Hospital Dr News

New efficiency proposals in general surgery could save NHS over £160m annually

There’s significant potential to cut variations in practice between general surgery services and make significant NHS savings.

Analysis by the Getting It Right First Time Programme (GIRFT) suggests that consultant-led surgical assessments at the hospital front door could lead to up to 30% fewer general surgery emergency admissions a year where no operation is delivered, and could cut the NHS’s annual cost for this (£361million) by £108m.

This is one of 20 recommendations from GIRFT aimed at improving general surgery in order to provide better outcomes for patients, and eliminate unwarranted differences between hospitals in areas such as effective procedures, length of stay, infection rates and procurement costs.

Mr John Abercrombie, a leading colorectal surgeon and author of the GIRFT national report into general surgery in England, identifies recommendations that would particularly benefit patients by helping to shorten the time they spend in hospital; and by reducing complications that can lead to readmissions.

Other opportunities to improve patient care and outcomes, and deliver potential efficiencies of over £160m annually, include:

  • A reduction in the length of stay for elective colorectal surgery patients from the current average of 10.2 days to the 5.5 days in the best performing hospitals, would ensure patients didn’t have to stay in hospital for so long and would free up to 84,000 bed days, equivalent to a saving of £23.6m.
  • A reduction in the length of stay for appendicectomy patients from an average of 3.5 days to 2 days would ensure people were back home more quickly and would free up 30,000 bed days for other patients, equivalent to a cost reduction of £8.5m.
  • Reducing elective general surgical admissions without any surgical procedure, which are rarely necessary, would save close to £7m a year.

Abercrombie’s recommendations were developed by reviewing data from all acute hospitals in England and visiting 50 general surgery departments, and the recommendations have also been fully endorsed by the Royal College of Surgeons.

He said: “My recommendations provide a blueprint for better care that will be good for patients and good for the NHS.”

He also recommended a review of national cancer targets following the creation of a new pathway for patients with colorectal cancer.

Abercrombie criticised data measuring surgeon-specific mortality rates rather than lives saved, or how quickly cancer patients had operations rather than which treatments were successful.

He wrote: “These politically derived measures are not clinically driven or motivated; they do not help improve our service or our skills nor do they lead to better outcomes for patients.

“They may even have adverse consequences by inducing surgeons to adopt risk averse behaviour.”

Mr Abercrombie’s recommendations fall under five themes, and cover areas such as surgical performance, choice, commissioning and care pathways, and data and performance measurement.

Proposals for changes in general surgery procedures by hospitals and consultants include:

  • An increase in the amount of day-surgery for some procedures so people can return home more quickly.
  • Minimising problems that can result in longer hospital stays or readmissions, as well as changes to pre-operative treatment that could help reduce surgical complications.
  • Better use of data to reduce variation in general surgery performance and to identify treatment pathways with the most effective outcomes for patients.

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