Evidence submitted by the British Association
of Day Surgery (ISTC 26)
The British Association of Day Surgery (BADS)
was founded in 1989 to encourage the expansion of day surgery
throughout the United Kingdom, to promote education and high quality
patient treatment. The Association is a multi-disciplinary organization
with a current membership of 750 comprising surgeons, anaesthetists,
nurses and managers involved in Day Surgery throughout the country.
Our Council consists of 23 members reflecting the interests of
the membership and also includes two lay-members to represent
patient views.
What contributions have ISTCs made to the reduction
of waiting times and waiting lists?
ISTCs have contributed to the Government's targets
for the reduction of surgical waiting times and waiting lists.
Are ISTCs providing value for money?
While ISTCs have contributed to the achievement
of the Government's day surgery targets there is limited evidence
at present to demonstrate the cost-effectiveness of such initiatives.
Does the operation of ISTCs have an adverse effect
on NHS services in their areas?
At present, NHS day surgery units provide quality
care through their dedicated nurse, anaesthetic and surgical teams.
While direct recruitment of NHS staff by an ISTC is prohibited
(within six months) recruitment may originate from other private
healthcare providers and create a "domino" effect whereby
other private health care providers recruit of existing day surgery
personnel from NHS.
What arrangements are made for patient follow-up
and the management of complications?
Where an ISTC is offering a limited 12 hour
facility the question arises as to the treatment of unplanned
overnight admissions ie failed day cases.
This figure currently runs at approximately
3% throughout the NHS.
By necessity such patients from ISTCs would
require emergency admission to an NHS facility for overnight stay.
What changes should the Government make to its
policy towards ISTCs in the light of experience to date?
What criteria should be used in evaluating the
bids for the Second Wave of ISTCs?
What factors have been and should be taken into
account when deciding the location of ISTCs?
Stand alone ISTC distant from an existing NHS
facilities (necessitating an ambulance journey to deal with unforeseen
complications) have limited effectiveness in delivering the Government's
day surgery target.
Limited opening, eg 8 am to 8 pm, creates a
loss of productivity of more major day surgery procedures in the
afternoon day surgery theatre as there is insufficient recovery
time before the evening closure of the unit to allow safe patient
discharge.
Traditional 12 hour opening times limits operating
to minor and intermediate day surgery procedures rather than the
more major day surgery procedures (eg laparoscopic cholecystectomy
or bi-lateral varicose vein surgery) which are required to enable
Government targets to be met.
ISTCs with limited day time opening hours are
only able to treat the fittest of patients (eg limited co-morbidity,
the non-obese and, by implication, younger patients). By 2019,
the population over retirement age will increase from 18.3% to
22.2% Population Projects 1994 based on Government Actuary Department
1996).
RECOMMENDATIONS
In the interests of quality of care and patient
safety, surgical productivity and patient access the British Association
of Day Surgery recommends that Government policy towards ISTCs
should focus on integrated units within an existing 24 hour NHS
facility.
The following members of the British Association
of Day Surgery Council would be willing to give oral evidence:
Mr Douglas McWhinnie, Consultant Surgeon, Milton
Keynes Hospital
Dr Ian Jackson, Consultant Anaesthetist, York
Hospital NHS Trust
Douglas McWhinnie
British Association of Day Surgery
10 February 2006
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