting through HealthStat we have a very powerful combination. HealthStat concentrates on output and throughput of facilities and individual consultant. By comparing data across the system we can establish where tax payer?' investment is having the greatest impact and can make effective planning decisions based on this data. Finally the 3rd Interim Report of the Public Accounts Committee on the 2006 Report of the Comptroller and Auditor General regarding health service made a number of recommendations and we believe that our implementation of the key provisions of the Consultant Contract 2008 has significantly addressed these recommendations. Thank you. 5 WEST AREA: This report covers the following Hospitals: Croom Orthopaedic Hospital, Letterkenny General Hospital, Mayo General Hospital, Merlin Park Regional Hospital, Mid Western Maternity Hospital, Mid Western Regional Hospital Dooradoyle, Mid Western Regional Hospital Ennis, Mid Western Regional Hospital Nenagh, Portiuncula Hospital, Roscommon County Hospital, Sligo General Hospital, St. Johns Hospital Limerick, University College Hospital Galway. Consultant Private Workload Summary Report In-patient % Consultant Specialty Paediatrics Gastro Enterology Orthopaedics Cardiology Rheumatology Respiratory Medicine Paediatrics Surgery Haematology Gastro Enterology Paediatrics Geriatric Medicine Oncology Geriatric Medicine Obstetrics Obstetrics Private Workload as Contract Limit a Percentage of Total 0.00% 11.20% 0.00% 22.10% 8.90% 50.80% 27.60% 25.80% 39.20% 80.00% 26.80% 23.60% 10.80% 6.00% 27.50% 21.50% N/A % N/A % N/A % 20.00% 20.00% 28.00% 22.00% N/A % 30.00% 30.00% 29.00% 22.00% 20.00% 20.00% 20.00% Day case % Private Workload as a Percentage of Total 0.00% 22.20% 0.00% 18.30% 0.00% 50.00% 0.00% 8.80% 23.30% 0.00% 24.80% 0.00% 0.30% 0.00% 39.50% 46.00% Contract Limit N/A % N/A % N/A % 20.00% 20.00% 28.00% 22.00% N/A % 30.00% 30.00% 29.00% 22.00% 20.00% 20.00% 20.00% Oncology Obstetrics Palliative Medicine Anaesthetics Endocrinology Neurology Haematology Nephrology Nephrology Radiology Endocrinology Infectious Diseases Respiratory Medicine Obstetrics Cardiology Paediatrics Paediatrics Endocrinology Clinical Immunology Otolaryngology Dermatology Gastro Enterology Endocrinology Rheumatology 33.20% 1.40% 18.20% 49.60% 10.80% 18.10% 38.90% 24.90% 29.20% 31.60% 12.80% 21.40% 11.30% 4.00% 14.40% 7.90% 37.00% 21.80% 27.20% 33.70% 58.60% 3.10% 14.70% 3.60% 20.00% N/A % 30.00% 20.00% 29.00% N/A % 20.00% 20.00% 20.00% 21.00% 20.00% 23.00% 20.00% 20.00% 22.00% 30.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 29.50% 0.00% 0.00% 42.80% 0.00% 5.90% 30.80% 0.00% 0.00% 44.00% 0.00% 0.00% 11.60% 0.00% 7.50% 7.80% 6.90% 0.00% 13.60% 16.30% 42.90% 20.00% 0.00% 0.00% 20.00% N/A % 30.00% 20.00% 29.00% N/A % 20.00% 20.00% 20.00% 21.00% 20.00% 23.00% 20.00% 20.00% 22.00% 30.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% Haematology Anaesthetics Haematology Paediatrics Respiratory Medicine Radiology Anaesthetics Anaesthetics Anaesthetics Radiology Urology Radiology Anaesthetics Anaesthetics Radiology Radiology Endocrinology Radiology Radiology Radiology Radiology Anaesthetics Paediatrics Gastro Enterology 64.50% 34.20% 32.90% 28.50% 0.00% 41.80% 36.90% 34.60% 54.00% 51.30% 46.70% 31.70% 0.00% 40.00% 55.40% 31.40% 0.00% 36.40% 84.20% 0.00% 0.00% 39.40% 17.60% 0.00% 20.00% 20.00% 20.00% 30.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% N/A % 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% N/A % 20.00% 20.00% 13.00% 55.00% 22.20% 14.00% 0.00% 0.00% 30.00% 37.30% 52.10% 0.00% 57.70% 0.00% 0.00% 39.10% 100.00% 0.00% 0.00% 0.00% 80.10% 0.00% 0.00% 43.60% 37.50% 0.00% 20.00% 20.00% 20.00% 30.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% N/A % 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% N/A % 20.00% 20.00% Oncology General Surgery Gastro Enterology Gastro Enterology General Medicine Gynaecology General Surgery Paediatrics General Medicine Paediatrics Orthopaedics Otolaryngology Oncology Anaesthetics Paediatrics Orthopaedics General Surgery General Medicine Opthalmology Psychiatry General Surgery General Medicine Oncology Paediatrics 0.00% 51.20% 11.10% 22.00% 0.00% 7.80% 22.50% 26.50% 16.40% 20.70% 14.70% 43.40% 34.80% 15.10% 31.20% 12.90% 26.00% 10.80% 53.20% 0.00% 27.50% 10.60% 0.00% 44.60% 20.00% 20.00% 20.00% N/A % 30.00% N/A % 20.00% 30.00% 30.00% 30.00% 20.00% 30.00% 30.00% 30.00% 20.00% 20.00% 30.00% 0.00% 0.00% 9.70% 8.60% 0.00% 20.90% 26.30% 0.00% 35.50% 33.30% 26.50% 31.20% 0.00% 13.70% 9.80% 25.20% 18.10% 5.60% 42.40% 0.00% 29.10% 34.40% 0.00% 75.00% 20.00% 20.00% 20.00% N/A % 30.00% N/A % 20.00% 30.00% 30.00% 30.00% 20.00% 30.00% 30.00% 30.00% 20.00% 20.00% 30.00% Otolaryngology Orthopaedics Gynaecology Psychiatry Psychiatry Psychiatry Psychiatry Haematology Obstetrics Dermatology Paediatrics Nephrology Anaesthetics Obstetrics Oncology General Medicine Obstetrics Opthalmology Radiology Otolaryngology General Surgery Anaesthetics Orthopaedics Opthalmology 27.20% 16.10% 16.60% 0.00% 8.10% 0.00% 0.00% 15.30% 0.00% 11.30% 16.50% 9.40% 20.70% 28.40% 28.90% 8.10% 14.20% 0.00% 21.10% 19.10% 15.00% 17.10% 7.20% 23.10% 30.00% 20.00% 20.00% 30.00% 30.00% 30.00% 20.00% 30.00% 20.00% 30.00% 30.00% 20.00% 30.00% 20.00% 16.40% 33.90% 31.80% 0.00% 0.00% 0.00% 0.00% 21.70% 0.00% 59.50% 32.40% 14.50% 33.90% 27.20% 15.90% 14.70% 0.00% 0.00% 25.80% 19.60% 20.60% 46.60% 60.60% 9.10% 30.00% 20.00% 20.00% 30.00% 30.00% 30.00% 20.00% 30.00% 20.00% 30.00% 30.00% 20.00% 30.00% 20.00% Opthalmology Anaesthetics Neurology General Medicine General Medicine Obstetrics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Maxiofacial Palliative Medicine Radiology Radiology Radiology Radiology Radiology Radiology Rheumatology General Medicine 21.10% 20.20% 24.60% 12.10% 7.10% 9.20% 31.90% 19.40% 28.90% 0.00% 17.50% 10.50% 37.40% 21.80% 0.00% 14.70% 4.40% 17.20% 15.70% 23.70% 15.90% 18.80% 14.10% 17.10% 30.00% 20.00% N/A % 20.00% N/A % N/A % N/A % 20.00% 30.00% 30.00% N/A % 30.00% N/A % 30.00% 30.00% 20.00% 30.00% 30.00% N/A % 30.00% 20.40% 15.40% 13.30% 23.60% 25.40% 0.00% 19.00% 28.10% 23.00% 0.00% 24.80% 31.50% 27.70% 25.30% 0.00% 0.00% 25.50% 43.40% 0.00% 21.60% 45.90% 34.80% 0.00% 0.00% 30.00% 20.00% N/A % 20.00% N/A % N/A % N/A % 20.00% 30.00% 30.00% N/A % 30.00% N/A % 30.00% 30.00% 20.00% 30.00% 30.00% N/A % 30.00% Anaesthetics Oncology General Medicine Opthalmology General Surgery General Surgery General Medicine Radiology Radiology General Medicine Anaesthetics Radiology Radiology Anaesthetics General Surgery Paediatrics General Surgery Obstetrics Paediatrics Obstetrics General Medicine Oncology Anaesthetics Oncology 0.00% 52.10% 23.60% 0.00% 25.70% 17.80% 22.60% 24.60% 19.10% 12.80% 14.90% 100.00% 29.60% 38.40% 34.10% 29.40% 23.50% 36.10% 0.00% 37.10% 20.00% 0.00% 47.30% 47.10% 20.00% 30.00% N/A % N/A % 30.00% 20.00% 0.00% 0.00% 0.60% 24.00% 33.10% 22.80% 0.80% 0.00% 28.50% 0.00% 18.10% 0.00% 0.00% 42.30% 36.30% 0.00% 10.20% 71.30% 0.00% 51.10% 0.00% 0.00% 54.00% 39.40% 20.00% 30.00% N/A % N/A % 30.00% 20.00% General Medicine Paediatrics Paediatrics General Medicine Radiology Radiology General Surgery Urology Maxiofacial Obstetrics General Medicine Obstetrics Anaesthetics Anaesthetics Radiology Radiology General Medicine Anaesthetics General Surgery General Medicine General Medicine General Medicine Anaesthetics Anaesthetics 25.70% 38.70% 42.40% 10.80% 14.40% 29.80% 23.50% 22.90% 49.40% 41.70% 14.90% 100.00% 27.50% 26.30% 29.30% 33.20% 0.00% 34.80% 9.70% 1.70% 4.40% 0.00% 40.60% 19.40% 30.00% 30.00% 20.00% 30.00% 20.00% 62.80% 0.70% 4.90% 65.30% 74.00% 56.70% 12.10% 18.40% 46.90% 50.10% 0.00% 0.00% 41.90% 34.30% 30.50% 60.70% 0.00% 34.80% 0.00% 0.00% 0.00% 0.00% 20.10% 0.00% 30.00% 30.00% 20.00% 30.00% 20.00% Paediatrics Obstetrics Obstetrics Obstetrics Radiology Paediatrics General Surgery Orthopaedics Rheumatology Respiratory Medicine Geriatric Medicine Palliative Medicine Nephrology Nephrology Radiology Respiratory Medicine Cardiology Clinical Immunology Dermatology Endocrinology Rheumatology Anaesthetics Respiratory Medicine Anaesthetics 0.00% 53.50% 100.00% 0.00% 26.60% 100.00% 0.00% 0.00% 10.20% 22.20% 8.20% 0.00% 11.80% 15.00% 0.00% 0.00% 0.00% 0.00% 0.00% 84.60% 6.50% 20.60% 18.50% 11.90% N/A % 20.00% 28.00% 20.00% 30.00% 20.00% 20.00% 20.00% 23.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 0.00% 0.00% 0.00% 0.00% 100.00% 0.00% 0.00% 0.00% 0.00% 40.40% 0.00% 0.00% 0.10% 0.60% 0.00% 28.20% 0.00% 0.00% 0.00% 0.00% 0.00% 24.40% 12.90% 0.00% N/A % 20.00% 28.00% 20.00% 30.00% 20.00% 20.00% 20.00% 23.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% Anaesthetics Anaesthetics Anaesthetics Anaesthetics Obstetrics/Gynaecology Paediatrics General Surgery General Medicine General Medicine Paediatrics Obstetrics/Gynaecology General Medicine Paediatrics General Surgery Obstetrics/Gynaecology Paediatrics General Medicine Orthopaedics General Surgery Orthopaedics Orthopaedics Obstetrics/Gynaecology Paediatrics Anaesthetics 19.80% 26.90% 38.50% 0.00% 0.20% 28.50% 26.20% 8.20% 8.80% 19.10% 34.40% 13.30% 31.00% 30.50% 0.00% 2.50% 11.70% 25.50% 16.20% 23.00% 31.80% 28.40% 22.60% 30.80% 20.00% 20.00% N/A % N/A % N/A % 30.00% 30.00% 20.00% 20.00% 30.00% 30.00% 20.00% 20.00% 28.00% N/A % 30.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 28.90% 20.00% 10.40% 0.00% 0.00% 100.00% 0.00% 36.90% 54.40% 2.60% 0.70% 2.50% 29.10% 0.30% 0.00% 42.10% 0.00% 5.40% 1.20% 48.50% 7.00% 33.10% 40.90% 53.10% 0.00% 41.50% 20.00% 20.00% N/A % N/A % N/A % 30.00% 30.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 30.00% N/A % 30.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics General Medicine Paediatrics Other General Medicine Paediatrics Orthopaedics General Surgery General Surgery Geriatric Medicine Otolaryngology General Surgery Cardiology General Surgery Anaesthetics Orthopaedics Obstetrics Respiratory Medicine Opthalmology 0.00% 35.30% 18.60% 37.00% 13.90% 31.30% 6.60% 0.00% 0.00% 8.70% 13.20% 32.80% 5.30% 16.50% 7.40% 100.00% 35.70% 0.00% 18.30% 20.90% 10.90% 12.40% 11.10% 12.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% N/A % N/A % N/A % N/A % N/A % 20.00% 20.00% 20.00% 0.00% 21.30% 46.30% 33.70% 33.40% 46.40% 6.80% 0.00% 10.10% 2.60% 0.00% 49.60% 11.00% 10.40% 28.90% 0.00% 2.10% 0.00% 24.10% 15.90% 19.30% 21.90% 9.50% 9.10% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% N/A % N/A % N/A % N/A % N/A % 20.00% 20.00% 20.00% Dermatology Orthopaedics Cardiology Opthalmology Gynaecology Radiology General Surgery Oncology Paediatrics General Medicine Otolaryngology Anaesthetics Nephrology Geriatric Medicine Paediatrics Opthalmology Otolaryngology Gynaecology Haematology Neurology Paediatrics General Surgery Anaesthetics Anaesthetics 0.00% 17.60% 17.00% 0.00% 25.20% 0.00% 16.50% 16.70% 19.40% 11.10% 48.80% 21.90% 11.00% 9.30% 0.00% 0.00% 0.00% 15.40% 7.90% 0.00% 15.40% 14.00% 11.30% 31.10% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% N/A % N/A % 20.00% 20.00% N/A % 0.00% 37.80% 28.80% 22.90% 22.10% 0.00% 24.50% 9.90% 0.00% 0.00% 0.00% 19.40% 0.00% 0.00% 0.00% 0.00% 0.00% 20.20% 9.50% 0.00% 0.00% 33.00% 38.40% 33.80% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% N/A % N/A % 20.00% 20.00% N/A % Anaesthetics Anaesthetics Radiology Anaesthetics Anaesthetics Radiology Psychiatry Microbiology Rheumatology Psychiatry Psychiatry Paediatrics General Medicine Paediatrics General Medicine Gynaecology Otolaryngology Opthalmology Opthalmology General Medicine General Surgery Geriatric Medicine General Surgery Orthopaedics 15.30% 23.70% 0.00% 22.80% 21.10% 0.00% 0.00% 4.20% 0.00% 0.00% 0.00% 10.10% 39.90% 38.70% 0.00% 14.90% 100.00% 25.90% 0.00% 43.20% 50.10% 28.40% 40.90% 33.60% N/A % N/A % 20.00% 20.00% N/A % 20.00% 20.00% N/A % N/A % N/A % N/A % N/A % 30.00% 30.00% 30.00% 30.00% 3.80% 30.20% 0.00% 0.00% 11.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 7.00% 20.10% 47.40% 0.00% 10.70% 53.40% 25.20% 0.00% 0.00% 53.90% 100.00% 0.00% 82.00% N/A % N/A % 20.00% 20.00% N/A % 20.00% 20.00% N/A % N/A % N/A % N/A % N/A % 30.00% 30.00% 30.00% 30.00% Paediatrics Gynaecology General Surgery General Surgery Gynaecology Paediatrics General Surgery General Surgery Anaesthetics Anaesthetics Anaesthetics Cardiology General Surgery Geriatric Medicine Respiratory Medicine Opthalmology Maxiofacial Gynaecology Orthopaedics Orthopaedics Cardiology General Surgery Gynaecology Gynaecology 37.30% 50.60% 31.70% 54.60% 53.10% 48.10% 62.40% 29.40% 44.60% 47.70% 42.10% 45.30% 0.00% 44.00% 0.00% 34.90% 41.70% 64.20% 45.90% 25.40% 41.10% 0.00% 57.90% 40.20% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 20.00% 30.00% 30.00% 37.90% 59.70% 53.60% 57.40% 69.70% 38.20% 58.80% 57.80% 59.90% 61.40% 58.70% 70.20% 0.00% 100.00% 0.00% 44.60% 9.70% 0.00% 48.00% 61.10% 53.50% 25.20% 77.00% 0.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 20.00% 30.00% 30.00% Oncology Orthopaedics General Medicine Paediatrics Dermatology Paediatrics Otolaryngology Haematology General Medicine General Medicine Anaesthetics General Surgery Maxiofacial Orthopaedics General Medicine Otolaryngology Cardiology General Surgery Otolaryngology General Medicine General Surgery Paediatrics Obstetrics Anaesthetics 63.60% 23.70% 17.50% 46.70% 46.20% 41.90% 37.00% 77.50% 77.20% 10.30% 100.00% 46.20% 29.10% 44.30% 22.80% 31.30% 50.30% 38.80% 51.80% 40.80% 48.60% 50.60% 35.30% 46.70% 30.00% 30.00% 20.00% 30.00% 30.00% 30.00% 30.00% 30.00% N/A % 30.00% 30.00% 30.00% 30.00% 20.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 65.30% 67.70% 48.40% 66.40% 0.00% 40.10% 73.10% 63.80% 0.00% 10.80% 17.70% 51.70% 25.30% 51.20% 0.00% 38.50% 59.00% 61.20% 57.90% 34.70% 57.90% 0.00% 22.90% 67.80% 30.00% 30.00% 20.00% 30.00% 30.00% 30.00% 30.00% 30.00% N/A % 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% Paediatrics General Medicine Paediatrics Palliative Medicine Haematology Palliative Medicine Anaesthetics Orthopaedics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Neurology Anaesthetics Psychiatry 47.00% 49.90% 42.90% 11.70% 40.20% 24.70% 53.90% 43.10% 53.90% 41.30% 42.80% 52.20% 35.60% 62.50% 48.20% 26.30% 51.20% 51.20% 40.00% 42.90% 0.00% 28.70% 28.40% 0.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 0.00% 0.00% 84.20% 0.00% 40.50% 0.00% 76.80% 52.90% 51.60% 26.30% 59.80% 68.60% 43.40% 78.80% 46.90% 0.00% 61.60% 59.70% 79.80% 78.10% 0.00% 0.00% 80.00% 0.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% Psychiatry Psychiatry Gastro Enterology Infectious Diseases Maxiofacial Orthopaedics Anaesthetics Anaesthetics Anaesthetics Orthopaedics Orthopaedics Orthopaedics Orthopaedics Anaesthetics General Medicine Anaesthetics Orthopaedics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Obstetrics 0.00% 49.50% 0.00% 96.10% 37.80% 36.30% 53.90% 59.20% 41.30% 63.70% 71.80% 45.80% 57.10% 62.10% 100.00% 83.80% 20.50% 56.60% 0.00% 56.40% 60.30% 100.00% 82.60% 1.00% 20.00% 30.00% 20.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% N/A % 0.00% 0.00% 0.00% 0.00% 0.00% 51.20% 66.70% 87.90% 78.90% 62.60% 84.00% 62.70% 63.70% 32.80% 19.40% 0.00% 0.00% 65.70% 0.00% 69.40% 48.30% 83.60% 100.00% 0.00% 20.00% 30.00% 20.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% N/A % Obstetrics Obstetrics Anaesthetics Anaesthetics Anaesthetics Obstetrics Obstetrics Obstetrics Obstetrics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Urology Geriatric Medicine Obstetrics/Gynaecology Maxiofacial Cardiology General Surgery General Medicine 24.50% 34.50% 51.20% 89.10% 41.70% 44.00% 96.70% 0.00% 41.60% 51.30% 46.00% 54.80% 44.90% 47.50% 70.00% 59.40% 66.70% 0.00% 5.90% 0.00% 0.00% 21.80% 18.50% 14.30% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% N/A % 21.70% 20.00% 20.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 10.30% 25.40% 14.80% 0.