Day-case rate variations by SHA

When I recently had a double arthroscopy I was booked in as an inpatient. However, at 9pm I discharged myself to recover at home and saved the NHS the price of a bed for the night.

It would not have been inconvenient for me to stay overnight, but there are others for whom being treated as a day case would have been an important variable in their choice ? if I had been a single mother, for example, with children to put to bed.

In the last Dr Foster Intelligence Data Briefing I suggested that these types of statistics are increasingly likely to be considered by patients in more detail given the context of the government's relentless drive on patient choice.

Another significant factor in how patients make their choices will be whether the procedure, where it is routine, can be conducted without a stay in hospital. Put that in the current climate of the need to make a drastic reduction in costs and the incentive for a hospital to increase its day-case activity doubles.

In data showing the latest position on day-case rates by strategic health authority, South West London continues to record the highest rate. There remains no correlation between the day-case rate and the level of improvement. For example, although Greater Manchester and West Midlands South are among the poorest performers, the former produced a 2 per cent improvement, the latter a 4.7 per cent deterioration.

Looking at the rates for a range of high-volume procedures by SHA, in North London, for extraction of cataract there is a 10 per cent difference between North East and North West, the former completing almost 98 per cent as day cases.

For other procedures, there is a greater divergence. In South Yorkshire, 90.3 per cent of varicose vein-stripping procedures are day cases while in South West Peninsula the figure is 41.8 per cent. In some areas there seem to be different policies. In South West London almost every tonsillectomy procedure is a day case, while in Northumberland, Tyne and Wear nobody is admitted and discharged on the same day.

Dr Marc Farr is market development manager at Dr Foster Intelligence (phone 020-7256 4916 or visist