12.1. Introduction

A large proportion of health service resources are employed not in emergency, life-saving treatment but in providing planned, elective procedures. During financial year 2001/2, 50.4% of all admissions to NHS hospitals in the West Midlands were elective, in which a therapeutic or diagnostic procedure was carried out 1.

Analysis of this activity shows that many of these admissions were for treatments aimed at improving quality of life for people with long-standing chronic conditions.

Owing to the numbers of people who require these treatments, prompt, fair access and optimal outcomes are seen as key bench marks by which many service users judge the quality and effectiveness of the NHS. This is reflected in the use of target setting and other performance management tools by Government to encourage providers to improve outcomes and waiting times for elective surgery.

This chapter takes a cross section of some of the most common surgical therapeutic interventions and looks at the overall incidence of admission for them, using PCT of residence as a reference geography.

The basket of procedures used in this analysis are: surgical treatment of cataract, surgical repair of hernia, endoscopic resection of prostate, primary hip replacement, primary knee replacement, coronary revascularisation, occlusion of fallopian tubes and surgical treatment of varicose veins of the leg.

These comparisons, like others in this publication are not intended to show a ‘league table’, but are merely a reference for stakeholders. No attempt has been made here to explain or interpret the patterns observed. Variations in these rates will be multi-factoral. Underlying epidemiology and demography of the populations, the key demand-side factors, will only be two of these. Many supply-side variables such as theatre capacity, proximity of treatment, local commissioning, referral and admission policies and access to diagnostics may also affect rates. The variation seen here may well promote debate and further enquiry, however it may also require the use of sophisticated multi-variate analysis to understand fully.

	Figure 12.1. Directly Standardised Admission Rates, Elective Surgical Treatment of Cataract, by PCT, 2002-2003, W. Midlands Region, All Ages, Males
	Figure 12.2. Directly Standardised Admission Rates, Elective Surgical Treatment of Cataract, by PCT, 2002-2003, W. Midlands Region, All Ages, Females
	Figure 12.3. Directly Standardised Admission Rates per 100,000, Elective Surgical Repair of Inguinal Umbilical or Femoral Hernia, by PCT, 2002-2003, West Midlands Region, All Ages, Males & Females
	Figure 12.4. Directly Standardised Admission Rates per 100,000, Elective Endoscopic Resection of Prostate, by PCT, 2002-2003, West Midlands Region, All Ages, Males
	Figure 12.5. Directly Standardised Admission Rates per 100,000, Elective Primary Hip Replacement, by PCT, 2002-2003, West Midlands Region, All Ages, Males
	Figure 12.6. Directly Standardised Admission Rates per 100,000, Elective Primary Hip Replacement, by PCT, 2002-2003, West Midlands Region, All Ages, Females
	Figure 12.7. Directly Standardised Admission Rates per 100,000, Elective Primary Knee Replacement, by PCT, 2002-2003, West Midlands Region, All Ages, Males
	Figure 12.8. Directly Standardised Admission Rates per 100,000, Elective Primary Knee Replacement, by PCT, 2002-2003, West Midlands Region, All Ages, Females
	Figure 12.9. Directly Standardised Admission Rates per 100,000, Elective Coronary Revascularisation, by PCT, 2002-2003, West Midlands Region, All Ages, Males & Females
	Figure 12.10. Directly Standardised Admission Rates per 100,000, Elective Endoscopic Bilateral Occlusion of Fallopian Tubes, by PCT, 2002-2003, W. Midlands Region, All Ages, Females
	Figure 12.11. Directly Standardised Admission Rates per 100,000, Elective Surgery on Varicose Veins of the Leg, by PCT, 2002-2003, West Midlands Region, All Ages, Males
	Figure 12.12. Directly Standardised Admission Rates per 100,000, Elective Surgery on Varicose Veins of the Leg, by PCT, 2002-2003, West Midlands Region, All Ages, Females

References

1 Hospital Episode Statistics 2001/2002, Department of Health.

Notes on chapter

All data for this chapter were taken from Hospital Episode Statistics 2002-2003. For all procedures, only admission episodes within spells were interrogated, where admission method was elective, where age, sex and postcode fields were valid, and where the patient was resident in a West Midlands PCT catchment area. Episodes were attributed to reference geography using Gridlink postcode matching, November 2003 edition. In most cases Health Care Resource Groups (HRGs) have been used to identify cases. This may result in a very small undercount of complex cases where a number of other procedures were being carried out. However HRGs are considered a robust way of identifying ‘typical’ cases

Inclusion criteria:

Figures 12.1 and 12. 2. An HRG code of B02 or B03 in the admission episode.

Figure 12. 3. An HRG code of F73 or F74 in the admission episode.

Figure 12. 4. Operation 1 of OPCS4 M651-653 inclusive, in the admission episode.

Figures 12.5 and 12.6. An HRG code of H02 in the admission episode.

Figures 12.7 and 12.8. An HRG code of H04 in the admission episode.

Figure 12.9. An HRG code of E04 or E15 in the admission episode.

Figure 12.10. An HRG code of M06 with a procedure of OPCS4 Q351 – Q369 inclusive in the admission episode.

Figures 12.11 and 12.12. An HRG code of Q11 in the admission episode.

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