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% N/A % 21.70% 20.00% 20.00% General Surgery Vascular Surgery Anaesthetics Anaesthetics Anaesthetics Anaesthetics Psychiatry General Medicine General Surgery Geriatric Medicine Urology General Medicine General Surgery Gastro Enterology Cardiology Anaesthetics Anaesthetics Anaesthetics General Surgery Psychiatry General Surgery General Surgery General Medicine Gastro Enterology General Surgery 10.90% 25.70% 8.70% 51.60% 12.80% 30.40% 0.00% 11.10% 17.40% 17.10% 46.10% 12.90% 25.40% 20.40% 20.20% 33.90% 50.80% 25.70% 12.70% 0.00% 0.00% 55.10% 45.60% 83.70% 47.40% N/A % N/A % 30.00% N/A % N/A % N/A % 20.00% 25.00% 20.00% 20.00% N/A % 30.00% N/A % 3.30% 38.00% 9.20% 18.60% 16.20% 22.30% 0.00% 16.70% 24.30% 0.00% 32.10% 0.00% 43.80% 39.40% 0.00% 63.40% 34.60% 18.50% 25.80% 0.00% 0.00% 40.30% 3.10% 72.60% 36.70% N/A % N/A % 30.00% N/A % N/A % N/A % 20.00% 30.00% 30.00% 20.00% N/A % 30.00% N/A % General Surgery Anaesthetics Anaesthetics Anaesthetics Cardiology General Medicine General Surgery Opthalmology Oral Surgery Gynaecology Obstetrics/Gynaecology Anaesthetics General Surgery General Medicine General Surgery Gastro Enterology Vascular Surgery Anaesthetics Anaesthetics Gynaecology Anaesthetics Psychiatry 0.00% 37.10% 55.60% 0.00% 0.00% 35.00% 38.70% 100.00% 66.70% 76.90% 56.40% 54.90% 0.00% 35.00% 51.60% 30.70% 33.00% 0.00% 62.90% 21.20% 52.20% 39.60% 0.00% 67.00% 69.00% 84.30% 0.00% 14.50% 16.10% 0.00% 55.00% 66.30% 100.00% 51.50% 0.00% 4.60% 32.40% 37.00% 0.00% 50.00% 71.00% 0.00% 65.90% 0.00% This report shows the in-patient and day case ratios for each consultant on the basis of the measurement system agreed for the consultant contract. DUBLIN MIDLANDS: Midland Regional Hospital Mullingar, Midland Regional Hospital Portlaoise, Midland Regional Hospital Tullamore, Naas General Hospital,National Maternity Hospital Holles Street, Our Ladys Hospital for Sick Children Crumlin, St Colmcilles Hospital Loughlinstown, Consultant Private Workload Summary Report Consultant Specialty Cardio Thoracic Surgery Neurology Orthopaedics Paediatric Endocrinology Paediatrics General Surgery Neonatology Paediatric Endocrinology Dermatology Surgery Paediatric Cardiology General Surgery Paediatric Respiratory Paediatric Radiology Surgery Paediatric Oncology Paediatric Infectious Di Paediatric Haematology Otolaryngology Paediatric Respiratory General Surgery In-patient % Private Workload as a Percentage of Total 57.70% 0.00% 41.10% 32.80% 39.50% 48.20% 0.00% 0.00% 100.00% 62.30% 35.40% 22.80% 0.00% 0.00% 22.40% 22.50% 30.10% 1.40% 65.10% 61.50% 34.90% Contract Limit 30.00% N/A % 30.00% 30.00% N/A % 30.00% 30.00% N/A % 26.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% N/A % 30.00% Day case % Private Workload as a Percentage of Total 79.40% 54.80% 59.80% 49.00% 100.00% 65.70% 0.00% 0.00% 60.00% 33.00% 0.00% 39.80% 100.00% 50.60% 67.00% 28.30% 47.70% 48.50% 39.60% 0.00% 47.90% Contract Limit 30.00% N/A % 22.00% 30.00% N/A % 30.00% 30.00% N/A % 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% N/A % 30.00% Created on 05/07/2010 Neonatology Paediatric Haematology Paediatric Gastro Entero NeUrology General Medicine Surgery Paediatric Cardiology Cardio Thoracic Surgery Paediatric Nephrology Paediatric Haematology Paediatric Haematology Dermatology Haematology Paediatric Cardiology Neonatology Otolaryngology Surgery Paediatric Gastro Entero Paediatric Cardiology Cardio Thoracic Surgery Neonatology Paediatric Gastro Entero Paediatrics General Medicine Paediatric Endocrinology Paediatric Nephrology 0.00% 35.70% 21.90% 68.60% 77.60% 13.60% 39.40% 17.80% 24.80% 7.10% 28.40% 0.00% 8.60% 10.30% 0.00% 45.50% 27.40% 59.90% 31.40% 17.40% 0.00% 45.10% 32.30% 24.50% 11.20% 11.50% 30.00% 30.00% 30.00% N/A % 30.00% 30.00% 30.00% 20.00% 30.00% 20.00% 22.00% 20.00% 30.00% 30.00% 20.00% 30.00% 30.00% 30.00% 30.00% 24.00% 30.00% N/A % 30.00% 30.00% 61.20% 36.10% 24.70% 19.20% 15.90% 63.00% 19.20% 66.70% 15.10% 24.90% 0.00% 82.80% 0.00% 21.60% 0.00% 36.50% 73.40% 36.40% 52.00% 0.00% 0.00% 53.80% 30.80% 0.00% 39.70% 0.00% 30.00% 30.00% 30.00% N/A % 30.00% 30.00% 30.00% 30.00% 30.00% 20.00% 30.00% 20.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 25.00% 30.00% N/A % 30.00% 30.00% Created on 05/07/2010 Rheumatology Neonatology Orthopaedics Paediatric Infectious Di Paediatric Oncology Paediatric Cardiology Anaesthetics Neonatology General Surgery Paediatric Oncology Paediatric Respiratory Anaesthetics Anaesthetics Paediatric Radiology Anaesthetics Anaesthetics Anaesthetics Anaesthetics Histopathology Anaesthetics Anaesthetics Anaesthetics Rheumatology Anaesthetics Gynaecology General Medicine 0.00% 0.00% 49.30% 19.80% 49.70% 11.40% 31.30% 0.00% 61.30% 48.80% 33.50% 66.40% 28.30% 0.00% 28.00% 47.10% 37.00% 48.60% 0.00% 49.70% 31.80% 34.80% 0.00% 35.90% 17.00% 11.40% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 20.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% N/A % 30.00% 20.00% 0.00% 0.00% 44.70% 0.00% 37.60% 20.20% 46.40% 0.00% 41.70% 68.10% 52.30% 43.40% 39.20% 0.00% 32.70% 50.60% 59.60% 32.90% 0.00% 42.60% 47.10% 40.00% 52.50% 42.50% 15.60% 22.50% Created on 05/07/2010 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 20.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% N/A % 30.00% 20.00% Paediatrics General Surgery Radiology General Medicine Psychiatry Paediatrics General Surgery Radiology General Surgery Obstetrics Anaesthetics Anaesthetics General Medicine General Medicine General Surgery Paediatrics Anaesthetics Obstetrics Haematology General Medicine General Surgery Anaesthetics Radiology Radiology General Medicine General Medicine 5.90% 21.70% 11.40% 14.30% 12.60% 9.30% 0.00% 6.80% 8.80% 22.50% 22.00% 17.90% 0.00% 9.00% 0.00% 11.80% 21.40% 22.70% 0.00% 11.30% 10.90% 25.80% 20.00% 9.30% 14.40% 5.10% N/A % 20.00% 20.00% 20.00% N/A % 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 0.00% 43.30% 0.00% 11.20% 0.00% 0.00% 0.00% 0.00% 23.50% 52.60% 42.90% 32.30% 0.00% 14.90% 10.10% 0.00% 31.60% 32.70% 0.00% 4.70% 10.70% 33.70% 0.00% 19.60% 7.60% 4.00% N/A % 20.00% 20.00% 20.00% N/A % 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% Created on 05/07/2010 Radiology Anaesthetics Anaesthetics General Surgery General Medicine General Medicine General Medicine General Surgery Anaesthetics Anaesthetics General Medicine General Surgery Anaesthetics Anaesthetics Anaesthetics General Medicine Haematology Oncology General Surgery Rheumatology General Medicine General Medicine Oncology Palliative Medicine Microbiology Microbiology 16.30% 35.60% 17.50% 0.20% 1.80% 2.20% 0.00% 1.80% 11.00% 0.00% 0.30% 8.70% 6.10% 0.00% 0.00% 2.30% 0.00% 0.00% 0.60% 0.00% 3.10% 2.40% 0.00% 0.00% 0.00% 0.00% N/A % 20.00% N/A % N/A % N/A % N/A % N/A % N/A % 0.00% 49.30% 37.50% 0.00% 3.30% 31.20% 4.50% 0.00% 53.20% 0.00% 0.00% 39.80% 96.30% 36.80% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% N/A % 20.00% N/A % N/A % N/A % N/A % N/A % N/A % Created on 05/07/2010 General Medicine Gynaecology General Surgery General Medicine General Surgery Paediatrics Oncology Psychiatry Anaesthetics Anaesthetics Anaesthetics Haematology Obstetrics Obstetrics Oncology Radiology Paediatrics General Medicine Radiology General Surgery Paediatrics Paediatrics Opthalmology Opthalmology Opthalmology Otolaryngology 6.90% 14.10% 29.00% 14.30% 25.90% 0.00% 0.00% 30.70% 24.90% 41.20% 43.40% 0.00% 22.90% 23.20% 0.00% 21.50% 0.00% 20.60% 17.90% 28.90% 0.00% 0.00% 48.40% 26.10% 6.10% 59.00% N/A % 28.00% 30.00% 24.00% 30.00% N/A % N/A % 25.00% N/A % N/A % 25.00% 20.00% N/A % N/A % 30.00% 20.00% 30.00% 0.00% 24.10% 53.10% 47.60% 39.30% 0.00% 0.00% 0.00% 18.50% 67.80% 28.50% 15.60% 43.60% 0.00% 16.70% 0.00% 0.00% 0.00% 0.00% 24.20% 0.00% 0.00% 64.10% 43.30% 12.40% 43.50% N/A % 30.00% 30.00% 30.00% 30.00% N/A % N/A % 30.00% N/A % N/A % 30.00% 30.00% N/A % N/A % 30.00% 20.00% 30.00% Created on 05/07/2010 Otolaryngology Otolaryngology Otolaryngology Opthalmology Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Opthalmology General Medicine General Medicine Oncologist Radiologist Haematologist Radiologist General Surgery General Medicine General Medicine General Medicine Otolaryngologist General Medicine Orthopaedic Haematologist General Surgery 43.80% 45.60% 56.30% 34.70% 43.10% 17.70% 48.80% 46.70% 62.40% 49.10% 0.00% 24.93% 18.43% 35.33% N/A 51.43% N/A 28.96% 27.26% N/A 13.96% 21.90% 15.65% 22.65% 15.86% 28.30% 30.00% 30.00% 20.00% 20.00% 20.00% 30.00% N/A % 30.00% 30.00% 20.00% 20% 20% 26.90% 20.00% 29.40% 20.00% 20% 20% 20% 20% 20% 20% 20% 20% 22.40% 44.30% 42.60% 27.90% 20.20% 51.50% 0.00% 27.40% 48.90% 46.50% 100.00% 0.00% 0.00% 12.10% 34.83% 0% 33.60% 0% 13.30% 23.76% N/A 5.93% 7.90% 0.00% 0.00% 23.73% 22.33% 30.00% 30.00% 20.00% 20.00% 20.00% 30.00% N/A % 30.00% 30.00% 20.00% 20% 20% 30% 20% 28.60% 20.00% 22.60% 30% 20% 24.20% 20% 20% 20% 20% 27.90% Created on 05/07/2010 Radiologist General Medicine Orthopaedic Cardiology Cardiology Cardiology Cardiology Cardiology Cardiology Cardiology Cardiology Respiratory Respiratory Respiratory Respiratory Thoracic Surgery Thoracic Surgery Thoracic Surgery Emergency Dept Gastro Enterology Gastro Enterology Gastro Enterology Gastro Enterology Gastro Enterology Gastro Enterology Immunology N/A 25.90% 32.46% 0% 20% 0% 0% 21% 23% 23% 17% 10% 0% 15% 14% 3% 42% 33% 13% 25% 24% 16% 8% 50% 14% 100% 20.00% 20.60% 30% 0% 19% 0% 0% 18% 20% 18% 16% 23% 0% 16% 8% 3% 43% 45% 11% 19% 25% 10% 0% 29% 10% 100% 33.33% 12.23% 32.96% 13% 10% 18% 18% 20% 38% 25% 21% 7% 0% 10% 0% 100% 0% 0% 0% 19% 19% 22% 20% 45% 5% 0% 20.00% 30.00% 30.00% 13% 11% 18% 20% 20% 38% 29% 16% 8% 0% 12% 0% 100% 0% 0% 0% 19% 19% 21% 20% 45% 5% 0% Created on 05/07/2010 Medicine Medicine Medicine Medicine Medicine Nephrology Surgery Surgery Surgery Surgery Surgery Urology Urology Urology Urology Urology Haematology Haematology Haematology Haematology Haematology Haematology Haematology Haematology Oncology Oncology 13% 0% 20% 22% 9% 46% 32% 17% 0% 36% 32% 29% 11% 9% 26% 30% 38% 36% 26% 23% 0% 0% 51% 12% 45% 48% 5% 0% 7% 16% 6% 24% 32% 11% 0% 44% 39% 34% 13% 6% 29% 30% 11% 28% 19% 45% 0% 0% 37% 6% 42% 41% 0% 0% 0% 0% 0% 0% 4% 5% 0% 31% 23% 0% 9% 32% 26% 26% 22% 16% 18% 0% 15% 0% 26% 1% 26% 21% 0% 0% 0% 0% 0% 0% 5% 7% 0% 30% 24% 0% 8% 29% 24% 24% 22% 15% 18% 0% 13% 0% 27% 0% 26% 21% Created on 05/07/2010 Oncology Oncology Geriatric Geriatric Geriatric Geriatric Geriatric Geriatric Maxillofacial Maxillofacial Orthopaedics Orthopaedics Orthopaedics Orthopaedics Orthopaedics Surgery Surgery Surgery Surgery Surgery Surgery Surgery Surgery Pain Management Pain Management Psychiatry 44% 25% 19% 11% 21% 11% 100% 38% 16% 25% 23% 23% 25% 11% 25% 15% 12% 0% 0% 0% 8% 24% 11% 25% 20% 0% 35% 10% 14% 10% 35% 5% 100% 45% 16% 23% 19% 15% 9% 11% 21% 16% 7% 0% 0% 0% 4% 33% 12% 8% 24% 0% 19% 24% 0% 0% 1% 0% 11% 0% 0% 28% 12% 5% 0% 0% 6% 3% 9% 0% 0% 4% 0% 0% 22% 9% 31% 0% 21% 24% 0% 0% 1% 0% 12% 0% 0% 24% 17% 3% 0% 0% 4% 4% 8% 0% 0% 4% 0% 0% 23% 9% 29% 0% Created on 05/07/2010 Psychiatry Psychiatry Psychiatry Psychiatry Psychiatry Psychiatry Psychiatry Dermatology Dermatology Dermatology Dermatology E.N.T. E.N.T. E.N.T. Endocrinology Endocrinology Guid Guid Guid Guid Gynaecology Gynaecology Gynaecology Gynaecology Gynaecology Neurology 0% 0% 0% 0% 0% 0% 0% 0% 50% 0% 0% 36% 29% 17% 20% 13% 0% 5% 0% 4% 25% 18% 41% 11% 11% 61% 0% 0% 0% 0% 0% 0% 0% 0% 65% 0% 0% 43% 39% 11% 19% 12% 0% 4% 33% 2% 24% 18% 40% 5% 8% 55% 0% 0% 0% 0% 0% 0% 0% 0% 19% 0% 0% 14% 12% 9% 0% 0% 0% 0% 0% 0% 0% 0% 67% 14% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 20% 0% 0% 19% 10% 0% 0% 0% 0% 0% 0% 0% 0% 0% 66% 4% 0% 0% Created on 05/07/2010 Neurology Neurophysiology Rheumatology Rheumatology Rheumatology Vascular Vascular Vascular Vascular 29% 0% 9% 15% 13% 0% 25% 16% 31% 22% 0% 12% 14% 22% 0% 33% 31% 30% 33% 3% 0% 0% 0% 0% 0% 0% 22% 33% 4% 0% 0% 0% 0% 0% 0% 24% This report shows the estimated in-patient and day case ratios for each Consultant on the basis of the measurement system agreed for the Consultant Contract Created on 05/07/2010 Created on 05/07/2010 Created on 05/07/2010 Created on 05/07/2010 Created on 05/07/2010 Created on 05/07/2010 Created on 05/07/2010 Created on 05/07/2010 Created on 05/07/2010 Created on 05/07/2010 Created on 05/07/2010 Created on 05/07/2010 Created on 05/07/2010 DUBLIN NORTH EAST: Beaumont Hospital, Cappagh National Orthopaedic Hospital, Cavan General Hospital, Connolly Hospital, Louth County Hospital, Monaghan General Hospital, Our Ladys Hospital, Navan, Our Lady of Lourdes Hospital Drogheda, Rotunda Hospital. Created on 05/07/2010 Consultant Private Workload Summary Report Consultant Specialty Nephrology Nephrology Neurosurgery General Surgery Respiratory Medicine Orthopaedics Opthalmology General Surgery Urology Neurosurgery Dermatology Orthopaedics Urology General Surgery Gynaecology Gynaecology Rheumatology Neurosurgery Neurosurgery Anaesthetics In-patient % Private Workload as a Percentage of Total 25.80% 0.00% 33.60% 32.40% 16.20% 17.00% 0.00% 45.00% 11.90% 26.00% 12.40% 26.70% 32.40% 37.60% 46.30% 62.80% 14.70% 55.90% 48.90% 37.40% Contract Limit 30.00% 30.00% N/A % 30.00% 30.00% 30.00% N/A % 30.00% N/A % 30.00% 30.00% 30.00% 30.00% 30.00% Day case % Private Workload as a Percentage of Total 0.80% 0.00% 33.00% 0.00% 38.80% 16.70% 0.00% 26.80% 7.50% 14.20% 4.90% 8.50% 10.70% 2.30% 11.90% 36.60% 1.80% 59.90% 77.90% 8.30% Contract Limit 30.00% 30.00% N/A % 30.00% 30.00% 30.00% N/A % 30.00% N/A % 30.00% 30.00% 30.00% 30.00% 30.00% Otolaryngology Otolaryngology General Surgery Cardiology Neuroradiology Radiology Rehabilitation Medicine Gastro Enterology Respiratory Medicine Otolaryngology Neurology Gastro Intestinal Surgery Endocrinology Radiology Rheumatology Nephrology Surgery Urology Anaesthetics General Surgery Gastro Enterology Oncology General Surgery Clinical Immunology General Surgery Opthalmology 10.30% 33.90% 32.00% 35.30% 36.60% 31.20% 23.30% 23.00% 24.80% 11.50% 37.00% 100.00% 22.70% 83.80% 17.90% 33.90% 37.20% 19.90% 27.80% 66.70% 25.50% 42.60% 76.40% 62.80% 35.70% 0.00% N/A % 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 9.90% 10.60% 3.50% 31.90% 0.00% 32.90% 0.00% 20.80% 8.60% 9.40% 0.00% 0.00% 24.50% 52.80% 0.00% 0.70% 5.40% 14.40% 13.50% 0.00% 13.50% 33.60% 91.20% 28.70% 13.60% 0.00% Created on 05/07/2010 N/A % 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% Neurology Neurology Urology Otolaryngology General Surgery Neurosurgery Accident & Emergency Geriatric Medicine Gastro Enterology Oncology Cardiology Haematology Dermatology Otolaryngology Cardiology Old Age Psychiatry Urology General Surgery Geriatric Medicine Dermatology Psychiatry Psychiatry General Medicine Cardiology Orthopaedics Gastro Enterology 43.50% 22.80% 30.50% 30.00% 40.00% 52.10% 3.70% 20.20% 0.00% 33.20% 30.40% 27.20% 0.00% 52.10% 28.70% 37.80% 43.50% 26.70% 8.90% 0.00% 0.00% 21.10% 16.50% 20.20% 30.40% 25.10% 30.00% 30.00% N/A % 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% N/A % N/A % 30.00% 30.00% 35.50% 23.80% 12.40% 4.40% 100.00% 21.70% 0.00% 0.00% 12.50% 34.30% 8.80% 10.80% 12.60% 16.40% 5.20% 0.00% 18.10% 1.50% 0.00% 12.90% 0.00% 0.00% 11.60% 8.60% 27.60% 9.70% Created on 05/07/2010 30.00% 30.00% N/A % 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% N/A % N/A % 30.00% 30.00% Endocrinology Orthopaedics Clinical Neurophysiology Clinical Neurophysiology General Surgery Respiratory Medicine Urology Neurosurgery Endocrinology Psychiatry General Medicine Neurosurgery Rheumatology Psychiatry Surgery Rheumatology Urology Nephrology Vascular Surgery Neurosurgery Anaesthetics Respiratory Medicine Nephrology Neurology Dermatology Neurology 18.30% 54.80% 56.50% 30.40% 21.00% 21.30% 46.90% 49.40% 20.00% 0.00% 100.00% 43.30% 14.30% 0.00% 58.30% 24.60% 17.40% 0.00% 25.40% 32.90% 24.40% 17.10% 15.00% 0.00% 100.00% 24.50% 30.00% N/A % 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% N/A % 30.00% 30.00% 30.00% N/A % 30.00% N/A % 30.00% 43.40% 22.50% 3.00% 3.10% 5.50% 18.10% 30.50% 55.30% 32.50% 0.00% 0.00% 100.00% 0.00% 0.00% 0.00% 28.80% 11.60% 0.00% 61.90% 0.00% 33.30% 3.40% 1.90% 0.00% 0.00% 0.00% Created on 05/07/2010 30.00% N/A % 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% N/A % 30.00% 30.00% 30.00% N/A % 30.00% N/A % 30.00% Anaesthetics Vascular Surgery Haematology Radiology Anaesthetics Microbiology Chemical Pathology Microbiology Radiology Radiology Radiology Radiology Radiology Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics 38.00% 24.40% 19.00% 0.00% 17.80% 30.00% 0.00% 18.80% 0.00% 0.00% 0.00% 23.50% 27.70% 33.00% 42.10% 47.70% 36.10% 42.30% 33.30% 29.50% 44.50% 55.10% 30.40% 23.40% 38.90% 37.60% 30.00% 30.00% 30.00% 30.00% 30.00% N/A % 30.00% 30.00% N/A % N/A % 30.00% N/A % N/A % N/A % 30.00% 22.70% 66.70% 6.50% 6.60% 33.40% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 29.50% 100.00% 45.70% 15.30% 31.10% 22.60% 21.40% 26.10% 29.10% 10.40% 32.20% 6.30% 17.80% 8.00% 49.50% Created on 05/07/2010 30.00% 30.00% 30.00% 30.00% 30.00% N/A % 30.00% 30.00% N/A % N/A % 30.00% N/A % N/A % N/A % 30.00% Anaesthetics Anaesthetics Anaesthetics Anaesthetics Radiology Anaesthetics Radiology Urology Neurology General Surgery Radiology Neurosurgery Nephrology Anaesthetics Neurology Anaesthetics Anaesthetics Orthopaedics Orthopaedics Orthopaedics Orthopaedics Orthopaedics Rheumatology Orthopaedics Radiology Anaesthetics 56.60% 42.50% 22.50% 27.60% 0.00% 15.80% 0.00% 18.90% 42.50% 36.90% 0.00% 23.50% 19.70% 29.00% 49.70% 31.50% 31.40% 3.90% 21.10% 30.60% 4.00% 4.80% 0.00% 42.90% 0.00% 15.90% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 37.70% 29.70% 9.00% 0.00% 9.10% 5.30% 0.00% 14.00% 0.00% 20.90% 0.00% 0.00% 0.30% 72.80% 0.00% 11.40% 35.50% 2.60% 0.00% 13.50% 44.90% 12.50% 0.00% 46.20% 37.90% 29.10% Created on 05/07/2010 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% Anaesthetics Orthopaedics Anaesthetics Orthopaedics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics General Medicine General Surgery General Surgery General Surgery General Surgery Gynaecology General Medicine Gynaecology General Medicine General Surgery Anaesthetics Anaesthetics Anaesthetics General Medicine General Medicine General Surgery General Medicine 23.30% 10.80% 13.10% 22.30% 44.60% 25.40% 4.80% 14.90% 17.80% 16.70% 0.00% 0.00% 0.00% 0.00% 0.00% 13.70% 0.00% 5.30% 0.00% 0.00% 0.00% 0.00% 12.30% 12.80% 100.00% 19.30% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 20.00% 20.00% 21.