Professor Frank Keane:

No. If one is a surgeon and one has a minor procedure to carry out, one can either do it on an outpatient basis, or in a minor operations room or bring the patient into a day surgery unit. Strictly, a day surgery unit is an equipped operating theatre that gives a general anaesthetic in which one does substantive day case work, not the relatively trivial operations which Deputy Nolan identified. There is no question that because of facilities and the number of operating theatres in certain hospitals that they are having to carry out all their inpatient work and their outpatient or day case work within the same resource.

That is an historical fact because that is what we are dealing with. A county hospital with four operating theatres will be providing a range of inpatient treatments in a number of different surgical specialties such as orthopaedics, obstetrics, gynaecology, paediatrics and ENT from those four operating theatres. One must fit that into a week's work. One must also carry out the day stuff through there. The best way to do day surgery is to run it in effect as a factory in order that there is a set-up that allows one to process patients through dedicated admission wards and dedicated operating theatres and then out the other end. Processing patients sounds a bit callous because it makes it sound like an industry, but to a certain extent it works best like that.

There is a process of transition within the groups of hospitals becoming dedicated day centres where this kind of process works much more efficiently. The way a majority of surgeons work their operating time in the theatre is often to do two day cases at the beginning of the list and then do the rest of the inpatient operations. I have done this for a long period. That is fine but it does not work the day case system as efficiently as it should be worked. It does not work the beds so it is better if it is isolated. It will take time for that system to evolve, especially at this particular moment. This does create efficiencies.

Certainly there are things being done as day cases in day theatres that are inappropriate because they do not require a general anaesthetic and that needs to be sorted. Part of the problem with that and the reason it did not happen up to this point is because people are not incentivised to perform these things, even in the outpatient department. The reason is because one does not get a coded procedure. The hospital, and nobody else, gets funded for that activity if it is done in the outpatients department because outpatient procedures are not coded. In many cases, patients in minor operation rooms that hospitals operate do not get coded so they are missing out. Clearly, that needs to be gradually corrected, and the money follows the patient exercises will do that. These things must become coded activities in order that they start being done in the right place.