Nick Edwards is quite right to suggest that efficiency indicators do not tell the story behind the numbers ( Comment, page 3, 26th October) so why did the HSJ compound this by labelling us the worst Acute Trust in England for day surgery rates?

Nick Edwards is quite right to suggest that efficiency indicators do not tell the story behind the numbers ( Comment, page 3, 26th October) so why did the HSJ compound this by labelling us the worst Acute Trust in England for day surgery rates?

We are a specialist cancer centre, and as one of the leading centers for clinical trials in Europe, pride ourselves on being at the forefront of innovation.

When it comes to productivity indicators, yes, we come bottom for percentage of day case surgery. Why? Because we hardly undertake any of the operations in the Audit Commission's basket of day case procedures. Less than 7% of our work is surgery, and less than 5% of our patients receive inpatient treatment. Our day case rate across all our surgical procedures was actually 40.5% in the last financial year.

The National Institute for Innovation and Improvement's assessment of our productivity opportunity from day case surgery rates is£16,000. This would place us as 11th out of the 170 trusts assessed, and is only 0.1% of the£16m total inefficiency suggested for day case surgery.

We are keen to be more efficient, but know that our efforts can be better directed at reducing our length of stay and tackling our agency costs - not by looking at this indicator. As a result, this year we are on target for a forecast£1.5 million surplus. We must be finding some efficiencies as we have just revised this figure up to£1.8 million with our SHA - not bad for the worst most inefficient day case rate in the country.

Roger Spencer, Director of Delivery, Christie Hospital trust