Marc Farr says day-case rates over the last three years have shown little sign of improvement

There has been little improvement in day-case rates over the last three years-just 2.1 per cent from the final quarter of 2002-03 to the same three months in 2005-06, according to the latest Data Briefing from Dr Foster Intelligence. If all trusts achieved the Healthcare Commission’s 75 per cent target across 25 procedures, at least390,000 bed days could be freed up, saving£88m,based on £225 per patient bed day per elective procedure.

The first table shows the latest position on the rate of day-case activity by the new strategic health authorities for the Healthcare Commission basket - the range of procedures deemed achievable as day cases. Trusts shouldaim to carry out three in four as day cases. The average for England is 67.8 per cent. The rate varies between NHS South Central (70.2 per cent), including the old Avon, Gloucestershire and Wiltshire SHA, which traditionally performed well on this metric, and NHS North West at 64.8 per cent.

The figure for the new London SHA masks a range of performance. The old South West London SHA, for example, was one of the best performing and North West London one of the worst. There is no historical comparison on how the reconfigured SHAs have performed on day cases, but context can be provided by looking athowthe former configuration of SHAs performed. This shows that for most of the new SHAs the pace of change is marginal, although NHS North West has improved by 2.5 percentage points and NHS West Midlands by 1.6 percentage points.

The second table shows rates for some of the procedures in the basket and the variation across SHAs. The analysis covers a range of the highest volume procedures, where you would expect the least difference between SHAs. While there is a gap for extraction of tooth, with 97 per cent in London and 80 per cent in Yorkshire and the Humber, both are above the target. For tonsillectomies, 83.9 per cent of the 249 operations in London were day cases while in North East none of the 230 were day cases.

Trusts that took part in the NHS Modernisation Agency’s day-surgery programme demonstrated that it is possible to improve day-case rates by between 6 per cent and 10 per cent in one year. Perhaps acute trusts should be asking themselves, ‘What is the justification for admitting the patient?’ rather than ‘Is the patient suitable for day surgery?’.

Marc Farr is market development manager at Dr Foster Intelligence (phone 020 7330 0472 or visit