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% N/A % N/A % N/A % 20.00% 20.00% 20.00% 36.30% 22.30% 27.90% 22.90% 43.80% 7.00% 49.10% 30.20% 25.30% 33.70% 19.20% 44.90% 26.20% 27.40% 52.70% 39.60% 0.00% 29.10% 14.50% 30.80% 36.40% 9.20% 6.20% 39.20% 0.00% 15.10% Created on 05/07/2010 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 20.00% 20.00% 30.00% 30.00% 20.00% 20.00% 20.00% 20.00% 21.00% 20.00% 20.00% 20.00% N/A % N/A % N/A % 21.00% 30.00% 30.00% Anaesthetics General Surgery General Surgery Oncology Obstetrics Paediatrics Paediatrics Paediatrics Orthopaedics General Surgery Obstetrics General Surgery Obstetrics Nephrology Obstetrics Palliative Medicine Dermatology Radiology General Surgery Anaesthetics Anaesthetics Radiology Anaesthetics Anaesthetics Anaesthetics Anaesthetics 27.20% 44.50% 26.70% 0.00% 18.10% 18.20% 35.10% 15.40% 100.00% 0.00% 0.00% 12.10% 13.90% 13.20% 22.40% 0.00% 0.00% 31.00% 25.00% 21.20% 0.00% 38.30% 19.10% 46.20% 39.30% 41.10% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 28.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 38.10% 66.70% 28.60% 15.40% 38.50% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 20.10% 46.50% 0.40% 46.10% 0.00% 50.00% 0.00% 13.40% 26.40% 0.00% 0.00% 34.40% 32.70% 38.00% 52.30% Created on 05/07/2010 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 30.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% Radiology Radiology General Medicine Radiology General Surgery General Surgery General Surgery General Surgery Gynaecology Gynaecology Urology General Medicine Gynaecology General Surgery General Surgery General Medicine Gynaecology General Surgery General Surgery General Medicine Orthopaedics General Medicine Anaesthetics Anaesthetics Anaesthetics Anaesthetics 25.90% 30.90% 11.50% 0.00% 46.50% 39.80% 18.10% 34.70% 0.00% 0.00% 0.00% 26.80% 0.00% 21.50% 32.20% 9.10% 0.00% 0.00% 0.00% 16.50% 0.00% 22.30% 0.00% 100.00% 0.00% 0.00% 20.00% 27.00% 30.00% 20.00% 27.00% 22.00% 27.00% 27.00% N/A % 30.00% 20.00% 20.00% N/A % 0.00% 0.00% 45.80% 0.00% 19.20% 51.40% 30.20% 49.00% 20.30% 55.20% 26.80% 11.00% 36.60% 40.80% 35.20% 24.40% 34.50% 0.00% 0.00% 0.00% 0.00% 35.30% 100.00% 0.00% 0.00% 0.00% Created on 05/07/2010 20.00% 30.00% 30.00% 20.00% 30.00% 30.00% 30.00% 30.00% N/A % 30.00% 20.00% 20.00% N/A % Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics General Surgery Anaesthetics General Medicine General Medicine Anaesthetics General Medicine General Medicine General Medicine General Medicine General Medicine General Medicine General Surgery Oncology General Surgery Paediatrics Paediatrics Obstetrics General Surgery General Surgery 0.00% 100.00% 0.00% 37.40% 21.10% 41.80% 32.10% 25.70% 0.00% 25.30% 21.50% 18.60% 0.00% 0.00% 0.00% 36.90% 30.40% 24.70% 22.60% 0.00% 31.50% 33.40% 14.80% 22.30% 21.80% 21.40% N/A % N/A % 20.00% 20.00% N/A % 30.00% 27.00% 30.00% 20.00% 27.00% 0.00% 75.80% 0.00% 45.60% 27.30% 43.80% 0.00% 11.60% 7.80% 0.00% 72.90% 14.00% 0.00% 0.00% 0.00% 0.00% 2.10% 25.30% 28.30% 0.00% 48.60% 0.00% 20.80% 20.30% 16.60% 0.00% Created on 05/07/2010 N/A % N/A % 20.00% 20.00% N/A % 30.00% 30.00% 30.00% 20.00% 30.00% Oncology General Medicine Obstetrics Obstetrics Paediatrics Otolaryngology General Surgery Opthalmology Dermatology Paediatrics Orthopaedics General Surgery General Medicine Gynaecology Palliative Medicine General Surgery Obstetrics Obstetrics Paediatrics Orthopaedics General Surgery Orthopaedics Endocrinology Orthopaedics Cardiology Gynaecology 51.50% 46.10% 16.80% 21.50% 12.80% 33.40% 31.90% 5.70% 20.00% 20.00% 32.30% 46.80% 23.40% 22.60% 32.60% 17.90% 0.00% 41.40% 19.10% 28.80% 17.60% 46.50% 0.00% 27.80% 36.10% 32.80% 30.00% 20.00% 20.00% 20.00% 30.00% 30.00% 27.00% 21.00% 27.00% N/A % 30.00% 30.00% 2.90% 0.00% 23.30% 2.10% 0.00% 50.00% 58.80% 0.00% 0.00% 0.00% 70.80% 20.70% 26.90% 5.80% 0.00% 38.50% 0.00% 0.00% 0.00% 68.80% 32.60% 0.00% 0.00% 66.70% 18.90% 8.00% Created on 05/07/2010 30.00% 20.00% 20.00% 20.00% 30.00% 30.00% 30.00% 2.00% 30.00% N/A % 30.00% 30.00% Obstetrics Gynaecology Orthopaedics Paediatrics General Surgery General Medicine Gynaecology Obstetrics Gynaecology Orthopaedics Tropical Paediatrics Orthopaedics General Medicine Palliative Medicine Haematology Dermatology General Surgery General Surgery Orthopaedics Orthopaedics Paediatrics Orthopaedics Pathology Anaesthetics Anaesthetics 4.50% 1.50% 26.50% 14.50% 0.00% 37.60% 58.90% 68.80% 39.90% 100.00% 0.00% 10.30% 53.00% 22.30% 21.80% 37.20% 100.00% 89.50% 28.10% 21.30% 27.70% 10.30% 0.00% 0.00% 31.10% 25.00% 30.00% 20.00% 20.00% 30.00% 30.00% 20.00% 20.00% 20.00% 20.00% N/A % 0.00% 0.00% 100.00% 13.80% 0.00% 0.00% 0.00% 0.00% 7.30% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 18.80% 46.80% 27.40% 37.70% 8.60% 0.00% 0.00% 30.70% 28.20% Created on 05/07/2010 30.00% 20.00% 20.00% 30.00% 30.00% 20.00% 20.00% 20.00% 20.00% N/A % Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Obstetrics Anaesthetics Anaesthetics Anaesthetics Anaesthetics General Surgery General Medicine Microbiology General Medicine General Medicine Anaesthetics Paediatrics Orthopaedics Orthopaedics General Medicine General Medicine Paediatrics General Medicine 29.10% 23.20% 28.60% 23.00% 14.20% 26.40% 29.30% 30.10% 7.50% 20.80% 38.00% 25.90% 28.70% 26.30% 27.80% 35.00% 0.00% 23.90% 0.00% 14.30% 0.00% 22.50% 10.00% 39.90% 26.60% 6.80% 20.00% 30.00% 30.00% 30.00% 30.00% N/A % 30.00% 20.00% 20.00% 20.00% 32.70% 54.70% 32.20% 23.70% 12.40% 39.50% 41.10% 25.40% 0.00% 43.40% 23.10% 50.00% 74.60% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% Created on 05/07/2010 20.00% 30.00% 30.00% 30.00% 30.00% N/A % 30.00% 20.00% 20.00% 20.00% General Surgery General Medicine General Surgery Gynaecology Geriatric Medicine Orthopaedics Anaesthetics General Surgery General Surgery General Medicine Orthopaedics General Medicine Orthopaedics Orthopaedics Gynaecology Orthopaedics Rheumatology General Medicine Orthopaedics Orthopaedics Orthopaedics Radiology Anaesthetics Anaesthetics Anaesthetics Anaesthetics 0.00% 7.40% 23.70% 0.00% 8.60% 0.00% 49.00% 20.10% 30.40% 14.70% 17.40% 2.10% 50.90% 31.80% 100.00% 14.60% 11.80% 13.00% 3.70% 0.00% 0.00% 0.00% 34.40% 22.40% 5.90% 21.50% 20.00% 21.00% 20.00% 30.00% 20.00% 30.00% 20.00% 20.00% 20.00% 20.00% 30.00% 30.00% 20.00% 20.00% 20.00% 0.00% 24.50% 28.90% 0.00% 33.60% 0.00% 57.20% 37.90% 45.70% 0.00% 28.40% 0.00% 64.40% 48.30% 34.10% 15.30% 34.50% 0.00% 7.10% 0.00% 0.00% 0.00% 54.70% 21.40% 15.10% 43.80% Created on 05/07/2010 20.00% 30.00% 20.00% 30.00% 20.00% 30.00% 30.00% 20.00% 20.00% 20.00% 30.00% 30.00% 20.00% 20.00% 20.00% General Surgery General Medicine General Surgery Orthopaedics Rheumatologist Gynaecologist Anaesthetist Respiratory Physician Rheumatologist Gastroenterologist Cardiologist Microbiologist Radiologist Ophthalmic Surgeon Cardiologist Histopathologist Microbiologist Radiologist Endocrinologist ED Consultant Neurophysiologist Surgeon Rheumatologist Dermatologist Microbiologist Cardiologist 12.00% 8.50% 7.10% 0.80% 8.90% 35.70% 46.70% 10.20% 4.20% 11.90% 15.10% 16.12% 16.12% 0% 2.80% 21.97% 16.12% 16.12% 8.60% 0.00% 11.60% 7.30% 0% 16.12% 10.50% 20.00% 20.00% 0.00% 0.00% 0.00% 3.10% 12.80% 35.50% 57.70% 0% 15.00% 18.90% 13.50% 15.12% 15.12%E 0% 0% 15.45% 15.12% 15.12% 27.80% 0.00% 9.90% 0% 0% 15.12% 0% Created on 05/07/2010 20.00% 20.00% Dermatologist Histopathologist Gastroenterologist Endocrinologist Haematologist Histopathologist 0% 21.97% 7.80% 7.80% 5.90% 21.97% 0% 15.45% 9.70% 0.00% 1.90% 15.45% Created on 05/07/2010 This report shows the estimated in-patient and day case ratios for each consultant on the basis of the measurement system agreed for the consultant contract. SOUTH AREA: Bantry Hospital, Cork University Hospital, Kerry General Hospital, Lourdes Orthopaedic Hospital Kilcreene Kilkenny, Mallow General Hospital, Mercy Hospital, South Infirmary Victoria Hospital, South Tipperary General Hosptial Clonmel, St Lukes General Hosptial Kilkenny, St. Marys Orthopaedic Hospital, Waterford Regional Hospital, Wexford General Hospital Consultant Private Workload Summary Report Consultant Specialty Geriatric Medicine Opthalmology Rheumatology Paediatrics Obstetrics/Gynaecology Respiratory Medicine Opthalmology Cardiology Dermatology Cardio Thoracic Surgery Gynaecology Haematology Oncology Neurosurgery Opthalmology Gastro Enterology Accident & Emergency Surgery Paediatrics Urology In-patient % Private Workload as a Percentage of Total 26.10% 34.60% 39.40% 17.00% 0.00% 10.80% 23.50% 0.00% 10.10% 70.90% 24.30% 0.00% 60.60% 38.90% 16.10% 34.00% 17.80% 23.50% 33.40% 40.10% Contract Limit N/A % N/A % N/A % 30.00% N/A % 30.00% N/A % 30.00% N/A % 30.00% 30.00% 30.00% N/A % 30.00% 30.00% Day case % Private Workload as a Percentage of Total 0.00% 0.00% 0.00% 0.80% 33.30% 21.30% 11.90% 0.00% 0.00% 0.00% 0.00% 0.00% 63.60% 36.60% 60.90% 55.10% 0.00% 84.40% 0.00% 33.20% Contract Limit N/A % N/A % N/A % 30.00% N/A % 30.00% N/A % 30.00% N/A % 30.00% 30.00% 30.00% N/A % 30.00% 30.00% Created on 05/07/2010 Endocrinology General Surgery Cardio Thoracic Surgery Neurology Cardiology Dermatology General Medicine Haematology Radiology Oncology Gastro Enterology Surgery Geriatric Medicine Accident & Emergency Orthopaedics Cardiology Neurosurgery Neurosurgery Anaesthetics Nephrology Gynaecology Accident & Emergency Accident & Emergency Geriatric Medicine Neuroradiology Gastro Enterology 25.20% 51.20% 52.00% 63.30% 31.30% 30.40% 36.30% 47.60% 31.10% 45.10% 46.00% 31.70% 26.10% 24.30% 27.00% 0.00% 52.00% 44.60% 38.60% 47.40% 64.70% 19.30% 9.80% 20.50% 21.90% 33.90% 30.00% 30.00% 30.00% 30.00% 30.00% 771.00% 30.00% 30.00% 30.00% 20.00% 30.00% N/A % N/A % 30.00% N/A % 20.00% 38.90% 36.50% 100.00% 60.20% 29.50% 0.00% 0.00% 49.10% 15.60% 53.40% 37.10% 76.10% 0.00% 0.00% 35.30% 49.20% 38.90% 36.00% 34.60% 2.30% 50.00% 0.00% 0.00% 0.00% 0.00% 24.50% 30.00% 30.00% 30.00% 30.00% 30.00% 771.00% 30.00% 30.00% 30.00% 20.00% 30.00% N/A % N/A % 30.00% N/A % 20.00% Created on 05/07/2010 Gynaecology Clinical Neurophysiology Paediatrics Urology Opthalmology Radiology Radiology Radiology Radiology Radiology Palliative Medicine Haematology Vascular Surgery Gastro Enterology Opthalmology Obstetrics Otolaryngology Dermatology Accident & Emergency Haematology Anaesthetics Anaesthetics Anaesthetics Radiology Paediatric Neurology Orthopaedics 61.30% 43.70% 28.50% 0.00% 28.90% 45.60% 38.50% 28.80% 27.10% 30.20% 47.20% 31.40% 46.60% 25.40% 40.40% 0.00% 0.00% 52.30% 9.60% 0.00% 0.00% 59.70% 30.80% 27.10% 8.20% 32.10% 30.00% 30.00% 30.00% 30.00% 30.00% N/A % 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% N/A % 20.00% N/A % 30.00% 30.00% 30.00% 20.00% 31.90% 0.00% 100.00% 0.00% 60.20% 24.30% 20.90% 0.00% 16.00% 23.30% 0.00% 38.20% 45.40% 53.10% 64.20% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 50.10% 91.70% 79.70% 12.90% 27.80% Created on 05/07/2010 30.00% 30.00% 30.00% 30.00% 30.00% N/A % 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% N/A % 20.00% N/A % 30.00% 30.00% 30.00% 20.00% Gynaecology Paediatrics Gynaecology Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Respiratory Medicine Anaesthetics Anaesthetics General Medicine Cardiology Surgery Geriatric Medicine Orthopaedics Cardiology Oncology Neurology Neonatology 12.30% 28.60% 36.30% 43.80% 53.00% 65.30% 32.20% 39.80% 51.20% 17.30% 44.10% 54.00% 36.00% 48.10% 27.60% 38.40% 45.40% 38.80% 19.10% 0.00% 29.50% 38.00% 14.80% 26.80% 28.60% 27.50% N/A % 30.00% N/A % N/A % 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 0.00% 26.40% 55.20% 44.90% 39.60% 100.00% 56.30% 41.20% 40.50% 100.00% 44.70% 33.30% 48.30% 35.80% 21.90% 53.10% 48.70% 46.60% 15.10% 0.00% 0.00% 30.90% 10.20% 39.50% 58.00% 50.00% Created on 05/07/2010 N/A % 30.00% N/A % N/A % 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% Surgery Anaesthetics Nephrology Radiology Oncology Paediatrics General Medicine Nephrology Cardiology Obstetrics/Gynaecology Oncology Oncology Anaesthetics Cardio Thoracic Surgery Surgery Obstetrics/Gynaecology Paediatrics Anaesthetics Obstetrics/Gynaecology Obstetrics/Gynaecology Radiology Orthopaedics Anaesthetics Neonatology Respiratory Medicine Obstetrics/Gynaecology 37.80% 50.20% 39.10% 41.20% 12.70% 18.20% 25.60% 34.20% 28.10% 46.10% 15.70% 0.00% 32.00% 40.60% 13.40% 35.50% 26.20% 30.60% 71.60% 27.30% 0.00% 0.00% 39.80% 31.90% 22.90% 14.10% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% N/A % N/A % 30.00% 30.00% 20.00% 47.20% 59.60% 0.10% 0.00% 39.70% 25.80% 36.80% 0.40% 0.00% 55.60% 20.80% 25.60% 30.90% 0.00% 3.50% 0.00% 26.10% 31.50% 100.00% 39.90% 0.00% 0.00% 34.10% 0.00% 25.80% 13.80% Created on 05/07/2010 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% N/A % N/A % 30.00% 30.00% 20.00% Paediatric Oncology Anaesthetics Oncology Obstetrics/Gynaecology Urology Obstetrics/Gynaecology Paediatrics Orthopaedics Orthopaedics General Surgery Haematology Rheumatology General Surgery Neuroradiology Obstetrics/Gynaecology Vascular Surgery Obstetrics/Gynaecology Paediatrics Anaesthetics Obstetrics/Gynaecology Endocrinology Vascular Surgery Radiology Gastro Enterology Cardiology Orthopaedics 0.00% 41.90% 5.00% 85.60% 24.40% 38.40% 14.40% 83.70% 0.00% 38.80% 0.00% 9.40% 35.50% 28.60% 0.30% 0.00% 30.20% 24.40% 33.30% 0.00% 21.00% 21.10% 31.40% 27.40% 7.10% 36.00% 30.00% 30.00% N/A % 20.00% N/A % 30.00% 30.00% N/A % 20.00% 20.00% 30.00% 30.00% 30.00% 30.00% 0.00% 37.30% 41.40% 51.70% 8.90% 83.30% 32.90% 0.00% 100.00% 0.00% 0.00% 14.20% 48.60% 51.00% 0.00% 0.00% 0.00% 22.50% 0.00% 0.00% 7.70% 9.90% 55.40% 7.20% 34.30% 42.40% Created on 05/07/2010 30.00% 30.00% N/A % 20.00% N/A % 30.00% 30.00% N/A % 20.00% 20.00% 30.00% 30.00% 30.00% 30.00% Radiology Anaesthetics Anaesthetics Haematology General Medicine Radiology Anaesthetics Orthopaedics Obstetrics/Gynaecology Opthalmology Neurology Orthopaedics Neuroradiology Cardiology Anaesthetics Paediatrics Orthopaedics Respiratory Medicine Radiology Gynaecology Obstetrics/Gynaecology Palliative Medicine Geriatric Medicine General Medicine General Surgery General Medicine 27.70% 0.00% 41.40% 0.00% 41.80% 0.00% 0.00% 18.10% 7.60% 11.90% 41.60% 20.70% 25.10% 4.90% 30.60% 23.30% 0.00% 13.10% 100.00% 0.00% 0.00% 0.00% 0.30% 1.60% 0.00% 0.