Hospital inpatient waiting times have fallen in England and Wales, whereas day case surgery has increased, says a progress report of the health service.
The Chief Executive's Report to the NHS , published this week, outlines activity and performance in the NHS over the past six months and in the three years since the publication of the NHS Plan .
It reports that the number of patients waiting longer than one year for surgery fell by 99% from 16 689 in September 2002 to 114 in September 2003. This was associated with an extra 129 000 procedures (a rise of 15%) carried out in outpatient clinics between April and September and an extra 5000 procedures (1.4% rise) carried out in general practice surgeries. This shift away from most procedures being carried out in hospitals represents one of the stated aims of NHS modernisation.
Improvements in anaesthetics, imaging, and surgical techniques have made it possible for many procedures to be performed in outpatient clinics. These include most investigative procedures, such as endoscopies and biopsies; minor heart surgery; skin operations; high tech diagnostics; chemotherapy; and blood transfusions.
The report notes that the number of routine hospital admissions rose by 61 600 (2.4%) during the six months from April to September 2003, which also contributed to a fall in the number of people on hospital waiting lists.
In a bid to cut waiting times still further, patients who have to wait for hospital admission for more than six months will be offered the choice of treatment at another hospital after pilot studies proved the feasibility of this approach.
A national pilot of patients with coronary heart disease waiting for revascularisation showed that 48% chose to move to another provider in order to be seen quicker. A London based pilot showed that 70% of patients waiting for cataracts, general surgery, and ear, nose, and throat procedures opted to do this.
Nigel Crisp, NHS chief executive, said: "Too often, people try to judge value for money in the NHS by looking only at acute hospital admissions. In fact, the majority of patient care is provided outside hospital settings. The report shows that we're beginning to see operations which used to need a stay in hospital move to take place outside hospitals, in the community."
The report can be accessed at www.doh.gov.uk/nhsreport/index.htm or by phoning 08701 555 455 (quoting 34126).