Research by Dr Foster and the NHS Institute for Innovation and Improvement analyses productivity savings across a range of areas including reductions in emergency admissions, statin prescribing and increases in day-case rates. For the latter, the most recent quarter shows a saving of £12m, down from £16m in quarter 1 2006. This data briefing provides a more detailed drilldown by strategic health authority over time and by procedure to highlight where some of these savings opportunities still exist.

The first table (see attached document for tables) shows the latest position on day-case rates by SHA for 2006. Compared to the Healthcare Commission's 75 per cent day-case target for 25 agreed procedures, there are still significant variations. Nonetheless, since 2005 there has been a 4.2 per cent improvement across England to 70.2 per cent. However, no SHA has achieved the target. South Central is closest and, with an average of 73.6 per cent, is likely to have several trusts that have achieved the target. North West is lowest at 67.5 per cent.

The second table sets this figure in context by providing the trend for all procedures going back to the beginning of 2001 when just one in two procedures were conducted as day cases. That has improved to almost three in five.

The third table shows, for a range of high-volume procedures, the variation in the day-case rate by SHA. Not surprisingly, there is an unconstructive parallel between the number of procedures conducted and the difference in day-case rate by SHA. This is demonstrated by tooth and cataract extractions, which have a difference of just 7 per cent and 6 per cent respectively between the best- and worst-performing SHAs.

There are a number of procedures where these differences are significant and must imply variation in clinical protocol. These include, for example, tonsillectomy - in London 28.5 per cent are performed as day cases, in the North East almost none.

While the savings published as part of the productivity metrics only show limited 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. 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.