Recent research by Dr Foster and the NHS Institute analyses productivity opportunities across a range of key areas such as reductions in emergency admissions, statin prescribing and increases in day-case rates. For the last of these there the most recent quarter shows an opportunity of£12m, down from£16m in Q1 2006. This data-briefing provides a more detailed drilldown by SHA, over time and by procedure to highlight where some of these opportunities still exist.
The first table shows the latest position on day-case rates by strategic health authority for the period to Q4 2006. Compared to the Healthcare Commission’s 75 per cent day-case target for a basket of 25 agreed procedures there remains significant variation. But within this is a good news story, since the last time this data briefing was presented (to Q4 2005) there has been a 4.2 per cent improvement acrossEnglandto 70.2 per cent.
However despite the increase there is still not one SHA which can claim to have achieved the target. South Central is closest and with an average of 74.3 per cent is likely to have a number of trusts that have achieved the target. North East is worst, 67.5 per cent, and is thus likely to contain trusts which still have a policy of admitting patients more often for procedures which can be conducted without the need for a stay.
The second table sets this figure in context by providing the trend for all procedures going back to the beginning of 2001 when just 1 in 2 procedures were conducted as day cases. In the space of five years that figure has improved to almost 3 in 5 procedures being carried out without a stay in hospital.
Aside from the clear monetary saving this implies there is presumably a massive improvement in patient experience with patients consistently claiming they would always prefer to spend as little time as possible in hospital whether it is the greater demand for home births, the move to provide greater levels of diagnostics and self care in primary care or simply general concern about the levels of infection recorded in hospital.
Drilling down in more detail the third table shows, for a range of relatively high volume procedures, the variation in the day case rate by SHA. Not surprisingly there is a reasonably strong negative correlation between the number of procedures conducted and the difference in the DCR by SHA. This is demonstrated by two extractions; tooth and cataract respectively show a difference of just 7 per cent and 6 per cent between the best and worst performing SHAs. There are however a number of procedures where these differences are significant and must imply variation in clinical protocol. These include for example Tonsillectomy where inLondon28.5 per cent are done as day cases, in the North East almost none are done this way. Certain types of pregnancy terminations are done as day cases 62 per cent of the time, the equivalent procedures in theWest Midlandsare only done this way 25 per cent of the time.
While the opportunities published as part of the productivity metrics only show a relatively small amount, plans to incorporate a wider range of procedures, those covered by the British Association of Day Surgery should increase the attention on gains to be made by changing patient pathways in this place. With all the attention for next year set to be on the 18 week target, providing procedures as day-cases and outside of secondary care should be paramount in service configuration decisions.
Next month’s data briefing covers the topic of PCT spend and HRG drift.
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