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 30.00% N/A % N/A % N/A % 0.00% 0.00% 40.30% 16.30% 0.00% 0.00% 0.00% 27.00% 60.50% 10.80% 38.50% 26.20% 37.50% 2.00% 31.30% 22.80% 0.00% 0.00% 0.00% 65.30% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% Created on 05/07/2010 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00% 30.00% N/A % N/A % N/A % Radiology General Medicine Paediatrics Orthopaedics Paediatrics General Surgery Anaesthetics Radiology Radiology Psychiatry Otolaryngology Opthalmology Psychiatry Psychiatry General Medicine Obstetrics Gynaecology General Surgery Orthopaedics Neurology Paediatrics General Medicine Palliative Medicine Psychiatry Anaesthetics Anaesthetics 0.00% 13.10% 11.40% 33.00% 37.90% 28.60% 36.50% 20.20% 26.20% 54.40% 34.10% 72.10% 0.00% 12.00% 30.40% 31.90% 34.20% 22.80% 37.00% 63.40% 25.70% 17.90% 37.00% 0.00% 24.10% 33.40% 30.00% N/A % N/A % N/A % N/A % N/A % 30.00% 30.00% 30.00% N/A % 20.00% 30.00% 30.00% 30.00% 0.00% 10.10% 0.00% 28.90% 41.40% 8.90% 42.70% 0.00% 59.20% 0.00% 41.70% 0.00% 0.00% 0.00% 23.20% 38.90% 5.30% 4.70% 19.10% 0.00% 65.30% 0.00% 0.00% 0.00% 37.80% 29.70% 30.00% N/A % N/A % N/A % N/A % N/A % 30.00% 30.00% 30.00% N/A % 20.00% 30.00% 30.00% 30.00% Created on 05/07/2010 General Medicine Psychiatry Orthopaedics Psychiatry Nephrology Obstetrics Oncology General Surgery Paediatrics Cardiology Radiology Anaesthetics Anaesthetics Anaesthetics General Surgery General Medicine Otolaryngology General Surgery General Medicine Geriatric Medicine Anaesthetics Anaesthetics General Surgery Anaesthetics Anaesthetics General Medicine Anaesthetics 12.60% 35.00% 39.30% 45.70% 11.30% 29.40% 8.20% 18.70% 17.10% 17.10% 20.00% 35.90% 35.10% 22.30% 34.00% 34.60% 39.70% 35.70% 16.60% 9.00% 38.10% 0.00% 25.10% 45.30% 31.60% 36.60% 44.50% 30.00% 30.00% 30.00% 30.00% N/A % 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% N/A % 30.00% 30.00% 20.00% 30.00% 0.00% 0.00% 30.90% 0.00% 0.00% 40.40% 0.00% 2.00% 0.00% 0.00% 45.50% 21.90% 34.10% 29.00% 65.80% 47.80% 67.20% 38.70% 19.80% 35.20% 53.50% 0.00% 9.50% 63.70% 41.70% 0.00% 68.10% 30.00% 30.00% 30.00% 30.00% N/A % 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% N/A % 30.00% 30.00% 20.00% 30.00% Created on 05/07/2010 Anaesthetics General Medicine Neurology General Surgery General Surgery Otolaryngology Haematology Radiology Anaesthetics Oncology Gastro Enterology General Surgery Geriatric Medicine General Surgery Urology General Surgery Opthalmology General Medicine Paediatrics General Medicine Paediatric Neurology Respiratory Medicine Cardiology General Medicine Respiratory Medicine Geriatric Medicine Cardiology Paediatrics 100.00% 21.40% 43.40% 48.70% 48.50% 100.00% 59.00% 40.10% 55.60% 48.90% 28.90% 57.90% 18.70% 0.00% 49.80% 43.60% 88.90% 0.00% 30.80% 44.30% 39.20% 31.60% 35.20% 21.00% 33.00% 31.30% 0.00% 100.00% N/A % 30.00% N/A % 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 20.00% 30.00% 30.00% 30.00% 30.00% 20.00% N/A % 0.00% 13.80% 55.10% 39.70% 43.30% 82.40% 53.40% 45.10% 61.90% 45.30% 48.80% 61.30% 0.00% 0.00% 40.50% 56.10% 93.10% 0.00% 10.90% 49.10% 19.50% 23.60% 38.50% 0.00% 41.80% 0.00% 0.00% 22.40% Created on 05/07/2010 N/A % 30.00% N/A % 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 20.00% 30.00% 30.00% 30.00% 30.00% 20.00% N/A % General Surgery Anaesthetics Paediatric Haematology Oncology Clinical Pharmacology Urology Gynaecology Gynaecology Paediatrics Radiology Radiology Radiology Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Radiology General Surgery Dermatology Neurology Gynaecology Rheumatology Otolaryngology 48.20% 65.70% 12.70% 19.00% 29.10% 25.70% 0.00% 7.20% 49.50% 41.60% 41.00% 41.40% 52.20% 57.00% 58.90% 36.80% 36.20% 50.80% 0.00% 0.00% 30.90% 0.00% 100.00% 58.60% 27.90% 34.40% 30.00% 30.00% 30.00% 30.00% 20.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% N/A % 20.00% 30.00% 30.00% 30.00% 48.90% 64.90% 15.30% 31.30% 7.70% 22.00% 100.00% 30.90% 25.90% 28.50% 30.90% 28.10% 68.90% 64.20% 82.20% 73.20% 65.90% 25.80% 0.00% 0.00% 33.10% 0.00% 0.00% 81.30% 66.00% 33.40% 30.00% 30.00% 30.00% 30.00% 20.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% N/A % 20.00% 30.00% 30.00% 30.00% Created on 05/07/2010 Rheumatology Dermatology Oncology Surgery Cardiology Anaesthetics Geriatric Medicine Anaesthetics General Surgery General Surgery Gynaecology Otolaryngology Dermatology Respiratory Medicine Geriatric Medicine Surgery General Surgery Endocrinology Cardiology Radiology Anaesthetics Anaesthetics Otolaryngology Anaesthetics Endocrinology Anaesthetics 33.70% 17.30% 0.00% 62.20% 45.60% 38.70% 14.80% 38.10% 41.40% 24.40% 42.00% 42.70% 71.00% 39.20% 18.00% 27.30% 55.80% 0.00% 33.80% 0.00% 35.70% 25.20% 34.60% 46.20% 18.50% 56.90% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 0.00% 46.20% 54.00% 78.70% 21.00% 65.30% 0.00% 64.30% 49.60% 17.00% 34.30% 49.60% 70.40% 0.00% 0.00% 54.10% 52.40% 66.70% 14.60% 100.00% 39.40% 28.00% 34.00% 51.60% 47.60% 33.70% Created on 05/07/2010 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% General Surgery General Medicine General Medicine General Surgery Paediatrics General Surgery General Medicine Paediatrics Oncology General Medicine General Medicine Paediatrics General Surgery Obstetrics/Gynaecology Obstetrics/Gynaecology Paediatrics General Surgery General Surgery Radiology Radiology Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Obstetrics/Gynaecology 21.40% 27.90% 13.80% 24.50% 30.20% 32.70% 17.40% 16.60% 16.60% 31.40% 12.20% 22.50% 53.40% 35.70% 22.90% 14.60% 0.00% 29.90% 0.00% 0.00% 35.80% 25.90% 24.90% 30.10% 27.50% 11.70% 20.00% 21.00% N/A % 24.50% 21.30% 20.00% 20.00% 20.00% 30.00% 29.40% 20.00% 22.00% 30.00% 23.10% 20.00% 20.00% 20.00% 30.00% N/A % 29.00% 29.00% 20.00% 28.60% 26.90% 0.00% 18.60% 11.50% 53.70% 0.00% 0.00% 34.10% 67.00% 0.00% 0.00% 0.00% 52.90% 42.00% 0.00% 0.00% 7.60% 0.00% 0.00% 43.20% 46.20% 18.90% 26.80% 5.10% 0.00% 20.00% 30.00% N/A % 20.00% 30.00% 20.00% 20.00% 20.00% 30.00% 30.00% 28.50% 30.00% 30.00% 30.00% 20.00% 20.00% 20.00% 30.00% N/A % 30.00% 30.00% 20.00% Created on 05/07/2010 Obstetrics/Gynaecology Obstetrics/Gynaecology General Surgery Paediatrics General Medicine Anaesthetics General Surgery Paediatrics General Medicine General Medicine Oncology General Medicine General Medicine Palliative Medicine Obstetrics/Gynaecology Paediatrics General Medicine Paediatrics Obstetrics/Gynaecology General Medicine General Surgery Anaesthetics Anaesthetics Anaesthetics Anaesthetics Surgery 1.40% 31.10% 22.40% 31.10% 20.60% 8.90% 24.60% 27.50% 15.70% 18.60% 37.40% 13.90% 17.20% 0.00% 26.70% 32.00% 9.00% 29.70% 29.80% 100.00% 22.00% 26.90% 47.00% 10.00% 29.20% 19.70% 20.00% 30.00% 25.20% N/A % 20.00% 20.00% 20.00% 26.30% 20.00% 20.00% 20.00% 20.00% 20.00% 29.30% 20.00% 28.50% 20.00% 20.00% 25.20% 20.00% 20.00% 30.00% 20.00% 23.00% 42.80% 8.80% 0.00% 27.30% 25.00% 5.30% 27.00% 7.40% 2.10% 13.70% 0.00% 4.00% 0.00% 12.40% 20.00% 0.00% 62.40% 3.90% 0.00% 9.30% 22.00% 0.00% 11.80% 20.10% 49.90% 20.00% 30.00% 20.00% N/A % 30.00% 20.00% 20.00% 30.00% 30.00% 30.00% 20.00% 30.00% 20.00% 30.00% 20.00% 30.00% 20.00% 20.00% 20.00% 20.00% 20.00% 30.00% 20.00% Created on 05/07/2010 Orthopaedics Orthopaedics Anaesthetics Anaesthetics Orthopaedics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Orthopaedics Surgery Anaesthetics Anaesthetics Anaesthetics Orthopaedics Anaesthetics Anaesthetics Orthopaedics Orthopaedics Anaesthetics Orthopaedics Orthopaedics Anaesthetics General Surgery Opthalmology Otolaryngology 33.30% 0.00% 0.00% 0.00% 1.90% 21.00% 11.30% 62.00% 26.20% 44.20% 15.90% 47.10% 14.30% 43.20% 0.00% 27.80% 15.00% 0.00% 16.90% 32.10% 7.30% 20.00% 21.20% 33.10% 32.70% 12.60% 30.00% 30.00% 30.00% 20.00% 30.00% 30.00% 30.00% 30.00% 30.00% N/A % N/A % 30.00% 20.00% 20.00% 30.00% 30.00% 20.00% N/A % 65.60% 0.00% 51.00% 4.60% 0.00% 28.20% 100.00% 47.70% 30.30% 47.20% 62.00% 52.40% 14.00% 50.50% 0.00% 48.40% 59.70% 0.00% 41.20% 48.50% 0.00% 66.10% 25.30% 59.60% 26.40% 6.30% 30.00% 30.00% 30.00% 20.00% 30.00% 30.00% 30.00% 30.00% 30.00% N/A % N/A % 30.00% 20.00% 20.00% 30.00% 30.00% 30.00% N/A % Created on 05/07/2010 General Surgery Paediatrics General Medicine General Medicine Orthopaedics Orthopaedics Haematology Orthopaedics Orthopaedics Paediatrics Orthopaedics Dermatology General Medicine Otolaryngology General Medicine Orthopaedics Orthopaedics Oncology Orthopaedics Paediatrics Radiology Obstetrics/Gynaecology Obstetrics/Gynaecology Obstetrics/Gynaecology Otolaryngology General Medicine 31.10% 30.40% 18.60% 18.00% 30.80% 0.00% 35.90% 16.40% 0.00% 0.00% 26.10% 17.00% 21.70% 20.80% 24.50% 19.20% 29.20% 29.20% 33.90% 43.20% 17.70% 27.00% 31.60% 33.10% 27.10% 24.70% 30.00% 30.00% 25.00% 20.00% 20.00% 20.00% 25.00% 20.00% 20.00% 20.00% 20.00% 20.00% 30.00% 25.00% 25.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 30.00% 35.50% 5.90% 45.60% 0.10% 12.80% 0.00% 38.50% 28.30% 0.00% 0.00% 22.90% 26.30% 46.50% 24.70% 43.50% 50.00% 39.80% 32.20% 53.70% 22.60% 18.00% 37.00% 49.60% 31.60% 60.50% 14.70% 30.00% 20.00% 30.00% 20.00% 30.00% 20.00% 30.00% 20.00% 20.00% 30.00% 20.00% 20.00% 30.00% 30.00% 30.00% 30.00% 20.00% 30.00% 30.00% 30.00% 30.00% 30.00% 20.00% Created on 05/07/2010 Haematology Opthalmology Anaesthetics General Surgery Haematology Palliative Medicine General Medicine Oncology General Medicine General Surgery General Medicine General Medicine General Medicine General Medicine Opthalmology General Surgery General Medicine Oncology General Medicine Neurology Palliative Medicine Radiology General Medicine General Surgery Paediatrics General Surgery 35.50% 0.00% 37.60% 28.70% 25.70% 38.10% 50.00% 35.10% 0.00% 12.90% 39.30% 15.30% 16.30% 13.40% 10.00% 26.90% 20.60% 19.70% 32.60% 23.70% 33.20% 28.50% 23.20% 28.90% 30.00% 0.00% 30.00% 30.00% 30.00% 30.00% 30.00% N/A % 27.00% 20.00% 20.00% 30.00% 20.00% 25.00% 20.00% 20.00% 20.00% 20.00% 30.00% 20.00% 20.00% N/A % 20.00% 28.00% 20.00% 25.00% 40.50% 0.00% 38.20% 34.80% 21.50% 0.00% 54.10% 25.30% 15.70% 22.10% 0.00% 43.00% 10.20% 0.20% 32.00% 10.70% 13.90% 34.80% 100.00% 0.00% 100.00% 19.30% 26.40% 20.50% 6.20% 0.00% 30.00% 30.00% 30.00% 30.00% 30.00% N/A % 30.00% 20.00% 30.00% 30.00% 20.00% 25.00% 20.00% 20.00% 20.00% 20.00% 30.00% 20.00% 20.00% N/A % 20.00% 30.00% 20.00% 20.00% Created on 05/07/2010 General Medicine Orthopaedics Otolaryngology Orthopaedics Otolaryngology Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Anaesthetics Opthalmology Opthalmology Anaesthetics Palliative Medicine Anaesthetics Orthopaedics Palliative Medicine Paediatrics General Medicine Paediatrics Obstetrics/Gynaecology General Surgery 14.20% 33.40% 5.10% 27.60% 24.50% 0.00% 26.20% 33.30% 30.70% 28.30% 35.50% 100.00% 31.50% 32.90% 22.00% 23.90% 24.60% 43.40% 18.30% 37.40% 18.70% 100.00% 22.30% 31.50% 23.90% 32.90% 21.90% 20.00% 20.00% 20.00% 20.00% 20.00% 30.00% 30.00% 30.00% 30.00% 30.00% N/A % 30.00% 30.00% 30.00% 20.00% 20.00% 20.00% N/A % 20.00% 20.00% N/A % N/A % 30.00% 20.00% 30.00% 20.00% 36.20% 16.80% 0.00% 40.80% 34.80% 0.00% 50.10% 27.20% 32.60% 27.10% 51.00% 0.00% 37.40% 45.10% 45.20% 2.30% 0.90% 26.00% 0.00% 11.00% 0.00% 0.00% 11.70% 41.40% 47.60% 31.90% 16.50% 20.00% 20.00% 20.00% 20.00% 20.00% 30.00% 30.00% 30.00% 30.00% 30.00% N/A % 30.00% 30.00% 30.00% 20.00% 20.00% 20.00% N/A % 20.00% 20.00% N/A % N/A % 30.00% 30.00% 30.00% 20.00% Created on 05/07/2010 General Medicine Oncology Obstetrics/Gynaecology Paediatrics General Medicine General Medicine General Surgery General Medicine Anaesthetics General Surgery Obstetrics/Gynaecology General Medicine Anaesthetics Anaesthetics General Medicine Anaesthetics 21.90% 100.00% 25.50% 30.40% 16.20% 18.90% 23.20% 17.40% 39.60% 22.10% 19.40% 0.00% 36.10% 31.90% 14.30% 0.00% 20.00% 30.00% N/A % 27.00% 28.00% 23.05% 20.00% 20.00% 20.00% 30.00% 26.00% 30.00% 30.00% 20.00% 19.70% 40.30% 31.00% 0.00% 54.20% 30.90% 7.40% 42.80% 20.10% 8.80% 33.50% 0.00% 24.60% 30.10% 17.50% 0.00% 30.00% 30.00% N/A % 30.00% 30.00% 30.00% 30.00% 20.00% 20.00% 30.00% 30.00% 30.00% 30.00% 20.00% This report shows the in-patient and day case ratios for each consultant on the basis of the measurement system agreed for the consultant contract. Created on 05/07/2010 Chapter 39 Health Service Executive Implementation of the Medical Consultants? Contract Implementation of the Medical Consultants? Contract 39.l in July 2008, agreement was reached between the Health Service Executive (HSE) and the consultants' representative organisations on a new Consultant Contract (Consultant Contract 2008). The new contract positions consultants, for the ?rst time, as employees working under terms and conditions similar to those in place for workers across the health service. It brings about alterations in consultants' working hours, reporting relationships, the structure of their employment and the terms governing private practice. it also introduces disciplinary procedures for consultants similar to those zippiying to other employees. Previous Review of Medical Consultants? Contract 39.2 in April 2007, a Special Report was published on an examination of the operation of the previous Medical Consultants" Contract. 11 reported on the extent to which the terms of that contract, agreed in 1997, were being implemented in the acute hospital sector. The report found that there was a persistent disagreement over a period of ten years in regard to the time commitment ol' consultants and there was little monitoring ol? the delivery of those commitments by hospital management. 39.3 in May 2008 the Public Accounts Committee of nan l?lireann considered the ?ndings ofthe examination. in its reportm the Committee recommended that - The new consultants? contract should provide absolute transparency on the time commitment to public hospital duty of consuitant staff and that those commitments should be monitored and enforced in order to ensure that value is received for the salaries paid to consultants, - The liSl'i should introduce a stringent monitoring regime oi?public and private caseloads in hospitals and data on the level ol?privatc practice in public hospitals should be pubiishcd on a consultai?it by consultant basis. I The terms oi~ the l997 contract should be strictly enforced in respect of those consultants who do not transfer to the new contract so that those consultants are seen to deliver services in accordance with their commitments. The contract implementation group, that will oversee the change process, should provide progress reports to the Minister for Health and Children. New Contractual Arrangements 39.4 Under the new arrangements there are four contract types as outlined in Figure 143. Dail Eireann Committee of Public Accounts - Third interim Report on the 2006 Report of the Comptroller and Auditor General Expenditure on Health Services (November 2008). 4011 II Health Service Executive Figure 143 Types of Consultant Contract under the New Contractual Arrangements Type A Consultants who work exclusively for the public hospital and are solely remunerated by way of salary 8 Consultants who may engage in private practice including - new entrants who may engage in limited private practice on-site in a ratio of 80% public to 20% private. I existing consultants who may engage in private practice in a ratio of 70% public to 30% private practice and retain off-site out-patient private practice. Existing consultants who may engage in private practice in a ratio of 70% public to 30% private practice and retain off?site inpatient and out-patient private practice. New consuttants entitled to engage in off-site in-patient and out-patient private practice. (Only to be created in exceptional circumstances where there is a demonstrable bene?t to the public health system). 39.5 The was voted 21 Supplementary Estimate, amounting to 668 million in 2008. The bulk of this (about 665 million) was intended for payment of consultant's pay arrears arising from acceptance and implementation of the new contract terms. The payments did not take place in 2008 and under cash accounting rules governing voted expenditure, the funds were surrendered to the Exchequer. Payments on loot of the contracts began in May 200?). A provision of E9l million was allocated to meet them. Key Provisions Consultant Contract 2008 39.6 The principal l'cnturcs ol?Ct?insultant Contract 2008 are as follows - the 20th contract delincs the commitment ol'cnch consultant us it scheduled 37-hour week delivered over the period Sam 1 8pm Monday to Friday. an increase of four hours on the previous scheduled working week. ln addition, consultants can now be restored to work on~sitc for up to live hours on Saturday, Sunday or public holidays. I The contract provides for team working which comprises the provision of diagnoses, treatments and care to patients that are under the care of other consultants on the same team. This extends to discharge and further treatment arrangements in order to facilitate a more timely discharge of patients and speedier admission of patients to hospital. I Each consultant is required to report to a Clinical Director who will, inter alia, prepare a Clinical Directorate Service Plan setting out how clinical services are to be delivered, how consultant resources are to he deployed and managed through rosters (with an emphasis in the short to medium term on the move to an item 8pm day and obtaining value from the additional four hours ofconsultant time: per week). I [Each consultant while remaining clinically independent in relation to decisions on the diagnosis, treatment and cure of individual patients will now also be subject to the corporate policies and procedures of their employing hospital including, inter alia, clinical governance and patient safety initiatives, participation in competence assurance arrangements, operation of quality and risk frameworks, maintenance of risk registers, and provision of education and training to other clinicians. I The Consultant Contract 2008 introduces a set of measures designed to improve equity for public patients, including at 20% limit on private practice for new consultants. Consultants who were previously employed under Consultant l997 may engage in up to 3 We private practice. A common waiting list is to be introduced for out-patient diagnostics (including rudioiogy and laboratory 'l?hcsc services are subject to the permitted Implementation of the Medical Consultants? Contractl 405 public private practice ratio and the employer must be satis?ed that billing for these services re?ects the pennittcd ratio. Audit Focus? Critical to the successful management of change in this area are the following I conclusion of contracts with a critical mass of consultants and veri?cation that the centrally negotiated terms are applied - continuation that the time commitments are being re?ected in onothe-ground rosters and that there are arrangements in place to con?rm adherence to pubiic private ratios I ensuring that clinical directorate models are in place and, where not, that interim arrangements suf?cient to guarantee delivery of the new arrangements are in place - enforcement of the delivery of commitments by those consultants who remain on the 1997 contract. The audit sought to ascertain the progress made in regard to each ot?the above. Audit Findings 39.? In 2009. the consultant workforce was composed of a mix of permanent, temporary and locum appointees. The whoie time equivalent workforce eligible for offer oi" Consultant Contract 2008 comprised L888 permanent employees and 312 locum or temporary employees a total of 2,200. 