Published: 26/05/2005, Volume II5, No. 5957 Page 25
It is 15 years since the Audit Commission pressed the NHS to improve efficiency by performing more operations as day cases. It identified a basket of 25 procedures and suggested hospitals should treat 75 per cent as day cases. Research from Dr Foster shows we are still some way from achieving this.
The first table shows the change in day cases in each strategic health authority from the Q4 2003 to Q4 2004, from a 6.1 percentage point increase in Hampshire and Isle of Wight SHA to a fall of 3.1 points in Cumbria and Lancashire SHA. The average is a 1-point rise to 69.5 per cent. The only authority to hit the target is South West London SHA.
The second chart contrasts the change in daycase rates per procedure over the past nine years.
In the case of cataracts (36 points higher), the increase is almost certainly the result of trusts focusing on a high-volume operation - where the largest cost saving is likely to be. But in fact, there is not a strong correlation between the percentage improvement and the volume of cases.
This also highlights what seems an odd inclusion of certain procedures. For example, despite an improvement in laparoscopic cholecystectomy, only 5 per cent of operations are day cases. But by volume it is the tenth most common procedure. So a trust with a high volume of these is at a significant disadvantage.
The second chart also shows the SHA with the highest percentage of day cases for each procedure. There is a more significant range between trusts that handle almost all of certain operations as day cases and those that do not handle any. This may be because some trusts record some of these conditions as outpatients.
The difficulty of achieving the overall target is clear again. Thames Valley SHA, the most successful in converting laparoscopic cholecystectomy, handles only 15 per cent of these as day cases. Similarly, while the number of haemorrhoidectomy day cases has risen quickly, there is significant variation: from 52 per cent for Shropshire and Staffordshire SHA to 5.9 per cent for Cheshire and Mersey SHA.
The increase in day cases is generally slow and variable. In some instances there seems to be nervousness to handle some procedures as day cases. It is difficult to tell whether this is because of a varying take-up of new technologies or simply inertia in clinical methodology. .
Dr Marc Farr is product development manager at Dr Foster (phone 020-7256 4916 or visit www.
drfoster. co. uk). The next Dr Foster page is on 12 May and will cover emergency admissions.