Published: 31/01/2002, Volume II2, No. 5790 Page 6
The government drive to offer patients a faster service by expanding day surgery has stalled due to a combination of lack of will, shortage of capacity and the focus on achieving inpatient waiting-list targets.
Last week, the government appointed Professor Ara Darzi, an honorary consultant surgeon at St Mary's trust in London, as the Department of Health's advisor in surgery to co-ordinate the day surgery push.One of his first tasks will be to iron out variations in performance, which health secretary Alan Milburn says are too wide: 'More day surgery means less waiting for patients.Reforms to protect planned operations from emergency cases are already in place in some NHS hospitals. I want to give other NHS hospitals the chance to learn from the best.'
But Paul Baskerville, clinical director of day surgery at King's Healthcare trust and president of the British Association of Day Surgery, said the current variations could be explained by lack of will, poor practice and the high priority given to inpatient targets. He said there had been examples of 'chaos' when day units were used to take the burden of inpatients. 'What was bothering us. .is that the need to get waiting time down for surgical inpatients is squeezing day-case beds.
'Day units haven't got the facilities of inpatients in terms of washing and toilets.We have had cases where the day unit was infected with [antibiotic-resistant bug] MRSA, and that was catastrophic.
We have also had the farcical situation where the day unit did not have bathing facilities so a woman was sent home in a taxi to have a bath and then taxied back.'
BADS is working with the NHS Modernisation Agency and Professor Darzi to target the worst-performing trusts. Mr Baskerville said hospitals needed the right support, transport and discharge procedures in place.
'Trusts should automatically think day surgery, rather than inpatient cases. There are dozens of places where there are examples of fantastic day surgery. But around 20 per cent of trusts claim it is purely a capacity problem - they just haven't got a day-unit space. For the rest, there is no good reason - it is just poor process.
'Hospitals do well in terms of overall numbers of day-surgery cases, but the bald figures are bulked out by doing lumps and bumps when the number of hernias, arthroscopies or cystoscopies is lower than it should.'
At present, around 3.2 million operations a year, 50 per cent of all NHS hospital procedures, are carried out as day surgery.While some hospitals achieve over 60 per cent, others only achieve 30 per cent or less, but variations are even wider for some procedures.The best-performing trusts carry out 80 per cent of hernia repairs as day cases, while the worst do only 5 per cent.