39.8 By July 1.688 consultants out of the permanent consuitants had opted into the new contract arrangements. The breakdown in respect ol" these contracts was as outlined in Figure M4. Figure 144 Filled Consultant Posts by Contract Type Type Number A 629 703 1,688 This represents an acceptance rate of around 89%. SW) While a large majority ol' locum or temporary employees accepted the ol'l'er of Consultant Contract 2008. many of these have left health service employment, due to the expiry of their contracts by June 2009. l0 The ?ve Universities employing Academic Consuitanls have from June 2009 begun the oi?i'er ol? Consultant Contract 2008 to those consultants that are in their employment. At 7 July 2009. around 50931, oi? Acadet?nic Consultants had accepted the terms of the new contracts. 39.] Of 326 consultant posts created by the USE between 1 March 2008 and 1 April 2009 (a 13 month period), 70 were Type A. 250 Type 13 and none Type C. 408 I Health Service Executive Verification of Adherence to Contract Terms 39.12 The USP. informed me that its Internal Audit Unit carried out a review to verify that the 1.66? contract documents as signed at March 2009 had not been altered from the agreed standard contract. 30.l3 In regard to the scope ol? the work carried out. the review was at a high level but examined all contracts issued and accepted by consultants employed in the HSE and Funded agencies. liach contract was reviewed to identify any alterations to the standard terms and conditions contained in the pro/omit: contract agreed with the medical representative bodies in July 2008. 39. The review found The vast majority of contracts signed by consultants and authorised by the employer were in accordance with the standard terms and conditions. - A relatively small percentage of contracts had been signed as approved by the employer rior to hcin I issued to the em )lovec (none ol?these contained any anomalies). l: . . I A small percentage ol'contracts were not physically signed as authorised by the employer, but these were included in the employer?s records as issued contracts. A very small number of contracts did contain manual amendments relating to the treatment of private out-patients, however. these were not found to materially affect the standard terms and conditions, 39.15 in regard to the extent ol? deviations found by internal Audit, the Accounting Of?cer informed me that deviations were limited to a small number of contracts signed by the consultant but not signed or authorised by the Hospital Manager or CEO and two instances where consultants had signed a contract categorised as Type even though 'l?ype was not on offer to those consultants. Rostered Time Commitments and Private Work 39.16 llSii? Human Resources (HR) Directorate conducted a veri?cation of work schedules to ensure that they re?ected a 37-hour commitment and an additional four scheduled hours dedicated to clinical work inciuding I the service gain resulting. from "the increase from 33 to 37 scheduled weekly working hours - the extent of service delivery over an extended working day as required [8am to 8pm in contrast to 9am to 5pm) the introduction of scheduled overtime on Saturdays. Sundays or bank holidays in place of Factor payments? for duties performed by consultants on-sitc while on?call outside their scheduled hours, the service gain arising and cost basis for same - measurement arrangements regarding each of the consultant?s clinical activities, inciuding in-paticnt. daycasc, out-patient and diagnostics I the extent to which there is compliance with the speci?ed ratio of" public private practice I the extent to which a single waiting list for out-patient diagnostics has been introduced. ?34 These relate to payments. on a per call-out basis, for the provision of on-site services by a consultant while on?catl outSIde their scheduled 37-hour week commitment. Implementation of the Medical Consultants' Contraetl 407 39.17 The extent to which work schedules were compliant with the agreed changes was recorded as part of the veri?cation process. Only complete schedules were vcriticd while incomplete schedules were set aside for revision and further review, The Further review has now been completed. 39.!8 The Accounting Officer informed me that the veri?cation by HR was undertaken immediately after the deadline for acceptance of Consultant Contract 2008 in order to ensure that key elements of the contract were in place prior to payments being made thereunder. The verification exercise entailed con?rming the presence of each of the elements rather than recording the extent of same. 39.19 A small number oi? hospitals are still dealing with data collection dif?culties, particularly with the reporting of on-sitc private out?patient department activity and diagnostics. Consultants in these hospitals have been asked to supply details oftheir private practice activity but this has not been provided to date. This is being tbllowed up by the l'lospital Managers in the particular hospitals concerned. Further discussions are continuing with the Dublin Maternity Hospitals on the particular requirements ol?the Maternity service for the n?teasurcment oi?privale practice. 39.20 The National i-lospitals Otiice WHO) is currently progressing the introduction ol? a common waiting list in outpatient diagnostics. Monitoring Private Practice 39.2] Since. September 2008, the llSli has introduced systems for reporting. public and private in~ patient and daycasc activity on a consultant by consultant basis. Reports from these systems which record individual consultant public and private practice in relation to daycascs, outpatients and diagnostics are being produced. Currently. these reports are five months in arrears. The llSl-Z informed me that it will be able to report the percentage of eligible consultants operating within the limits speci?ed by Consultant Contract 2008 in addition to overall compliance at hospital level in the second At that point, the information will begin to he used to inform the decisions ot?clinical directorates. 39.22 The report will be. circulated to the Clinical Director and the Hospital Manager and an overall status report will be prepared for internal llSli monitoring and management purposes and shared with the Department and the representative associations of consultants. 39.23 The .i?tccounting Of?cer stated that a key requirement for the implementation ofConsultant Contract 2008 was the monitoring ot? private practice activity by consultants individually. Prior to, during and since the veri?cation exercise, new measurement systems had been developed in order to l?ultil this requirement in the manner set out in the Contract negotiations, in. measuring clinical activity adjusted for case mix. The features ol~ the measurement system included - The development of the measurement system in conjunction with the Economic and Social Research Institute (liSRl). This has now been introduced in the 49 acute hospitals through the Hospital Enquiry System?? The measurement system records in- patient and day casc activity (as weighted l'or cascmix??) by consultant and reports on the level ot?privatc practice on a basis The HIPE System collects demographic. clinical and administrative data on patients in acute general hospitals nationally. Casemix provides a means for standardislng data coilected on activity and costs within acute hospitats, so that meaningful comparisons can be made between different areas of activity and different hospitals. 408 I Health Service Executive I Residual activity which is not yet captured by the l-llPlIi system including details of on~site private out-patient activity and certain diagnostic activity is being collected manually by the hospitals as an interim measure pending the development of automated data collection systems. I There is an inevitable time lag (minimum ol'4 months) in providing reports, due to the time required for coding activity from the patient charts. The lirst measurement reports covering the January 2009 activity period were coming on stream in mid 2009 and have been issued to individual consultants. I 'l?hese reports are being prepared for the attention of Clinical Directors and Hospital Managers for compliance monitoring purposes. 39.24 Consultants have been receiving individualised reports each month since the beginning of 2009. Implementation and Operation of Clinical Directorates 39,25 The revised arrangements make provision for a new service wide senior management position that ol?ti'linical Director. Clinical Directors are expected to I ensure that service standards and govemancc requirements are met I monitor and manage the public private mix I develop and manage consultants? rosters, deal with grievances and disputes I manage the initial stages of the disciplinary process and I help organise medical education and training. 39.26 in December 2008. the commenced the appointment process for Clinical Directors, As of July 200?), 46 Clinical Directors had been appointed across the hospital system from amongst those consultants who accepted the Contract 2003. The expect further Clinical Director appointments to be made over the next two years as services evolve. 39.27 Clinical Directors appointed under Consultant Contract 2008 receive an allowance of ?50,000 per annum. 39.28 Work has not commenced on the veri?cation of the operation of Clinical Directorates. The terms of reference for an audit have yet to be agreed. It is intended that it will concentrate on evidence available to support increased working hours? improved ?exibility in accessing theatres, improved discharge rates. compliance with agreed public private ratios, reduced waiting times in Emergency Departments. 39.29 The Accounting ()l?liccr stated that changes are being implemented by local and regional hospital management with support and guidance from HR and the Nllt'). In relation to change management. the ?Si: is currently pursuing an integrated services programme which entails the appointment of Regional Operations Directors and Clinical Directors in key areas. The Clinical Directors appointed under Consultant Contract 2008 are taking lead roles in aligning services to patient need, meeting care and quality standards and structuring consultant commitments accordingly. Clinical Directors function as senior managers in the larger hospitals reporting at hospital or regional level. 39.30 Prior to the introduction of Consultant Contract 2008. there were a range of Clinical Director, Medical Director and other clinical leadership posts in place, under historical local arrangements in various hospital and community settings. 'l?herc was little consistency in the roles Implementation of the Medical Consultants Contract! 409 assigned to those posts and in most instances. consultants holding them did not have a management role in relation to other consultants, Consultants who held remunerated leadership roles under Consultant Contract 199? may retain those roles and receive payments under Consultant Contract 2008 pro~rata to their payments under Consultant Contract 1997. The number of consultants bene?ting from these arrangements are not maintained centrally and were not available at the time of' the review. 39.31 The Accounting Of?cer informed me that in many instances consultants holding, Clinical Director or other leadership roles under the previous contract has either secured new appointments as Clinical Directors under Consultant Contract 2008 or has taken a different role in new management structures. Where that had not happened, management were seeking to build on the benefits associated with the consultant?s existing role, align it to the new management structures and ensure maximum cost effectiveness. Consultants who remain on Previous Contracts 39.32 Consultants who remain on Consultant Contract 1997. the Academic Consultant Contract 1998, the Consultant Contract l99l or previous contractual arrangements will not be subject to the terms and conditions 01? Consultant Contract 2008. The llSli stated that they will, however, be required to work closely with Clinical Directors as senior managers in the health service. The has informed me that it anticipated that approximately 200 consultants would remain on their previous contractual arrangements. 39.33 The USP: has stated that it will ensure consistency in application of the various contractual arrangements applying to consultants. in relation to Consultant Contract 1997 and the Academic Contract l998, this will include full implementation of those provisions relating to the consultant?s time commitment to the public hospital and to their entitlement to engage in private practice. The llSli has indicated that it will commence implementation of these provisions once initial payments under Consultant Contract 2008 are completed. Conclusions 89% of permanent consultants have opted into the new contract arrangements. Work has been done to ensure that the contracts signed by hospitals accord with the standard terms and that schedules incorporate the extra time commitment negotiated. Arrangements to monitor private practice, introduce changes associated with the Clinical Directorate moch and monitor contractual compliance for consultants who remain on contractual arrangements that predate Consultant Contract 2008 have yet to be bedded in. "the HSE needs to push ahead with arrangements to verify that the envisaged gains resulting from increased resource availability and changed management processes are being realised in practice. Implementation of Consultant Contract 2008 Briefing Note 21st October 2009 1 Table of Contents 1. Key points .............................................................................................................................. 3 2. Longer, more flexible working hours ..................................................................................... 3 3. Greater equity for public patients........................................................................................... 3 4. Regulation of public : private mix........................................................................................... 4 5. Delivering and measuring public:private mix......................................................................... 5 6. Ensuring patient safety .......................................................................................................... 5 7. Teamworking ......................................................................................................................... 6 8. Better services for patients .................................................................................................... 6 9. Clinical Directors appointed to manage Consultants ............................................................ 6 10. 49 Clinical Directors in place ............................................................................................... 7 11. High uptake of Consultant Contract 2008 ........................................................................... 7 12. Large increases in Consultant workforce ............................................................................ 7 13. Verifying contract delivery ................................................................................................... 