§ Mr. Freeman
My hon. Friend will be aware that the booklet "Comparing Health Authorities" published by my Department in April 1988, copies of which are in the Library, illustrated wide variations in a number of aspects of performance. I will be placing in the Library tomorrow a copy of some key indicators for 1987–88. These show that variations remain substantial. For example, within England in 1987–88 for general surgery-urology and for all medical specialties, as in earlier years, the average expenditure per cash and average length of stay varied by a factor of about three. The indicators show wide variations in waiting time. For general surgery in some districts no patients had been waiting for more than a year on 31 March 1988 but in others over one third were in this position. Another indicator showing wide variations is the proportion of cases treated as day cases rather than admitted to hospital which ranges from less than 10 per cent. to over 30 per cent. for general surgery-urology and from less than 5 per cent. to over 20 per cent. for general medicine.
Where there is no apparent good clinical explanation for these variations, and in those places where a high cost per case prevails, local management will need to investigate, particularly where other indicators such as waiting times appear to be poor. This critical examination of performance, as a routine part of managing the service, will be particularly important for all those providing, and all authorities purchasing, services if the changes set out in the White Paper are to be fully effective.