The report, published today, shows that day surgery, where clinically appropriate, reduces the risk of hospital-acquired infections and minimises the length of a patient’s stay in hospital. The Assembly Government recognises the benefits of day surgery but, despite running several initiatives, there has been no clearly articulated strategy to improve day surgery rates. There are also large variations in day surgery performance between NHS trusts in Wales and in the ways trusts record short-stay surgery.

Key leaders in health communities are not focusing enough on improving day surgery rates. For example, few Local Health Boards (LHBs) offer incentives or sanctions to encourage day surgery as part of their commissioning strategies, and there is no financial incentive for providers to change patterns of service delivery.

It is essential that NHS trusts have processes in place that are designed to support the safe provision of day surgery. However, key processes are not always consistent with known good practice. For example, while some trusts have protocols that support GPs in making referrals to day surgery services, others do not. And LHBs carry out only limited monitoring of the appropriateness of GP referrals.

Capacity is not a major barrier to increasing day surgery in most trusts. However, the way beds are used, the adequacy of recovery areas and the opening hours of day surgery units are constraining the number of patients being treated this way. Another cause of inefficiency in the use of some dedicated day surgery units in Wales relates to them being used for inappropriate procedures. For example, fully equipped theatres are often used for minor surgery and endoscopies which do not require a general anaesthetic. 

There are a number of recent developments which have the potential to support further improvements in day surgery rates. For example, a recent modernisation assessment by the National Leadership and Innovation Agency for Healthcare is expected to provide a further source of good practice in this area. Also, the Assembly Government’s Designed for Life strategy contains ambitious targets for 2015 that are relevant to day surgery, particularly its target that 85 per cent of patients should stay in hospital for less than 48 hours. Some NHS trusts have also taken specific actions to improve their processes and increase rates of day surgery since 2003/2004 (see Notes to Editors)..

This report makes recommendations for further improvement relating to five key areas of change - strategy, leadership, people, capacity and processes. These include:

• The Assembly Government should measure short-stay surgery across a wider range of procedures;
• LHBs should together develop a commissioning approach that provides stronger financial incentives for day surgery;
• NHS trusts should routinely include day surgery within the performance appraisal of relevant staff; and
• NHS trusts should monitor the number of patients scheduled for day surgery but who are admitted the day before for non-clinical reasons, and investigate the reasons for such unnecessary overnight stays.

Auditor General for Wales, Jeremy Colman, said today:
“Day surgery rates are not as high as they could be in Wales. My recommendations aim to promote improvement so that the benefits of day surgery to patients and the NHS are being fully realised.” 

Notes to Editors:

• In this report, ‘day surgery’ means pre-planned surgery, where the patient is admitted and discharged on the same day. It also addresses surgery taking place over a 24 hour period, but not necessarily on the same day (known as 23 hour 59 minute surgery).

• The report examines whether NHS Wales has done enough to tackle the barriers to optimising day surgery rates.

• Details of the 2003/2004 day surgery rates in each NHS trust in Wales can be found in Appendix 3 of today’s report.

• The Wales Audit Office is independent of government and is responsible for the annual audit of some £19 billion of annual public expenditure.

• Its mission is to promote improvement, so that people in Wales benefit from accountable, well-managed public services that offer the best possible value for money. It is also committed to identify and spreading good practice across the Welsh public sector.

• The Wales Audit Office was created in April 2005 through the Public Audit (Wales) Act, 2004, which expanded the functions of the Auditor General for Wales and enabled the transfer of staffs from the Audit Commission in Wales and National Audit Office in Wales to his employment.
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For more information please contact Rachel Harries on 02920 262 675 or email rachel.harries@wao.gov.uk