8 14. Payment to Consultants ...................................................................................................... 9 15. Implementing Public Accounts Committee recommendations ............................................ 9 2 1. Key points Consultant Contract 2008 introduces a range of reforms which will benefit patients, help develop a consultant-provided service and ensure that maximum value for money is obtained from the investment in existing and additional Consultant posts. Key changes include: x x x x x x x a longer working week, a longer working day, weekend working when required, greater equity for public patients through a public-only contract type, limits on private vs. public practice and a common waiting list in diagnostic services, measures to ensure high quality services and patient safety, the introduction of Clinical Directors to manage Consultants and ensure clinicians have a senior role in planning and managing services, and a significant increase in Consultant posts over the past 12 months. In early 2009 the HSE engaged in a detailed verification process regarding implementation of Consultant Contract 2008. This was designed to ensure that the changes described above were being implemented for patients and that value for money is achieved. 2. Longer, more flexible working hours Consultant Contract 2008 provides for a 37 hour working week delivered over the period 8am - 8pm Monday to Friday. In addition, Consultants rostered on-call may be scheduled to work on-site for up to 5 hours on Saturday, Sunday or public holidays. This contrasts with the Consultant Contract 1997, which provided for a 33 hour week, delivered over the period 9am - 5pm Monday to Friday with no provision for scheduled onsite work at weekends. 3. Greater equity for public patients Together with a series of measures introduced by the HSE in recent months, Consultant Contract 2008 introduces a series of measures designed to improve equity for public patients, including a limit on private practice - for new Consultants - of 20% of clinical activity. Existing Consultants may engage in up to 30% private practice. Consultant Contract 2008 provides for two main contract types: i. ii. Type A: Works exclusively for the public hospital and will be remunerated solely by way of salary. Type B: Works exclusively for the public hospital by may engage in limited private practice on campus (80% public, 20% private). The measure include requirements that all patients - public or private - requiring diagnostic or treatment procedures following an outpatient consultation must be placed on a Common Waiting List if there is a waiting period for access to the procedure. A Common Waiting List is one which includes all patients - irrespective of public or private status - awaiting a particular procedure. Patients must be called from Common Waiting Lists regardless of public or private status: i) ii) in order of clinical priority, followed by length of waiting time. 3 Any outpatient diagnostic or treatment services / sessions / clinics organised to meet demand must be open to both public and private patients called in order of clinical priority and length of waiting time. Separate outpatient diagnostic or treatment services / sessions / clinics for private patients are not permitted within contracted hours or otherwise. Section 21 of Consultant Contract 2008 sets out the circumstances under which the Consultants employed under Consultant Contract 2008 may charge private fees in relation to private patients undergoing diagnostic investigations, tests and procedures on an outpatient basis. These are as follows: x the volume of such private practice not exceeding the set ratio of public to private practice (a maximum of 30% for existing Consultants in employment when offer of Consultant Contract 2008 was made in July 2008, 20% for new appointees). x all billing being processed by the Consultant in a manner that is satisfactory to the hospital and in the event that insufficient information is available for verification purposes recourse may be had to the measures provided for at Section 20 (d) and (e) of the Contract. Section 20 (d) notes that the Employer has full authority to take all necessary steps to ensure that for each element of a Consultant's practice, s(he) shall not exceed the agreed ratio. x A common waiting list operated by the public hospital applying to both public and private patients undergoing diagnostic investigations, tests and procedures (including radiology and laboratory procedures) on an out-patient basis in public hospitals (including referrals from General Practitioners). Status on the common waiting list will be determined by clinical need only. The list will be subject to clinical validation by the relevant Clinical Director. All outpatient diagnostics are included as regards the Common Waiting List. For example, outpatient diagnostic tests and procedures in cardiology, neurophysiology and gastroenterology. 4. Regulation of public : private mix Section 20 of the Consultant Contract 2008 deals with the regulation of private practice and the mechanisms for ensuring compliance with the 80:20 / 70:30 ratio of public to private practice. It provides that the volume of private practice may not exceed the specified ratio in any of the Consultant's clinical activities including inpatient, day-patient and outpatient. The volume of practice refers to patient throughput adjusted for complexity through the casemix system. It does not include non-clinical activities, nor does it apply to time. Section 20 of the Contract states that the Employer has full authority to take all necessary steps to ensure that for each element of a Consultant's practice, s(he) shall not exceed the agreed ratio. Other relevant sections include Section 4 b), which states that "both the Consultant and the Employer shall co-operate in giving effect to such arrangements as are put into place to verify the delivery of the Consultant's contractual commitments" and Section 12 l), which requires the Consultant "to participate in and facilitate production of all data/information required to validate delivery of duties and functions and inform planning and management of service delivery." 4 5. Delivering and measuring public:private mix A key requirement for the implementation of Consultant Contract 2008 is the monitoring of private practice activity by Consultants individually. Since September 2008 the HSE has developed new measurement systems in order to fulfil this requirement in the manner set out in the Contract negotiations, i.e. clinical activity adjusted for case mix; x x x x x The ESRI has been central to the development of the measurement system, which has now been rolled out to the 49 acute hospitals through the HIPE (Hospital In-Patient Enquiry) system. The measurement system captures inpatient and day case activity (as weighted for case mix) per consultant and reports on the level of private practice on a monthly basis. Where residual activity which is not yet captured by the HIPE system (e.g. details of onsite private OPD activity and certain diagnostic activity) is being collected manually by hospitals as an interim measure pending the development of automated data collection systems. Each Consultant in the employment of the public health service - irrespective of whether they hold Consultant Contract 2008 or not - should be issued with a public private mix measurement report every month since January 2009. This documents their activity in relation to inpatient, daycase, outpatient and diagnostic activity over the previous three months. The report is also issued to the relevant Clinical Director and Hospital Manager / CEO for consideration and to facilitate action to ensure with Consultant Contract 2008. An overall status report is also prepared for internal HSE monitoring and management purposes and monitoring. From the January 2009 reporting period this report is considered as informing decisions by Clinical Directors and managers on individual Consultant compliance on a contractual basis. It will be provided monthly to the HSE Board, the Department of Health and Children and will be available under FOI. There is an inevitable time lag (minimum of 4 months) in providing reports due to the time required for coding activity from the patient charts. A small number of hospitals are still dealing with data collection difficulties, particularly with the reporting of on-site private OPD activity and diagnostics. In this context, the HSE has instructed that - should Consultants engage in private outpatient practice on campus such practice should, like all other public or private activities undertaken on the public hospital campus, be subject to measurement as part of the 80:20 / 70:30 ratio of public to private practice under Consultant Contract 2008. Measurement includes co-located hospitals on campus, private rooms on campus and private clinics on campus - with three exceptions. The exceptions are the private outpatient practice of existing Consultants in th private clinics (as of 26 July 2008) on the campus of St James', Beaumont and Cork University Hospital. The HSE has issued a substantial volume of guidance on the measurement of public : private practice, including three volumes of guidance on the implementation of Consultant Contract 2008, separate guidance on the measurement of inpatient and daycase activity, diagnostic and outpatient activity most recently, in September 2009, comprehensive guidance on the treatment of public and private patients. 6. Ensuring patient safety Consultant Contract 2008 requires that the Consultant - while clinically independent - is subject to statutory and regulatory requirements and corporate policies and procedures. Consultants will be expected to work in teams, participate in competence assurance arrangements and provide education and training to other clinicians. The Contract also requires that new appointees to Consultant posts must now be eligible for membership or have membership of the relevant division of the Register of Medical 5 Specialists maintained by the Medical Council. This means that patients can be assured that Consultants meet the highest standards - both when appointed and throughout their careers. 7. Teamworking Under Consultant Contract 2008, Consultants must work as part of a team of Consultants this means that the Consultant provides diagnosis, treatment and care to patients under the care of other Consultants on his/her Consultant team and vice versa. This may include discharge and further treatment arrangements thereby facilitating a more timely discharge of patients and speedier access of patients into hospital. 8. Better services for patients Consultant Contract 2008 offers a significant opportunity for hospitals to achieve greater flexibility in relation to the delivery of services to patients and move to a Consultant-provided service. Consultants are on-site for longer periods - meaning that there is a greater senior clinical decision-making presence on-site. Key service enhancements can include: x x x x x x x x x x x Improved decision making in Emergency Departments utilising 8am to 8pm by 7 day cover as appropriate and the additional 4 hours for Consultants to reduce inappropriate admission waits; Rostered daily ward rounds that deliver improved Discharge Planning to address bed occupancy rates; Reduced overtime costs for NCHDs arising from a Consultant-provided service - EUR100 million in savings currently being negotiated with NCHDs. Theatre Schedules that reflect a shift to day work and address elective waiting times and deliver improved equity across specialties. This should ensure inappropriate queue-jumping related to patient designation is addressed; Re-designation of inpatient beds to day beds to improve day case throughput; Re-designation of 7 day to 5 day beds that promotes reduced length of stay, allows for improved budgetary performance and eases pressure on WTE rostering and staff; Improved day of surgery admission rates; OPD schedules that reflect increase in new patient consultations while decreasing return patient reflecting new ratios and reductions in DNA's to 5% target through improved scheduling. Improved access rates for GP's to diagnostic services by ring-fencing additional Consultant hours to direct access initiatives for GP diagnostic radiology, scoping etc; Improved clinical governance through the Clinical Directorate model that facilitates the relevant Quality and Risk frameworks, Serious Untoward Incident policies and maintenance of Risk Registers; Improvements in compliance with Hospital Accreditation, Medical Records Audit, and Hygiene standards 9. Clinical Directors appointed to manage Consultants Consultant Contract 2008 introduces a new senior management position across the health service - that of Clinical Director. Consultant Contract 2008 describes Clinical Directors as key members of the local corporate management team. Clinical Directors are expected to plan how clinical services are to be delivered, how resources are employed, contribute to strategic planning and achieving service and organisational priorities and deploy and manage Consultants. The Contract requires that each Consultant will report to a Clinical Director who ensures service standards and governance requirements are met; monitors and manages public:private mix; develops and manages rosters (with an emphasis in the short to medium term on move to an 8am - 8pm day and obtaining value from the additional 4 hours per 6 Consultant per week) and deals with grievances and disputes, manages the initial stages of the disciplinary process, and helps organise medical education and training. The HSE is working with the Forum of Postgraduate Medical Training Bodies and a number of sub-groups to develop the role of and support the work of Clinical Directors 10. 49 Clinical Directors in place In December 2008, taking account of significant engagement with Clinicians, management and other health service staff over a period of months, the HSE commenced an appointment process for Clinical Directors under Consultant Contract 2008. To date, 35 Clinical Directors have been appointed across the hospital system from amongst those Consultants who accept Consultant Contract 2008. A further 14 have been appointed in the Mental Health Services. Further Clinical Director appointments will made over the next two years as services evolve. Up to 77 appointments may be made in total. Appendix I refers. 11. High uptake of Consultant Contract 2008 The Consultant workforce is composed of a mix of permanent, temporary and locum appointees. The whole time equivalent (wte) workforce eligible for offer of Consultant Contract 2008 comprised 1,888 permanent employees and 312 locum or temporary employees - 2,200. Of the 1,888 permanent Consultants, negotiations continue between the Universities, the Department of Education and Science and the Higher Education Authority on the offer of the contract to 150 Academic Consultants. An element of the HSE vote for 2009 was transferred to the Department of Education and Science and subsequently to the HEA and the Universities to fund the offer of Consultant Contract 2008 to Academic Consultants. The HSE has no further involvement in the matter. In June, some of the Universities employing Academic Consultants began the offer of Consultant Contract 2008 to those Consultants in their employment. At 7 July 2009, around 50% of Academic Consultants had accepted the terms of the new contracts. By July 2009, 1,688 consultants out of the 1,888 permanent consultants had accepted the offer of Consultant Contract 2008. This represents an acceptance rate of approximately 90%. The breakdown by Contract Type is as follows: x x x Type A: 629 Type B: 703 Type B*: 356 12. Large increases in Consultant workforce In March 2008 the IMO and IHCA agreed to advertisement of Consultant posts under Consultant Contract 2008. Following this agreement, the HSE approved 128 Consultant posts which were advertised by the Public Appointments Service throughout April. In the period up to 31st December 2008, a further 155 posts were approved - for a total of 283 posts in 2008. 