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Operations

Volume 201: debated on Friday 20 December 1991

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To ask the Secretary of State for Wales what variations may be found between the costs of each type of operation carried out under the national health service in Wales; what is the average cost; and what are the highest and lowest costs.

[holding answer 5 December 1991]: Information regarding the costs of each type of operation carried out under the national health service in Wales is not collected centrally.Data relating to specialty costs are available in the booklet "Welsh Health Costing Returns" and the latest version of this, for 1989–90, is available in the Library of the House. However, for ease of reference the following tables provide some information from the booklet giving high and low costs, and average costs by specialty within the least heterogeneous group of Welsh hospitals—acute general hospitals group I (i.e. those which are the main general acute hospitals providing a wide range of in-patient and out-patient specialist services together with the necessary support services)—illustrating:

  • (i) cost per patient using bed (in-patients) Table 1
  • (ii) cost per day care attendance (day cases) Table 2
  • (iii) cost per out-patient attendance. Table 3
  • Low

    Average

    High

    Number of hospitals

    Anaesthetics35·73170·561,161·903
    A and E10·2438·2874·362

    Table 2

    Cost per day care attendance

    £ unit cost

    Hospital type B—acute general hospitals: group 1

    Low

    Average

    High

    Number of
    hospitals

    Medical specialties:

    Paediatrics33·6433·6433·641
    Geriatrics22·2027·7535·377

    Psychiatric specialties:

    Other8·9218·0924·425

    Other specialties:

    Radiotherapy26·6326·6326·631

    Table 3

    Cost per out-patient attendance

    £ unit cost

    Hospital type B—acute general hospitals: group 1

    Low

    Average

    High

    Number of hospitals

    Medical specialties:

    Paediatrics28·3742·0569·4014
    Geriatrics22·7238·3460·8811
    Other10·1325·7542·1415

    Surgical specialties:

    General surgery/urology23·3627·8337·3415
    Orthopaedics13·4224·8337·1414
    ENT14·6429·7244·2214
    Ophthalmology8·4020·3228·4212
    Gynaecology18·2027·0946·3413
    Dental specialties11·2422·4652·5013
    Neurosurgery3·0229·59169·228
    Plastic surgery4·8910·6119·1310
    Other surgical7·9323·6429·223

    Maternity function:

    Obstetrics15·8726·49229·3611
    GP18·8730·0235·962

    Psychiatric specialties:

    Mental handicap26·8731·2640·172
    Other13·6332·7595·6414

    Other specialties:

    Radiotherapy1·9741·4196·8713
    Path/Radiology2·7012·6543·816
    Anaesthetics19·0546·9669·974
    A& E12·7826·6627·062

    Specialty costing in its current form was introduced in 1987–88 and represents the average cost of treating a broad range of conditions within each specialty grouping. This costing is undertaken annually by disaggregating total costs via a process of direct allocation and cost apportionment.

    Whilst it represents an improvement on the sort of "whole hospital" costing available prior to 1987–88, caution should be taken when using this information for comparison purposes since it does not take account of (i) differences in the case mix (in terms of condition, complexity and severity) within each specialty as between different hospitals which have an impact upon the levels and type of staffing and equipment necessary to provide appropriate care and (ii) differences in the range, age and condition of the hospital accommodation which have an impact upon the pattern and overhead costs of service delivery. The averages shown should not therefore be regarded as normative standards against which efficiency or quality of service can be judged, since it must be recognised that a wide and complex range of factors need to be taken into account when making such assessments. However, authorities are encouraged when analysing their costs to explore those areas of service delivery where costing figures suggest significant differences between authorities.

    The specialty costing booklet for 1990–91 is due to be published in the new year, and it will be the last produced regarding the period prior to the NHS reforms. From 1991–92 onwards one of the benefits, indeed an imperative of the NHS reforms, is that service providers will be obliged to cost their services more frequently, more accurately and in greater detail. To this end a major programme of investment in better information systems for resource management and case-mix costing purpose is currently under way. When fully implemented throughout Wales, these new systems will enable service providers to identify costs to sub-specialty levels—for example to "Diagnosis Related Groups" and, where necessary, to particular operations and procedures or even to individual patients, depending on the nature of the service contracts with purchasing authorities or GP fundholders.