Dr. Tony O'Connell:

I can give Deputy Nolan the latest figures. We have the year-to date 2014 figures on that basket of 24 procedures to which he referred. For the 41,500 cases this year to date the day case rate is now up to 77%, so we are continuing to improve. However, Deputy Nolan is correct, there is a variance between the rates for individual procedures. I might just quote a handful of them to give an example. Procedures which everyone is quite comfortable doing as day cases have quite high rates. For example, removing a ganglion, which is a swelling in a tendon in the hand, or orchiopexy, or repairing a nasal fracture. Each of these have rates of day case procedures that are well in the 90s. The four that are lowest are tonsillectomy at only 10%, 18% for bunions, 34% for transurethral resection of the prostate and 34% for laparoscopic cholecystectomy. I think bunions are an aberration, but tonsillectomy is a good example of the answer to the question the Deputy is raising, namely whether consultants are comfortable with doing these procedures as day cases.

Tonsillectomy is something which ENT surgeons and anaesthetists have been quite uncomfortable about doing as a day case procedure. It has taken many years across the globe for practice to change in this regard, because they all remember cases of a bleeding that first night after the tonsillectomy which was horrendous, which was in the airway and which threatened the life of the patient, requiring them to come in from home to almost repeat the tonsillectomy in order to get the bleeding under control. They are plagued by the memory of these cases from the past, which make them uncomfortable saying that they are going to change their entire practice to doing every tonsillectomy as a day case. They will change over time and that rate will increase, but they must be reassured that there are systems in place where a patient can come in from home rapidly, where their entry to the hospital's emergency department will be accelerated and where the time between leaving home and getting to the operating theatre is not so long that they expire from the haemorrhage. It is uncommon for a haemorrhage to occur on that first night after the operation but it is such a worrying event that it has swayed the opinions of doctors.

I was pleased that, in his opening statement, the Comptroller and Auditor General mentioned that we cannot have metrics overriding professional judgement. Ultimately, we have to convince our surgeons that their practice needs to change, and convincing independent, strong-willed people like competent surgeons is a challenge. This is the reason there will always be some variation. The other reason there will be variation is that there is a different range of numbers of cases in each of those 24 procedures in the various hospitals.