Dáil Éireann debate -
Wednesday, 27 Jan 1999

Vol. 499 No. 1

Written Answers. - Surgical Procedures.

Michael D. Higgins

Question:

116 Mr. M. Higgins asked the Minister for Health and Children his views on a clinical audit policy in relation to all surgical procedures; his further views on whether patients have a right to know the success rates for any individual surgeon; and if he will make a statement on the matter. [1943/99]

Minister for Health and Children (Mr. Cowen)

I fully support the development of clinical audit programmes at all levels across the health service, including the area of surgery. The need for development in this area is clearly identified in the health strategy, Shaping a Healthier Future.

I see clinical audit of surgical procedures as just one component of the overall quest for quality improvement in health care. In my view there are a number of prerequisites for the development of a clinical audit programme. These include commitment from hospital consultants, boards and management and the availability of accurate, timely and comparable activity data. The need, in particular, for directly comparable data is critical in assessing the success rates for specific surgical procedures.

In line with the recommendations in the strategy, a number of initiatives have been taken to promote and assist the development of clinical audit at hospital level. For example, the recent negotiated consultant's common contract requires public hospital consultants to participate in a process of clinical audit which is to be resourced and supported locally by the hospital management. The common contract further pro vides for the extensive involvement of clinicians in hospital service management. My Department is currently engaged with health agencies on putting the structures in place which will allow for the implementation of these contractual undertakings.

In addition a national database has been developed which records discharge information on all acute hospital in-patient and day case discharges. Under the hospital in-patient inquiry system a detailed information set is collected on demographic data, diagnostic data, and information on any procedure performed on a patient in the course of his or her hospital stay. This information is available to participating hospitals and is of considerable benefit in developing clinical audit programmes at individual hospital and health board level.

In general the Irish acute hospital sector has compared favourably with its European counterparts over a range of measurement parameters. In line with a move internationally towards a more critical evaluation of outcomes I recently approved the development, on a pilot basis, of an accreditation system for the acute general hospital sector. The objective is to develop a system that would allow Irish hospitals to assess their overall performance against an objectively agreed set of standards and to create an environment of continuous review and improvement. The pilot scheme will initially be concentrated in the larger academic teaching hospitals but will be structured in a way that it will eventually encompass all hospitals in the public acute hospital sector or completion of the pilot phase. I am confident that the availability of a fully-fledged acute hospital accrediation programme will greatly assist in the development of individual quality improvement measures such as clinical audit.