`I'd have liked one night in hospital'

As hospitals are pressured to carry out ever more day surgery, Cherrill Hicks describes her own swift return to family and work, and Annabel Ferriman asks if the NHS gives adequate support

Beryl Fordham had her first hernia operation about 12 years ago. She was in hospital for five days, had all her meals brought to her and did not go home until she was well on the way to recovery.

Mrs Fordham underwent very similar surgery recently. Only this time, she spent nine hours in hospital, was discharged at 6pm and two hours later was making her husband's supper. The wound in her abdomen had started bleeding again within 48 hours and she had to return to the ward. The three-to-four-inch incision had been held together by a couple of clips and covered by a small strip of bandage.

"I much preferred it the first time," says the 62-year-old retired book- keeper from north London. "I would have liked at least one night in hospital. I would have found it reassuring to have someone check the dressing."

The way Mrs Fordham was treated flouted at least four of the guidelines on day surgery laid down by the Royal College of Surgeons in 1992. She was cared for on a general ward, not a dedicated day unit; she was given no written material about the operation beforehand, no analgesics to take home and no telephone number to ring if anything went wrong.

Her case, and others like it, suggest that the stampede to day surgery is going too fast. About 40 per cent of the six million operations carried out in Britain each year are now performed on a day basis, some of the most common dealing with gall bladders, cataracts, varicose veins, anal fissures and bat ears. The NHS Executive recommends a rise to 60 per cent by 1997-98, with savings to be made of at least pounds 100m.

But Professor Alfred Cuschieri, consultant surgeon at Ninewells Hospital, Dundee, who chaired a working party on minimal access surgery, which reported in 1993, says the target is "wholly unrealistic".

"It ignores the fact that there is not sufficient aftercare in the primary sector and it ignores the fact that a lot of patients have serious co- morbidity [existing illness] unconnected to their surgery, such as lung or heart disease," he says. "Even if their surgery is minor, early discharge is not feasible. We should be expanding short stay rather than daycare units so that if a patient who is scheduled for day surgery is not well enough to go home they can be accommodated."

Mr Andrew Johnson, consultant general surgeon at Ormskirk Hospital, Lancashire, is also worried about this helter-skelter rush to nine-hour admissions. "There is a big push towards day surgery by management and health economists, but sometimes it is not in the interests of patients," he says. "People have a great fear of being in pain, or something awful happening to them during the night. If they are anxious, it makes their discomfort worse. Some patients might think their wound is going to explode or burst. If they are in a hospital ward, there is a nurse there who can reassure them, or if necessary give them extra pain relief. If people do not want to be discharged home, they should not be bounced into it.

"I can see why some clinicians choose to do day surgery, because there is a shortage of beds, but it only works if everything is set up for it. Patients need to know what to expect and local GPs and district nurses need to be geared up."

In addition, there is evidence that for many day-surgery cases, pain control is a major problem. A small study published in Nursing Times found that although most patients had anticipated some pain, they had also expected it to resolve quickly - and that when this did not happen they found it difficult to cope with. Most required something stronger than paracetamol; not all had received sufficient analgesia.

The study also found that all of the patients resumed "normal activity" too soon - often out of guilt, the need for money or pressure from employers. "Day surgery is not an easy option ... one-day surgery does not mean one- day recovery," comments Janet Thatcher, study author and senior lecturer in surgical nursing at the University of Greenwich, London.

Patricia Bottrill, clinical nurse manager at the Royal Victoria Infirmary, Newcastle-upon-Tyne, runs a nurse-led unit dealing with 3,000 day surgery cases a year. She says there have to be strict criteria to decide suitability: "We ask about their general health, their home circumstances, who will care for them after the operation and how far away they live. We go through all these matters, which surgeons are not good at discussing. We also give them a great deal of information, including written information, about the procedure."

If patients are properly selected, she says, day surgery can be successful. "Most people prefer their own beds and are more relaxed in their own homes."

Sport
Australia vs New Zealand live
cricket Follow over-by-over coverage as rivals New Zealand and Australia face off
News
Zayn has become the first member to leave One Direction. 'I have to do what feels right in my heart,' he said
peopleWe wince at anguish of fans, but his 1D departure shows the perils of fame in the social media age
Life and Style
Researchers found that just 10 one-minute swill-and-spit sessions are enough to soften tooth enamel and make teeth vulnerable to erosion
health
News
i100
Life and Style
ebookNow available in paperback
ebooks
ebookPart of The Independent’s new eBook series The Great Composers
Arts and Entertainment
The Regent Street Cinema’s projection room in the 1920s
film
News
Leah Devine is only the ninth female to have made the Young Magician of the Year final since the contest began more than 50 years
peopleMeet the 16-year-old who has set her heart on being the first female to win Young Magician of the Year
News
Jonathan Anderson was born in Northern Ireland but now based between London, where he presents a line named JW Anderson
peopleBritish designer Jonathan Anderson is putting his stamp on venerable house Loewe
News
Andy Davidhazy at the beginning (left) and end (right) of his hike
video
News
Taylor Swift is applying to trademark song lyrics from 1989
people
Voices
The popularity of TV shows such as The Liver Birds encouraged Liverpudlians to exaggerate their Scouse accent
voicesWe exaggerate regional traits and turn them into jokes - and those on the receiving end are in on it too, says DJ Taylor
  • Get to the point
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating
    and  

