Board Meeting Agenda July 2012 - Birmingham Children's Hospital

Ref. Item Action
when Birmingham City Council is reducing funding for some aspects of
CAHMS and other related services. Both services are looking at current
demand and where they need to be in five years.
• Cancelled Operations continue to be a concern, with 38 operations cancelled
on the day, which was 2.1% of our activity, and a further 25 operations
cancelled the day before. The reasons generally relate to a lack of PICU and
theatre capacity. Gill Derrick, Clinical Director of Specialised Services has
produced a detailed analysis which demonstrates that most cancelled
operations are driven by urgent demand. Urgent unplanned patients are
prioritised to the front of the planned list, which means we cannot always
complete the list. There can also be issues relating to complex patients,
where an operation takes longer than planned. Less complex electives at the
end of the list are then cancelled.
Because we have focused on improving quality through specialist based
theatre teams there is also less flexibility to more patients around.
DE added that theatres run at maximum capacity and the challenge is to
create sufficient headroom within the system to be able to respond to these
urgencies. We could reduce the patient flow, but this would affect our 18-
week wait performance which affects the patient experience in another way.
There are two ways to resolve this problem:
1. Build more operating theatre capacity,
2. Look at operating in ‘retail hours’, later into the evening and on
Saturdays as routine. We do currently do some Saturday lists, but as
it is not routine we pay premium rates.
Work on adopting retail hours has now begun, based on the analysis
undertaken by the directorate.
VD added that the Productive Operating Theatre work may also help address
some of these issues.
The Board raised the following points in relation to cancelled operations:
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Whether we can learn from practices of other organisations.
Whether as a Board we should consider an acceptable minimum
number of cancellations, particularly in view of reputational issues.
The level of confidence that the expansion of PICU will start to
address this issue.
The issues relating to a patient with learning disabilities referred to in
the report.
The Executive Team responded as follows:
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A lot of organisations have looked to industry for learning around
cancelled operations. Sherwood Forest Hospital for example has
partnered with Unipart and they are starting to learn from their
approach to business. This is something we can look at.
We put the patient at the centre of our decision making about
prioritisation. The Executive Team has discussed in depth with the
specialists in the hospital a potential tolerance level and they are very
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