156 of these were new posts and 127 replacement. During 2009 and noting the constraints imposed by the Government Recruitment Moratorium which requires the abolition of two NCHD posts for every Consultant post approved, the HSE approved 127 Consultant posts - 65 additional and 68 replacement. Of the posts approved in 2009, 18 were Type A, 109 Type B, none Type C. 7 This means that during the period March 2008 to September 2009 the HSE approved 221 new Consultant posts and 195 replacement. This represents an increase of 10.4% in the number of Consultant posts in an 18-month period. There are now 2,342 Consultant posts in the Irish public health service. Tables setting out the current distribution of Consultant posts and the distribution of additional posts between March 2008 and September 2009 are set out below: Additional Consultant posts approved under Consultant Contract 2008 March 2008 - September 2009 HSE Area Specialty Anaesthesia Intensive Care Emergency Medicine Medicine Obstetrics & Gynaecology Paediatrics Pathology Psychiatry Radiology Surgery Total Dublin MidLeinster 6 2 Dublin North East Total South West 5 2 4 1 16 4 4 2 1 3 10 15 11 10 15 51 3 3 1 7 2 6 12 12 4 66 7 2 8 8 6 54 5 8 6 8 8 55 19 21 36 35 22 221 5 5 10 7 4 46 Permanent Consultant posts in the Irish public health system September 2009 HSE Area Specialty Total Dublin MidLeinster 748 Dublin North East South West 570 497 527 Total 2342 13. Verifying contract delivery Each signed Consultant Contract was reviewed and documented by HSE Internal Audit as part of an internal audit process. This was a key means of ensuring that the significant contribution made by Consultants to the delivery of health services was recognised and recorded, that there was absolute transparency on the delivery of public hospital services and that value was achieved for the resources allocated to contract implementation. The review examined all contracts issued and accepted by consultants employed in the HSE and HSE funded agencies. Each contract was reviewed to identify any alterations to the standard terms and conditions contained in the pro forma contract agreed with the medical representative bodies in July 2008. The review found: x The vast majority of contracts signed by consultants and authorised by the employer were in accordance with the standard terms and conditions; 8 x A relatively small percentage of contracts had been signed as approved by the employer prior to being issued to the employee (none of these contained any anomalies); x A small percentage of contracts were not physically signed as authorised by the employer, but these were included in the employer's records as issued contracts; x A very small number of contracts did contain manual amendments relating to the treatment of private out-patients, however, these were not found to materially affect the standard terms and conditions. The HSE Human Resources Directorate also engaged in a verification process for the 1,385 permanent Consultants who have accepted the offer of Consultant Contract 2008 to confirm that the arrangements below were in place. a) Appropriate standardised Contract documentation b) Increased working hours, particularly: i. the service gain resulting from the increase from 33 to 37 scheduled weekly working hours. ii. The extent of service delivery over an extended working day as required (8am to 8pm in contrast to 9am to 5pm). iii. The introduction of scheduled overtime on Saturdays, Sundays or bank holidays in place of C Factor payments, the service gain arising and cost basis for same. c) New measurement arrangements for Public Private Mix, particularly: i. measurement arrangements regarding each of the Consultant's clinical activities, including Inpatient, daycase, outpatient and diagnostics - Section 20 and 21 of Consultant Contract 2008 refer. ii. The extent to which there is compliance with the specified ratio of public:private practice iii. The extent to which a single waiting list for outpatient diagnostics has been introduced in line with Section 21. d) The appointment of Clinical Directors The verification process concluded in March 2008. 14. Payment to Consultants Following the HSE's verification process and to ensure the gains to patient services from the new contract were secured, the Minister for Health & Children set out in a statement on the supplementary budget of the 7th April 2009 that the Consultant Contract was to be implemented on the basis of part payment of the new Consultant Contract salary rates. Approximately half of the differential between the 1997 and 2008 salary rates was to paid in 2009 as and from 1st January 2009. The original payment schedule had identified the new rates for Consultants accepting the new contracts to apply from the 1st June 2008. The other half scheduled for the 1st June 2009 was not sanctioned and has not been sanctioned to date. The HSE has no authority to make payments other than those approved by the Minister for Health & Children. 15. Implementing Public Accounts Committee recommendations The 3rd Interim Report of the Public Accounts Committee on the 2006 Report of the Comptroller and Auditor General regarding health service expenditure recommended that: 9 x x x x the new contract should provide absolute transparency on the time commitment to public hospital duty of Consultant staff: These commitments should be monitored and enforced in order to ensure that value is received for the salaries paid to Consultants the HSE should introduce a stringent monitoring regime of public and private caseloads in hospitals and publish data on the level of private practice in public hospitals; the terms of the 1997 contract should be strictly enforced in respect of those consultants who do not transfer to the new contract so that these consultants are seen to deliver services in accordance with their commitments six-monthly progress reports should be provided to the Minister for Health and Children. The HSE's implementation of key provisions of the 2008 Contract has significantly addressed the recommendations of the Oireachtas Public Accounts Committee regarding Consultant Contracts. In addition, the HSE has moved to ensure that the provisions of Consultant Contract 1997 regarding the Consultant's private practice being aligned with the number of designated private beds is enforced. The HSE will be taking further measures to implement these recommendations in coming months. 10 Appendix I - Clinical Directors appointed under Consultant Contract 2008 Clinical Directors in the acute hospital setting Hospital Network and Network Manager North East Hospital Groups Clinical Director 1 Louth Meath Hospital Group Interviews in Mid-October 2009 2 Regional remit Dr Alan Finan, Consultant Paediatrician 3 Cavan Monaghan Hospital Group Dr James Hayes, Consultant Physician & Gastroenterologist 4 5 Dublin North Dublin South South East Prof Shane O'Neill Prof J Conor O'Keane 6 Rotunda Hospital Dr Sam Coulter Smith, Consultant Obstetrician & Gynaecologist 7 Connolly Hospital Dr Patricia McCormack, Consultant Geriatrician 8 St. James' Hospital Dr Barry White 9 10 Dublin Midlands Beaumont (Incl. the National Rehabilitation Hospital) Mater Misericordiae Hospital (Incl. Cappagh National Orthopaedic Hospital) St. Vincent's University Hospital (Incl. St. Michaels), St. Colmcille's & The Royal Victoria Eye & Ear Hospital National Maternity, Holles Street Dr Risteard O Laoide Dr Peter Boylan, Consultant Obstetrician & Gynaecologist 11 ADMiNCH Tallaght Dr John Barragry, Consultant Physician 12 Naas General Hospital Dr Catherine Collum 13 Tullamore General Hospital Dr Gerard Crotty, Consultant Haematologist 14 Mullingar General Hospital Dr Ron Charles, Consultant Anaesthetist 15 Portlaoise General Hospital 16 Coombe Women's Hospital 17 Waterford Regional Hospital 18 Wexford General Hospital Dr Colm Quigley, Consultant Physician 19 St. Luke's Hospital, Kilkenny Dr Garry Courtney, Consultant Physician 11 Dr John Connaughton, Consultant Physician Dr Chris Fitzpatrick (Master of Coombe) filling position on temporary basis pending interview process Dr Rob Landers, Consultant Histpathologist 20 South Tipperary General Hospital Dr Aamir Majeed 21 CUH (Incl. Mallow & Bantry) Professor Richard Greene 22 Kerry General Hospital, Tralee Dr Richard Liston, Consultant Physician 23 South Infirmary/Victoria Hospital Mr Denis Richardson, Consultant General Surgeon 24 Mercy University Hospital 25 Mid-western Regional Hospital 26 Galway University Hospitals 27 Portiuncula Hospital (Incl. Roscommon) 28 Mayo General Hospital, Castlebar Dr Michael O'Neill, Consultant Paediatrician 29 Sligo General Hospital Dr Paul Mullaney 30 Letterkenny Hospital Southern Mid-west West/Northwest Other Clinical Directors Dr Anthony Dempsey, Consultant Obstetrician & Gynaecologist Mr Jack McCann Dr Gerry Clarke, Consultant Physician Dr Paul O'Connor, Consultant Anaesthetist 31 National Renal Programme Dr Liam Plant 32 Southern Reconfiguration Prof John Higgins 33 MidWestern Reconfiguration Mr Paul Burke 34 National Cancer Control Programme Mr Arnie Hill 35 National Cancer Control Programme Prof Donal Hollywood 36 National Cancer Control Programme Prof Maccon Keane Total Appointed Acute Sector 35 and 1 outstanding 12 Clinical Directors in Mental Health Area 1 Dr Jack O'Riordan Con Psychiatrist (Adult) 6 Waterford/Wexford Dr Noel Shepard Consultant Psychiatrist 7 Carlow/Kilkenny Dr Francis Kelly Consultant Psychiatrist 8 North Dublin Mental Health Located at St Ita Dr. Mary Cosgrave Consultant Psychiatrist (Old Age) 9 Louth/Meath/Cavan/Monaghan Dr Anne Jackson, Consultant Psychiatrist 3 4 10 11 12 Dublin MidLeinster Limerick Mental Health Services Located at Churchtown Day Hospital 5 West Dublin North East Clinical Director Sligo Mental Health Services Located at Ballytivnan Sligo Galway Mental Health Services Located at St Brigids Hospital Ballinasloe North Lee/North Cork Adult Mental Health Services Located at North Lee South Lee/WestCork/Kerry Adult Mental Health Located at South Lee 2 South Remit 13 14 North West Dublin/Dublin North Central Wicklow Adult Mental Health Service located at Newcastle Hospital Dublin West, South West Adult Mental health Service located in St Lomans Palmerstown Laois Offaly Mental Health Service National Forensic Mental Health Service Located at Central Mental Hospital Dundrum Total Appointed in Mental Health Services Overall Total Dr Owen Mulligan Consultant Psychiatrist (Adult) Dr Kieran Power Clinical Director Dr Maeve Rooney Consultant Psychiatrist (Adult) Dr Eamon Moloney Clinical Director Dr Margo Wrigley Consultant Psychiatrist (Old Age) Dr Justin Brophy A/Clinical Director Dr Ian Daly Clinical Director Dr Maurice Gervin A/Clinical Director Dr Harry Kennedy Clinical Director 14 49 (one post to be filled) 13 Note on measurement of public private mix under Consultant Contract 2008 - 21st October 2009 Set out below is an update from each Hospital Network by HSE Area on the issues related to compliance with public private measurement under Consultant Contract 2008. HSE Dublin North East The Network Manager in the Dublin North area has written to Hospitals in that group pointing out the number of non compliant Consultants in each Hospital and Hospital Managers have been requested to issue formal letters immediately. Compliance levels are particularly high in this area. The number of non compliant Consultants in the North East area is small and informal meetings have taken place at the Louth, Meath and Cavan, Monaghan Hospital groups. Individual action plans to address non compliance have been agreed with the Clinical Directors and timelines agreed. HSE Dublin Mid-Leinster Private Day Case activity levels at Crumlin are recorded as significantly higher than contractual limits, as is the percentage of Consultants with activity in excess of the permitted limits. The Network Manager in the Dublin Midland area has written to all Hospitals in that group pointing out the number of non compliant Consultants in each Hospital and Hospital Managers have been requested to issue formal letters immediately. The National Maternity Hospital, Holles Street and the Royal Victoria Eye and Ear are recording a high percentage of Consultants in excess of their contractual limits and high overall private activity levels. The Network Manager in the Dublin South area has written to the two Hospitals with problems highlighted in that group pointing out the number of non compliant Consultants in each Hospital and Hospital Managers have been requested to issue formal letters immediately. The Network manager has also identified this as a priority for the new CEO at RVEEH who took up post on 21/9/2009. The Clinical Director has also been involved. HSE West Consultants in the West area have been contacted individually. The number of non compliant Consultants is small and issues surrounding the volume of emergency workload are emerging i.e. the difficulty of managing large emergency case loads within the confines of the 2008 Contract. This is being followed up with the Network Manager. The Mid Western Regional Hospitals and St. Johns Hospital in Limerick are recording very high percentage rates for Consultants in excess of their permitted private activity levels and high overall hospital activity levels. It should be noted that private bed designations in Limerick have been traditionally high due to the absence of a private inpatient facility in the city e.g. the designation of private beds by the Department of Health and Children for St. John's Hospital is 45%. In addition, only 3 Consultants in St. Johns Hospital have taken up the 2008 Contract. Consultants at the regional Hospitals who are not compliant have received letters in relation to same from the Hospital Manager. HSE South A significant percentage of Consultants in Waterford Regional Hospital are outside of their contractual limits, however, the rolled-up figures for private activity at the hospital are under 30%, suggesting that Consultants may be marginally exceeding their limits. The South East Network 1 area has been particularly active on this both formally and informally. 14 letters have issued to Consultants who are outside of their contract limits to date. Over 50% of the contract holders at Cork University Hospital are exceeding their contractual limits for private practice, with significant non-compliance indicated in day case activity levels. The Mercy and South Infirmary Hospitals are reporting a very high percentage of Consultants outside of their contractual limits, as well as high rolled-up levels of private activity at overall hospital level. The Clinical Directors in the Southern Network area are reviewing the private practice activity data and ratios. They are now progressing to formal meetings and correspondence. Measurement issues A small number of measurement issues remain outstanding. x The backlog of HIPE coding in the South East is a continuing issue and means that reports are being produced on the basis of 80% approximately of activity coded on HIPE. x PAS generated reports (as opposed to HIPE) still feature at the Mercy and Bantry Hospitals in the South. Measures to address this are underway. x Diagnostic data is not being furnished at Mayo and Limerick Hospitals. It should be noted that all Consultant Radiologists in Limerick Regional opted to remain with the 1997 Consultant Contract. x HIPE coding issues remain outstanding at Tallaght and diagnostic activity manual data is not being supplied. x Diagnostic activity data for the manual generation of reports is not being supplied by Consultants in Crumlin. Patterns and Trends 2009 Performance in relation to the collection and measurement of activity has improved significantly during the course of 2009, with only a handful of outstanding issues to be dealt with as outlined above. The pilot on-line collection of OPD activity is working well and should address residual issues over the next few months. Review of the private activity figures for the bigger hospitals suggests little change on a month by month basis in relation to the majority of hospitals. Activity patterns in the following hospitals have moved as follows in the period from January 2009 to September 2009. Waterford No significant change in inpatient activity. Private day-case activity has increased from 10% to 25%. Cork University Hospital No significant change in inpatient activity. Private day-case activity has increased from 31% to 45%. Tallaght Private inpatient activity has moved from 17% to 31% - however there have changes in the activity coding arrangements from mid year. Crumlin Private inpatient activity has reduced from 34% to 25%. Preparation of the next monthly report is underway. It is anticipated that it will include the number of Consultants holding Consultant Contract 2008 per hospital and standard deviations. It will also include a monitoring mechanism for follow up on compliance. 2 Oireachtas Committees from 1st September 2009 ?