Dr. Tony O'Connell:

There is no denying that at the time, and even to some extent currently, there is an over-counting of procedures which should probably not be counted as true day case procedures based on the definition used by the Comptroller and Auditor General in the opening statement in the sense of there being an anaesthetic and one has something cut out. That is a short way of saying it. Some procedures are just done under local anaesthetic. What we heard in the opening statement from the Comptroller and Auditor General is that there is a perverse incentive because of the funding arrangement to count as much as one can as something that is happening within the hospital. That is something we must resist and we will do that much more forcefully as we introduce the money follows the patient activity-based funding arrangements. We will be able to financially reward much more appropriately something that is good clinically, which is good for the hospital.

There are some perverse financial incentives which are currently running in the system. There is also an incentive because of changes in the recent reimbursements to count cases as overnight cases rather than day cases.