Day Surgery Key To Hitting NHS Targets

More patients should be having day surgery if Wales is to meet challenging waiting time targets, an influential report will say today. The National Assembly’s audit committee believes that unless day surgery rates improve, the NHS will not achieve significant government milestones.

The Welsh Assembly Government wants 85% of patients having planned surgery to be discharged from hospital in just 48 hours. And by 2009, the maximum waiting time will be 26 weeks from the time a patient is referred by their GP to treatment – the current waiting time target is eight months for inpatient treatment and for an outpatient appointment.

But Wales is lagging behind the rest of the UK in the number of patients who are admitted, operated on and discharged on the same day. Some Welsh NHS trusts will not even meet the Assembly Government’s day case efficiency target of 75% for those procedures which are suitable for day surgery, despite a £30m investment in facilities.

The day case rate in Wales is currently 60% compared with England’s 68%. And the audit committee found that, except for cataracts, day surgery rates had barely improved in the past five years, even though the default position for all elective surgery is that it should be carried out on a day surgery basis wherever appropriate.

Stefan Coghlan, chairman of the BMA’s Welsh consultants’ committee, said, “Day surgery is a crucial aspect of the 2009 targets and the Assembly Government has come to realise quite late that we should be emphasising day surgery. There is significant potential to improve day surgery rates in Wales, but facilities are not as good as they could be.”

Janet Davies, chair of the audit committee, said, “Overall, we concluded that day surgery rates remain too low in Wales and the Assembly Government’s increased recognition of the importance of day surgery needs to translate into measurable improvements in day surgery rates and concerted action to tackle the main barriers to day surgery provision.”

The committee’s report, which is published today, reveals that although day case rates did improve overall between 1999 and 2004, this was mainly the result of a considerable improvement in the rate for cataract extraction – one of the original waiting list target areas. But when cataracts are excluded from the group of 25 procedures, the overall improvement was less than 0.5% and eight NHS trusts saw a decline in their day surgery rates.

Ann Lloyd, chief executive of the NHS in Wales, said, when giving evidence to the audit committee, that Wales had been slower than England in putting in place the infrastructure, guidance and policy direction to support day surgery. Wales’ different political approach to health compared with England – which concentrated on improving waiting times – could also be responsible for low day surgery rates.

Mrs Lloyd said “In Wales, we quite rightly determined that we could move all the waiting times and lists that we liked, but unless we started to attack the fundamental problem of ill health, whatever we tried to do, we were on a treadmill.”

The audit committee’s report said patients had yet to be “persuaded” that day surgery is a good option, including being reassured that it is safe for them to be discharged so soon after surgery.

But Jeremy Colman, the Auditor General for Wales, said in his report on day surgery last year, that it is beneficial to patients as it reduces the length of time they are in hospital and the risk of infections.