VAST BUREAUCRATIC WASTE IN BRITAIN

Nearly half of the time allocated for day surgery in hospitals is lost to late starts, cancelled operations and excessive delays between patients, according to a report. A review by the Healthcare Commission has found that the average day surgery theatre is being used effectively for only 16 hours a week, placing other parts of the NHS under pressure. The report on day surgery in England concludes that at least an extra 74,000 patients a year could be treated, rather than admitted as in-patients, if hospitals were more efficient, freeing beds for more serious cases. A quarter of day surgery units were found to cancel one in ten admissions, while half of patients had not been assessed for suitability before they arrived for their operation.

Day surgery — when a patient is discharged on the same day — includes many non-emergency operations that usually require a general anaesthetic, such as hernia repairs, removal of cysts and bunions, and treating cataracts. It has many advantages for patients and the NHS. It helps to reduce waiting times, allows people to recover at home — avoiding the stress of mixing non-serious patients with the more seriously ill — it limits the risk of cross-infection and gives more cost-effective care.

In the NHS Plan published in 2000, the Government set a target that three quarters of elective admissions should be day cases. However, the commission found that only around two thirds are, some 740,000 operations a year. For some procedures the ratio of day surgery to in- patient admissions has fallen, and some trusts recorded an overall decline in day surgery. The average time allotted to day surgery was 16 hours a week, just over half the planned 30 hours, but one small unit was found to carry out on average only three hours’ work.

Anna Walker, the commission’s chief executive, said that trusts had to improve their handling of day surgery by monitoring patients more closely, cutting down on cancellations and ensuring appropriate staffing levels. “Efficiency and good patient care go hand in hand,” she said. “When operations are cancelled or when patients stay overnight for something which could be done in a single day, patients are inconvenienced and resources are wasted.” Ms Walker said that the commission would talk to the trusts, the Department of Health, other inspectorates and strategic health authorities to ensure that the lessons of the report were acted on. “The worst performers need to learn from the best,” she said.

The report comes after Patricia Hewitt, the Health Secretary, said that high levels of investment in the health service would not continue indefinitely and that trusts should strive to gain the “potential pot of gold” available from simple efficiency savings.

The study, which looked at 313 units in England, also found that one in ten day surgery units cancels more than a third of the available operating theatre sessions and many patients have operations cancelled at short notice. The study also found that overall staff numbers in day surgery units are rising faster than their activity. However, the report highlights improvements in some aspects of patient care and management of day surgery. More patients receive good written information before admission and have the opportunity to choose a convenient date for their operation.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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