The Comptroller & Auditor General report on Managing Elective Day Surgery has been published before the Dáil, in accordance with the Comptroller & Auditor General (Amendment) Act 1993, which requires that the Minister lays it before the Dail.
The findings of the report are supportive of Minister Varadkar's view that wherever appropriate Day Surgery should be used as an alternative to overnight stays for patients.
The report includes the HSE statement that day surgery should be the default option for many elective surgical procedures, unless there is a valid reason for an overnight hospital stay, such as an underlying medical condition.
“The C&AG report highlights the importance of treating patients in the appropriate setting. Making day surgery the default option for more surgical procedures should increase the number of procedures being carried out, and benefit patients by helping to reduce waiting lists. It should also produce some savings in the longer term,” Minister Varadkar said.
The Minister also thanked the C&AG for its work on the report on this most important area. Day surgery refers to treatment provided when a patient is admitted to a hospital for an elective surgical procedure and is expected to return home on the same day. It has a number of potential benefits including:
· Patients can recover in their own home;
· There is a reduced risk of hospital acquired infection;
· There is reduced cost to hospitals;
· Waiting lists are reduced, due to improved throughput of cases.
The HSE estimated that day cases were on average 60% less costly to perform than inpatient cases. A high proportion of procedure costs are fixed and day cases are generally less complex than in-patient cases. So if the level of day surgery increases, there won’t be an immediate rise in potential savings in the short term. However, the introduction of ‘Money Follows the Patient’ in the future should incentivise a move from inpatient to day surgery, and from day surgery to out-patient settings, and thus achieve savings in the costs of the relevant treatments.
The C&AG’s examination also found that it is more appropriate to set targets for individual procedures in line with current best practice, rather than setting an overall target for day surgery. Targets also need to be set at individual hospital level, given the different specialty mix of services in each hospital.
The report found that expressing performance in terms of overall day surgery rate for all procedures in each hospital is not appropriate as this masks significant differences in performance of day surgery for individual procedures.
The Money Follows the Patient approach is initially being applied to inpatient and daycase activity in public hospitals. While the new funding model will encourage hospitals to use resources at their disposal more efficiently, it does not seek to reduce budgets. Instead it provides a more transparent funding mechanism and it more fairly rewards hospitals for the activity that they undertake.
ENDS
Notes for editors:
In 2006 the HSE identified 24 surgical procedures, which cover the majority of specialties, for which hospitals were asked to submit details annually of the total number of elective cases and the proportion of there that were carried out as day cases.
24 Surgical procedures, covering the majority of specialties were examined from 2006 onward. It was found that the overall Day Surgery rate for all hospitals has increased from 57% in 2006 to 74% in 2012, with a significant variation in performance rates between hospitals. In 2012 the rates for individual hospitals ranged between 50% and 92%.
The examination found that expressing performance in terms of overall day surgery rate for all procedures in a hospital masks significant differences in performance of day surgery for individual procedures.
Separate targets should be set for each surgical procedure, with targets for performance being based on the current performance achieved by top performing hospitals.
Clinicians must determine whether inpatient or day surgery is appropriate for an individual case. During the examination some clinicians expressed the view that some of the targeted 24 procedures are the most suitable procedures to target for day surgery. Considerable work has been carried out by the National Clinical Programme for Surgery with the HSE and Royal College of Surgeons in Ireland working in partnership to define a more extensive set of surgical procedures more in keeping with up to date practice (which is developing very quickly in this area). The implementation of the recommendations of this report will be carried out taking this work into account.
The HSE’s accounting officer has pointed out that the current method of funding of hospitals does not provide an economic incentive to perform procedures in their most appropriate setting, because the payment rate for the same procedure is higher in a day setting than in an outpatient setting. He noted that the situation will be addressed when the new “Money Follow’s the Patient” MFTP funding model and mechanisms are put in place, to pay the same price for the same procedure regardless of the delivery setting.
Encouraging hospitals to use the resources at their disposal more efficiently and increasing transparency in the provision of hospital services are two of the central objectives of MFTP. MFTP is crucial to the movement of day case activity to the Out-Patient Department (OPD), or if possible, into the primary care setting, as part of the overall movement of activity out of hospitals to the Community and Primary Care. Such transfer of activity is essential to achieving maximum efficiency in the overall system, and has the potential to achieve a reduction of 25% or slightly more on current day cases.
The report advocates hospitals putting in place locally agreed protocols and checklists setting out clearly the criteria for use by clinicians when assessing patient suitability for day surgery. It also suggests Hospitals should measure performance against targets and identify areas where improvements are needed.
Money Follows the Patient – Background
Money Follows the Patient (MFTP) is a new model for funding public hospital care. It involves moving away from inefficient block grant budgets to a new system where hospitals are paid for the actual level of activity undertaken. As such, hospitals will be funded based on the quantity and quality of the services they deliver to patients. They will be liberated, subject to overall budgetary ceilings, to pursue the most cost-effective means of achieving this standard of performance. Budgetary discipline will be delivered through the use of fixed budgets for MFTP activity. The MFTP approach is initially being applied to inpatient and daycase activity in public hospitals.
While the new funding model will encourage hospitals to use resources at their disposal more efficiently, it does not seek to reduce budgets. Instead it provides a more transparent funding mechanism and it more fairly rewards hospitals for the activity that they undertake.
Implementation
Money Follows the Patient represents a major change in the way hospitals are funded. Full roll-out of MFTP is therefore a multi-year project and a phased approach to implementation is being taken in order to ensure operational stability in hospitals.