Operations (Hansard, 20 December 1991)

§ Mr. Nicholas Bennett

[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

365W

	Low	Average	High	Number of hospitals
Anaesthetics	35.73	170.56	1,161.90	3
A and E	10.24	38.28	74.36	2

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:
	Paediatrics	33.64	33.64	33.64	1
	Geriatrics	22.20	27.75	35.37	7
	Psychiatric specialties:
	Other	8.92	18.09	24.42	5
	Other specialties:
	Radiotherapy	26.63	26.63	26.63	1

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:
	Paediatrics	28.37	42.05	69.40	14
	Geriatrics	22.72	38.34	60.88	11
	Other	10.13	25.75	42.14	15
	Surgical specialties:
	General surgery/urology	23.36	27.83	37.34	15
	Orthopaedics	13.42	24.83	37.14	14
	ENT	14.64	29.72	44.22	14
	Ophthalmology	8.40	20.32	28.42	12
	Gynaecology	18.20	27.09	46.34	13
	Dental specialties	11.24	22.46	52.50	13
	Neurosurgery	3.02	29.59	169.22	8
	Plastic surgery	4.89	10.61	19.13	10
	Other surgical	7.93	23.64	29.22	3
	Maternity function:
	Obstetrics	15.87	26.49	229.36	11
	GP	18.87	30.02	35.96	2
	Psychiatric specialties:
	Mental handicap	26.87	31.26	40.17	2
	Other	13.63	32.75	95.64	14
	Other specialties:
	Radiotherapy	1.97	41.41	96.87	13
	Path/Radiology	2.70	12.65	43.81	6
	Anaesthetics	19.05	46.96	69.97	4
	A& E	12.78	26.66	27.06	2

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 366W 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 367W 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.