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    iJobs Job Widget
    iJobs General

    Recruitment Genius: Junior Web Designer - Client Liaison

    £6 per hour: Recruitment Genius: This is an exciting opportunity to join a gro...

    Recruitment Genius: Service Delivery Manager

    Negotiable: Recruitment Genius: A Service Delivery Manager is required to join...

    Recruitment Genius: Massage Therapist / Sports Therapist

    £12000 - £24000 per annum: Recruitment Genius: A opportunity has arisen for a ...

    Ashdown Group: Practice Accountant - Bournemouth - £38,000

    £32000 - £38000 per annum: Ashdown Group: A successful accountancy practice in...

    Day In a Page

    Election 2015: How many of the Government's coalition agreement promises have been kept?

    Promises, promises

    But how many coalition agreement pledges have been kept?
    The Gaza fisherman who built his own reef - and was shot dead there by an Israeli gunboat

    The death of a Gaza fisherman

    He built his own reef, and was fatally shot there by an Israeli gunboat
    Saudi Arabia's airstrikes in Yemen are fuelling the Gulf's fire

    Saudi airstrikes are fuelling the Gulf's fire

    Arab intervention in Yemen risks entrenching Sunni-Shia divide and handing a victory to Isis, says Patrick Cockburn
    Zayn Malik's departure from One Direction shows the perils of fame in the age of social media

    The only direction Zayn could go

    We wince at the anguish of One Direction's fans, but Malik's departure shows the perils of fame in the age of social media
    Young Magician of the Year 2015: Meet the schoolgirl from Newcastle who has her heart set on being the competition's first female winner

    Spells like teen spirit

    A 16-year-old from Newcastle has set her heart on being the first female to win Young Magician of the Year. Jonathan Owen meets her
    Jonathan Anderson: If fashion is a cycle, this young man knows just how to ride it

    If fashion is a cycle, this young man knows just how to ride it

    British designer Jonathan Anderson is putting his stamp on venerable house Loewe
    Number plates scheme could provide a licence to offend in the land of the free

    Licence to offend in the land of the free

    Cash-strapped states have hit on a way of making money out of drivers that may be in collision with the First Amendment, says Rupert Cornwell
    From farm to fork: Meet the Cornish fishermen, vegetable-growers and butchers causing a stir in London's top restaurants

    From farm to fork in Cornwall

    One man is bringing together Cornwall's most accomplished growers, fishermen and butchers with London's best chefs to put the finest, freshest produce on the plates of some of the country’s best restaurants
    Robert Parker interview: The world's top wine critic on tasting 10,000 bottles a year, absurd drinking notes and New World wannabes

    Robert Parker interview

    The world's top wine critic on tasting 10,000 bottles a year, absurd drinking notes and New World wannabes
    Don't believe the stereotype - or should you?

    Don't believe the stereotype - or should you?

    We exaggerate regional traits and turn them into jokes - and those on the receiving end are in on it too, says DJ Taylor
    How to make your own Easter egg: Willie Harcourt-Cooze shares his chocolate recipes

    How to make your own Easter egg

    Willie Harcourt-Cooze talks about his love affair with 'cacao' - and creates an Easter egg especially for The Independent on Sunday
    Bill Granger recipes: Our chef declares barbecue season open with his twist on a tradtional Easter Sunday lamb lunch

    Bill Granger's twist on Easter Sunday lunch

    Next weekend, our chef plans to return to his Aussie roots by firing up the barbecue
    Joe Marler: 'It's the way I think the game should be played'

    Joe Marler: 'It's the way I think the game should be played'

    The England prop relives the highs and lows of last Saturday's remarkable afternoon of Six Nations rugby
    Cricket World Cup 2015: Has the success of the tournament spelt the end for Test matches?

    Cricket World Cup 2015

    Has the success of the tournament spelt the end for Test matches?
    The Last Word: Justin Gatlin knows the price of everything, the value of nothing

    Michael Calvin's Last Word

    Justin Gatlin knows the price of everything, the value of nothing