- 14th June 2010-06-24 Committee th Date Joint Oireachtas Committee 8 September 2009 on Health (JCHC) 7th October 2009 9th February 2010 9th March 2010 23rd March 2010 20th April 2010 1st June 2010 Public Accounts Committee (PAC) 5th November 2009 17th December 2009 4th March 2010 10th June 2010 Topic Issue relating to swine flu Update on Health & HSE issues Update on Health & HSE issues Healthy Eating, Combating Obesity and Eating Disorders Centralisation of Medical Card Services Mental Health National Drug awareness campaign under the National Drug Strategy 2008 C&AG Chapter 37 & 39 Special Report Number 64 Drug Addiction Treatment & Rehabilitation 2008 C&AG Chapter 38 & 40; & the 2008 Financial Statement Correction of evidence given to the Committee on the 4th March meeting Public Accounts Committee 5th November 2009 Private Patient Income Briefing Note Actions taken on foot of Comptroller and Auditor General's Report 2008 The Health Service Executive fully accepts that the delay in recovering private insurance accommodation claims is excessive and has set in motion a number of initiatives to resolve this issue. The timeliness of debt recovery is a cash flow issue for the H.S.E. and 97% of all private insurance claims are ultimately paid by the insurer. No patient services have suffered as a result of this delay in cash payments. A number of actions have been initiated by the H.S.E. to address this particular issue: Hospital Managers have been instructed by Senior Management to reduce their debtor days down to 60 days initially and budget sanctions will be imposed on Managers who fail to reach this target in 2010. Our ultimate target is to move to 30 days. The H.S.E. has negotiated with the V.H.I. to introduce an improved payment arrangement. A cash acceleration of EUR50m has been agreed with V.H.I. for a period of six months from receipt, this money is anticipated in the last quarter of 2009. We are now pushing for all private insurers to accelerate payment or we will take further steps to achieve this. We are introducing incentives for consultants to sign their claim forms on a timely basis. This is linked to a more general issue relating to the coding of hospital cases on a timely basis. Specifically we are considering the possibility of direct billing patients where the consultant has not signed the claim form within 30 days of discharge and also possible limitations on admission rights if there is no improvement over time. Targets for income for all hospitals in 2010 will be based upon a reduced number of days and this will be implemented through the budgeting process. A concentration of effort on Private Insurance income collection has been ordered by me. The focus at individual hospital level on the issue will be concentrated on; 1. ? ? Follow up of claims which have been submitted already but not yet settled, i.e. any outstanding queries to be addressed as a matter of urgency. Compile and clear any outstanding claims that are awaiting submission to the Health Insurer. 2. All the Hospital CEO's and Finance Managers/Accountants are being circulated again with the National Director's memo dated 21/10/2009, instructing urgent action on this issue (copy attached Appendix I) and followed up with a phone call to the Hospital Chief Executive from the respective Regional Director of Operations (R.D.O) to highlight the importance and urgency of addressing outstanding private insurance payments. 3. Clinical Directors are being asked to assist as necessary in addressing difficulties that may arise at individual Consultant level. Liaison with all Private Insurance Companies A high level group chaired by a Hospital Network Manager and with representatives from H.S.E Finance and Voluntary Hospitals continues to negotiate with the Private Insurance Providers on business processes and the reduction of debtor days and with the following terms of reference. - Streamlining transaction processing and data exchange Setting parameters for private and semi-private charges by public hospitals both voluntary and statutory Billing and payment methods Implications of new Consultants contract. Level of debt Administration of Private Insurance claims process. Service Level Agreement The ultimate focus of the above high level group is to formulate a Service Level Agreement with the private insurers to streamline agreed business terms and ensure payment of hospital accommodation bills within 30 days in accordance with normal business terms and conditions. Electronic Submission of Claims Negotiations are ongoing with the Private Insurance providers to implement electronic exchange of data which will significantly speed up the claims and payment process. The H.S.E is working with the Department of Health and Children and the Department of Finance with a view to implementing electronic submission of claims data in the bigger Voluntary and H.S.E hospitals in the first instance. Signoff by Consultants The H.S.E has secured agreement with the major insurance providers for signoff of claims by a secondary Consultant Clinician where the primary Consultant has failed for whatever reason to signoff in a timely manner. Centralised Billing Approval has been obtained from the Department of Health and Children and the Department of Finance to commence the centralisation of the entire H.S.E billing system which will lead to streamlining of this process and focus the attention on collection of all outstanding debts. Bed Designation The H.S.E is working with the Department of Health and Children with a view to implementing flexibility in the Private bed designation of individual hospitals throughout the public hospital system notwithstanding the realisation that it is government policy not to increase the overall number or percentage of private beds. This will facilitate maximum generation and collection of private patient income. Audit Committee of the H.S.E Debt collection is now a standing item on the agenda for the H.S.E. Audit Committee and the focus continues to be on the performance of individual hospitals in the management of their patient debt. Hospital Managers have been informed that failure to improve on their debt collection rates where applicable will result in budget sanctions which equate with the level of non compliance. Consultants Contract Category A The H.S.E continues to be of the view that private patients who wish to avail of private accommodation and are admitted by Category A consultants are liable for private accommodation charges where these are availed of by the patient. We are currently clarifying this matter with the Department of Health and Children. 28th October 2009 Finance Directorate Report on Consultant Private Practice Measurement Monthly Report (covering HIPE Reporting Period February, March & April 2009) South Eastern Hospitals Group - Feb 09 - Apr 09 Inpatient & Day Care Reports Wexford General Hospital Current Status Reports issued Waterford Regional Hospital Reports issued St. Luke's General Hospital, Kilkenny Lourdes Orthopaedic Hospital, Kilcreene, Kilkenny South Tipperary General Hospital, Clonmel Reports issued Reports issued As part of WRH Reports issued Note: *IP = Inpatients, *DC = Daycases. *PAS = Patient Administration System % overall Private Practice (Case mix adjusted) Percentage of eligible Consultants within contract limit OPD Reports Diagnostic Reports IP 23% DC 22% IP 83% DC 72% Current Status Reports Issued Reports Issued Current Status Awaiting data from Radiology Dept to issue report Reports Issued IP 27.7% DC 25.8% Based on 82% coded on HIPE IP 22% DC 13% _______ IP 56.7% DC 53.73% Based on 82% coded on HIPE IP 86% DC 95% __________ Reports Issued Reports Issued IP 23% DC 37% IP 61% DC 76% Reports Issued _________ ________ Reports Issued Report on Consultant Private Practice Measurement Southern Hospitals Group - Feb 09 - Apr 09 Inpatient & Day Care Reports Cork University Hospital St. Mary's Orthopaedic Hospital, Cork Current Status Reports issued Reports issued % overall Private Practice (Case mix adjusted) Percentage of eligible Consultants within contract limit IP:34.8% DC:45.8% IP: A:100% B:46.8% B*:66.7% IP:31.3% DC:30.1% DC: A:100% B:36.7% B*: 33.3% IP: A:100% B:69.2% B*:N/A Mercy University Hospital, Cork Reports issued (PAS) IP:41.2% DC:44.5% DC: A:100% B:46.2% B*:N/A IP: 23% DC: 41% South Infirmary-Victoria Hospital, Cork* Reports issued IP:40.6% DC:44.4% IP: 50% DC: 50% Mallow General Hospital Reports issued IP:33.1% DC:46.3% IP: A:100% B:37.5% B*:N/A DC: A:100% B:37.5% B*:N/A OPD Reports Diagnostic Reports Current Status Exempt Current Status Radiology Reports Issued N/A Radiology Reports Issued PAS reports available next month No Private Practice Not known when reports will be available No Private OPD N/A Reports Issued Report on Consultant Private Practice Measurement Southern Hospitals Group - Feb 09 - Apr 09 (continued) Kerry General Hospital Reports issued IP:24.8% DC:9.4% IP: A:100% B:69.23% B*:100% No Private OPD Reports Issued No Private OPD Reports Issued DC: A:100% B:61% B*:100% Bantry General Hospital Reports issued (PAS) 3.6% *Please note 54.6% of cases were uncoded when the HIPE reports were run. Status Report on Consultant Private Practice Measurement West/North Western Hospitals Group - Feb 09-Apr 09 Inpatient & Day Care Reports % Private Practice (Case mix adjusted) Proportion of Consultants within contract limit OPD Reports Diagnostic Reports Current Status Reports issued Inpatient Daycase Inpatient Daycase 15% 11% 100% 100% Current Status Reports issued Current Status Reports issued Reports issued 17.3% 25.4% 90.1% 71.4% Reports issued Reports issued Roscommon County Hospital Portiuncula Hospital Reports issued 24.3% 20.1% 45% 60% Reports issued Reports issued Reports issued 30.30% 40% 58.82% 82.35% Reports issued Reports issued University College Hospital, Galway Merlin Park Regional Hospital Mayo General Hospital Reports issued 25.6% 15.9% 55.6% 76.2% Reports issued 16.2% 9.2% 79.9% 78.3% Reports issued 19.4% 24.8% 62% 54% Reports issued (1/4ly as agreed) Reports issued (1/4ly as agreed) No private OPD Service Reports issued (1/4ly as agreed) Reports issued (1/4ly as agreed) Information requested but not yet provided by consultants. Letterkenny General Hospital Sligo General Hospital Report on Consultant Private Practice Measurement Mid Western Hospitals Group - Feb 09 - Apr 09 Inpatient & Day Care Reports Nenagh General Hospital Current Status Reports issued Mid Western Regional Hospital, Ennis Mid Western Regional Hospital, Dooradoyle Reports issued Mid Western Regional Maternity Hospital Mid Western Regional Orthopaedic Hospital St. John's Hospital Reports issued Reports issued Reports issued Reports issued % overall Private Practice (Case mix adjusted) Percentage of eligible Consultants within contract limit OPD Reports Diagnostic Reports IP 20.9% DC 36.2% IP 66.6% DC 66.6% Current Status No Private OPD Current Status N/A IP 16.8% DC 16.9% IP 41.7% DC 49.7% IP 87.5% DC 87.5% IP 41% DC 50% Reports issued N/A Reports issued IP 55% DC n/a IP 36.8% DC 36.8% IP 16% DC 60% N/A Information requested but not yet provided by consultants. N/A IP 38.7% DC n/a IP 60.7% DC 60.9% IP 46.4% DC 38.2% Participating in pilot web based solution. No Private OPD N/A Reports issued Report on Consultant Private Practice Measurement North Eastern Hospitals Group - Feb 09 - Apr 09 Inpatient & Day Care Reports Louth County Hospital Current Status Reports issued Our Lady of Lourdes Hospital, Drogheda Our Lady's Hospital, Navan Reports issued Monaghan General Hospital Reports issued Cavan General Hospital Reports issued Reports issued % overall Private Practice (Case mix adjusted) Percentage of eligible Consultants within contract limit IP 21.20% DC 33.50% IP 27.00% DC 19.70% IP 19.40% DC 33.40% IP 16.44% DC 33.84% IP 66.66% DC 33.50% IP 54.00% DC 73.00% IP 83.00% DC 55.50% IP 66.67% DC 33.33% IP 16.05% DC 3.71% IP 85.71% DC 85.71% OPD Reports Diagnostic Reports Current Status No Private OPD Data collected from August (Nov report) Reports issued Current Status Data collected from August ( Nov Report) Data collected from August (Nov Report) Data collected from August ( Nov Report) Reports issued Reports issued Reports issued No Private OPD From August 2009, information on OPD reports and Diagnostic Reports in the Louth/Meath Hospital Group are recorded. Report on Consultant Private Practice Measurement Dublin Midlands Hospitals Group - Feb 09 - Apr 09 Inpatient & Day Care Reports % overall Private Practice (Case mix adjusted) Percentage of eligible Consultants within contract limit Current Status Adelaide & Meath & National Children's Hospital, Tallaght Coombe Women's Hospital Reports issued Reports not issued OPD Reports Diagnostic Reports Current Status Current Status Automation of diagnostics is still work in progress IP 31% DC 31% IP 86% DC 64% Reports issued IP 27% DC 45% We estimate overall compliance is being achieved. Percentage of private patients booking into the hospital is 16%. Our Lady's Hospital for Sick Children, Crumlin Reports Issued 25.5 IP 43.9 DC IP 51 consultants out of total of 77 ie 66% within allowed workload ratio. DC 32 consultants out of total of 77 ie 41% within allowed workload ratio. Reports have been produced but we have not received the % to date. Based on private activity in hospital, the CWIUH estimate that overall compliance has been achieved. Diagnostic Consultants have been requested to supply the information and templates have been issued for collection of same. the activity in the total denominator. Naas General Hospital Reports Issued Weighted HIPE report used No breaches 2.0 IP 14 DC Confirmation received of 1 Consultant doing private OPD work Consultant 1 - 6% Private The GM has confirmed that of the 4 consultant radiologists 2 have confirmed they can and will supply the information. The GM expects all will supply the figures. Radiologist 1 - 4% private Radiologist 2 - 4% private Naas operate a common waiting list for radiology. Midland Regional Hospital, Mullingar Reports Issued 14.2 IP 21.3 DC 3 cons> target IP 78.57 compliance 5 cons > target DC 64.29 compliance 3 of 11 Consultants have given private OPD figures, others have just not responded. Requests for data issue and template supplied. Update requested. Reports issued 4 Consultants returning OPD. Private Ratios are as follows - Reports issued. 1 Consultant Anaesthetist returning diagnostics. Private Midland Regional Hospital, Tullamore Reports issued Midland Regional Hospital, Portlaoise Reports Issued 26.3 IP 25.1 DC IP 74% DC 81% IP 20% DC 45% IP 2 cons > target 86.67 compliance DC 4 cons > target 77.78 compliance Dr. 1 - 22% private Dr. 2 - 25% private Dr. 3 - 13% private Dr. 4 -15% private ratio is as follows - Dr. 1 - 34% private Report on Consultant Private Practice Measurement Dublin South Hospitals Group - Feb 09 - Apr 09 Inpatient & Day Care Reports St. Vincent's, Elm Park Current Status Reports issued St. Michael's, Dun Laoghaire Reports issued St. Colmcille's Hospital, Loughlinstown National Maternity Hospital, Holles Street Royal Victoria Eye & Ear Reports issued St. James's Hospital Reports issued Reports issued Reports issued % overall Private Practice (Case mix adjusted) Percentage of eligible Consultants within contract limit IP 21% DC 1% IP 16.82% DC 16.58% IP 9.4% DC 34.2% IP 41% DC 39% IP 44.4% DC 37.4% IP 23% DC 20% IP78% DC 92% IP 83.18% DC 83.42% 92% IP 32% DC 32% IP 33% DC37% IP 75% DC 94% OPD Reports Diagnostic Reports Current Status No Private OPD Current Status Reports Issued No Private OPD Reports Issued No Private OPD Reports Issued Reports Issued Reports Issued Reports Issued Reports Issued No Private OPD Reports Issued Report on Consultant Private Practice Measurement Dublin North Hospitals Group - Feb 09 - Apr 09 Inpatient & Day Care Reports Mater Misericordiae University Hospital Beaumont Hospital Current Status Reports issued Reports issued Connolly Hospital Reports issued Rotunda Hospital Reports issued Children's University Hospital, Temple Street Cappagh National Orthopaedic Hospital Reports issued Reports issued % overall Private Practice (Case mix adjusted) Percentage of eligible Consultants within contract limit *IP 23% DC 14% IP 30.2% DC 14% IP 13.3% DC 12.3% *IP 70% DC 82% IP 70.89% DC 81.01% IP 100% DC 100% IP 32% DC 54% IP 29.8% DC 35.7% IP 27.40% DC 30.50% IP DC IP 71.21% DC 60.61% IP 67% DC 64% * Data for Feb to April period awaited. Figures quoted are for the Jan to March period. OPD Reports Diagnostic Reports Current Status No private OPD Current Status Reports issued No private OPD Clinics Reports Issued Information requested from Private Clinic Reports Issued Reports Issued 100% compliant Reports Issued