Published: 21/11/2002, Volume II2, No. 5832 Page 8 9

The collapse of the consultant contract could undermine government attempts to increase day case surgery across the NHS, senior doctors have warned.

Paul Baskerville, clinical director of King's College Hospital trust and former president of the British Association of Day Surgery, claimed that many consultants would see managers' demands to introduce more day surgery as motivated by government targets rather than the interests of patients.

Speaking at the Expanding Horizons for Day Case Surgery conference in London, he said: 'The [consultant contract] vote last month has left many people starting to think, 'I am not prepared any more to do what management tells me.We want clinical freedom to do what we want.'

This is one of the battles to change the clinical culture.

'But it is going to be very difficult for those who believe in doing day surgery if we start talking about how It is going to benefit the individual trust. We have got to tell consultants, if we are going to sell the idea, that It is better for the individual patient.'

Day surgery is regarded as one of the government's key weapons in cutting waiting lists and freeing much-needed capacity. The NHS plan says 75 per cent of all elective surgery could be done as day cases.

In October the Department of Health announced a£68m investment to increase day surgery by 70,000 operations a year.

But figures released by the British Association of Day Surgery and the Audit Commission suggest that its full potential has yet to be realised: last year 264,000 bed days - the equivalent of 723 beds - were occupied by patients who could have been treated as day cases.

Mr Baskerville believes patient choice would be a driver for change. Many patients who were not sick, he said, would be prepared to travel for quick and effective procedures that can be carried out as day surgery - particularly cataract operations.

Variations between trusts and between specialties in day surgery were still too great, however, and he blamed areas of poor management, lack of proper facilities and the 'traditional' attitudes of some consultants.

Kingston Hospital trust general and vascular surgeon Professor Paul Jarrett suggested the new tariff scheme being introduced from next year would eventually offer incentives to hospitals to expand the amount of day surgery they carry out.

'It would be a simple question of setting a tariff rate above the costs of carrying out day cases but below the cost of inpatient treatment. That would have a significant effect.'

He too agreed that consultants' attitudes had to change, and medical students had to be exposed to day surgery during training. 'It is like the Catholic church, you have got to get them young, ' he added.

But Barts and the London trust consultant anaesthetist Dr David Wilkinson said: 'I think the issue is about quality of treatments.

'We have heard a lot of numbers [on the possible impact of increasing day surgery] but it is only going to work if day case patients have a quality experience - say, in terms of pain control - once they return home.'