Scottish audit shows wide variation in use of day surgery

Use of same day surgery varies widely across Scotland, a review has found. It concludes that £8m could be freed up by increasing usage.

The percentage of surgical procedures carried out as day cases has continued to rise in Scotland since targets were first introduced in the 1990s, and all Scottish NHS boards have improved performance. In 2006-7 targets were met on 10 of 19 specific procedures, the audit shows, whereas in 2002-3 only seven of 19 were met.

However, Audit Scotland, which audits public spending, found that the national variation could not be explained by differences in location or in patients’ circumstances.

The worst performing board, NHS Tayside, achieved just under 30% of the targets for day surgery, whereas neighbouring NHS Fife achieved more than 80%. NHS Tayside said there seemed to be data problems that resulted in its rates appearing lower than they actually were. However, a spokesman added: “There is room for improvement, and we are currently identifying opportunities to increase all our day case activity.”

The report says that previous audits have found the main barriers to increasing the use of day surgery to be inappropriate and inadequate use of day surgery units, poor management and organisation of day surgery units, and a preference among some clinicians for inpatient surgery.

Audit Scotland’s report notes that Scotland generally has lower rates of day surgery than England does and said that there is scope for improvement.

The Scottish government has set a target that 75% of elective procedures should be carried out as day cases. To achieve this target an extra 34 000 day case procedures would need to be carried out each year. As day case treatment is cheaper than inpatient care, this would free up £8m of NHS resources.

The report recommends that NHS boards monitor the level of day case surgery by individual hospital and by specialty and take appropriate action where rates are found to be low. It also calls on the Scottish government to monitor the progress of individual boards.

Robert Black, Scotland’s auditor general, said, “It’s long been recognised that day surgery benefits patients through promoting a speedy recovery and minimising the disruption that an overnight stay in hospital can have on people’s lives. It also promotes a more efficient use of NHS resources by reducing waiting times and freeing up hospital beds.”

Brian Williams, president of the Royal College of Physicians and Surgeons of Glasgow, agreed with the report’s conclusion that the use of day surgery could be expanded further in Scotland. “To be fair, the trend is up anyway,” he said. “Clinicians have changed the culture of inpatient care very significantly over the past decade and are continuing to do so. I would have thought we are on track to be much closer to the performance requirements by 2011-12.”