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Welcome to 2010! BADS enters the new decade optimistically – our membership continues to increase, strategic partners continue to offer support and our programme is currently being finalised for Portsmouth to celebrate 21 years of our Association. We have a superb line up of speakers, as you can see from the provisional programme within the Journal. The only cloud on the horizon for all of us seems to be ongoing worries with NHS funding.
As hospitals up and down the country attempt a “Houdini” act on balancing their books, there is no doubt that NHS redundancies are on their way. Hopefully, front-line staff will not be axed but it is possible that rationalisation of services could see entire departments amalgamated between hospitals with staff relocation. My wish for 2010, with an upcoming general election, is to finally see an end to “target culture” and the return to key performance indicators which relate to quality. I fear in the short term, this may be a forlorn hope. But, in the meantime, BADS continues as an Association of members committed to sharing best practice for Day and Short Stay Surgery.
One of the areas where we have enjoyed success is with planned changes in England for Payment by Results for 2010. Over the past few months, we have created a joint BADS/PbR steering group to help incentivise day surgery activity. The PbR team listened patiently to our arguments and have agreed that, this year, elective tariffs are shifting back to a single day case/ inpatient tariff for most procedures, replacing last year’s experimental joint day case / outpatient tariff. In practice this means that there is again an incentive to move from inpatient work to day case surgery and thereby capture the saving of the cost of an overnight stay.
Furthermore, day case laparoscopic cholecystectomy is one of four high volume “Best Practice” tariffs proposed for 2010 (along with fractured neck of femur, stroke care, and cataract surgery). BADS proposed a positive incentive for day case laparoscopic cholecystectomy to encourage a national shift to shorter stay management for this procedure. We welcome the news that from next April, the PbR team are incentivising day case laparoscopic cholecystectomy by approximately £300 per case. Therefore a shift from an overnight stay to day case will result in an overnight bed saving of approximately £250 with an additional financial incentive of approximately £300 for the procedure thereby offering your hospital a £550 improvement in revenue. I would like to personally thank all those centres who contributed reference cost information to BADS to enable us to argue our case from a position of strength. At present this incentivisation is scheduled to last for only one year, so we should consider 2010 the year of the gallbladder!
Within the same political agenda, the Association is promoting concerns regarding single sex accommodation in the Day Surgery environment. I have therefore convened a meeting with the NHS Leads for this remit at our next Council meeting in January. I will keep you updated on the outcome of these discussions. All of us recognise that issues of patient privacy and dignity should be afforded the highest priority in Day and Short Stay Surgery, yet there appear to be ongoing differences in interpretation of guidelines disseminated by the Department of Health. These require clarification.
And, finally... I was pleased to see that the BBC have made a special report on their website, showing the management of laparoscopic nephrectomy as a day case procedure. Go on-line to www.bbc.co.uk and type “Kidney removal as day case surgery” into the search box.... and enjoy!
Happy New Year!
DOUG MCWHINNIE |
