`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."

Arts and Entertainment
Characters in the new series are based on real people, say its creators, unlike Arya and Clegane the Dog in ‘Game of Thrones’
tv'The Last Kingdom' embraces politics, religion, warfare, courage, love and loyalty, say creators
Sport
Sergio Romero saves Wesley Sneijder's penalty
world cup 2014But after defeating the Dutch, Lionel Messi and Argentina will walk out at the Maracana on Sunday as underdogs against Germany
Sport
Scoreboard at the end of the semi-final World Cup match between Brazil and Germany at The Mineirao Stadium in Belo Horizonte
Sport
'Saddest man in Brazil' takes defeat with good grace, handing replica trophy to German fans
PROMOTED VIDEO
Life and Style
ebookA wonderful selection of salads, starters and mains featuring venison, grouse and other game
News
peopleThe Game of Thrones author said speculation about his health and death was 'offensive'
Arts and Entertainment
Martin Freeman and Lauren O'Neil in Jamie Lloyd's Richard III
theatreReview: The monarch's malign magnetism and diabolic effrontery aren’t felt
News
Glamour magazine hosts a yoga class with Yogalosophy author Mandy Ingber on June 10, 2013 in New York City.
newsFather Padraig O'Baoill said the exercise was 'unsavoury' in a weekly parish newsletter
Extras
indybest
News
people'She is unstoppable', says Jean Paul Gaultier at Paris show
Sport
Alexis Sanchez and apparently his barber Carlos Moles in Barcelona today
football
Arts and Entertainment
Miley Cyrus has her magic LSD brain stolen in this crazy video produced with The Flaming Lips
video
Arts and Entertainment
In his own words: Oscar Wilde in 1882
theatreNew play by the Oscar Wilde's grandson reveals what the Irish wit said at his trials - and what they reveal about the man
News
people
Arts and Entertainment
Unless films such as Guardians of the Galaxy, pictured, can buck the trend, this summer could be the first in 13 years that not a single Hollywood blockbuster takes $300m
filmWith US films earning record-breaking amounts at the Chinese box office, Hollywood is more than happy to take its lead from its new-found Asian audience
News
The garage was up for sale in Canning Place Mews for £500,000
newsGarage for sale for £500,000
Life and Style
tech
Independent
Travel Shop
the manor
Up to 70% off luxury travel
on city breaks Find out more
santorini
Up to 70% off luxury travel
on chic beach resorts Find out more
sardina foodie
Up to 70% off luxury travel
on country retreats Find out more
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

    Mobile App/IOS Developer (C#, ASP.NET, .NET, MVC)

    £50000 - £60000 per annum + Benefits + Bonus: Harrington Starr: Mobile App/IOS...

    Front End Developer-JavaScript, Angular J.S, HTML, CSS, ASP.NET

    £40000 - £45000 per annum + Benefits + Bonus: Harrington Starr: Front End Deve...

    Associate CXL Consultant

    £40000 - £60000 per annum + BONUS + BENEFITS: Harrington Starr: CXL, Triple Po...

    Associate CXL Consultant

    £40000 - £60000 per annum + BONUS + BENEFITS: Harrington Starr: CXL, Triple Po...

    Day In a Page

    The true Gaza back-story that the Israelis aren’t telling this week

    The true Gaza back-story that the Israelis aren’t telling this week

    A future Palestine state will have no borders and be an enclave within Israel, surrounded on all sides by Israeli-held territory, says Robert Fisk
    A History of the First World War in 100 Moments: The German people demand an end to the fighting

    A History of the First World War in 100 Moments

    The German people demand an end to the fighting
    New play by Oscar Wilde's grandson reveals what the Irish wit said at his trials

    New play reveals what Oscar Wilde said at trials

    For a century, what Wilde actually said at his trials was a mystery. But the recent discovery of shorthand notes changed that. Now his grandson Merlin Holland has turned them into a play
    Can scientists save the world's sea life from

    Can scientists save our sea life?

    By the end of the century, the only living things left in our oceans could be plankton and jellyfish. Alex Renton meets the scientists who are trying to turn the tide
    Richard III, Trafalgar Studios, review: Martin Freeman gives highly intelligent performance

    Richard III review

    Martin Freeman’s psychotic monarch is big on mockery but wanting in malice
    Hollywood targets Asian audiences as US films enjoy record-breaking run at Chinese box office

    Hollywood targets Asian audiences

    The world's second biggest movie market is fast becoming the Hollywood studios' most crucial
    Grindr founder Joel Simkhai: 'I've found love on my dating app - and my mum keeps trying to hook me up!'

    Grindr founder Joel Simkhai: 'I've found love on my dating app'

    Five years on from its launch and Grindr is the world's most popular dating app for gay men. Its founder Joel Simkhai answers his critics, describes his isolation as a child
    Autocorrect has its uses but it can go rogue with embarrassing results - so is it time to ditch it?

    Is it time to ditch autocorrect?

    Matthew J X Malady persuaded friends to message manually instead, but failed to factor in fat fingers and drunk texting
    10 best girls' summer dresses

    Frock chick: 10 best girls' summer dresses

    Get them ready for the holidays with these cool and pretty options 
    Westminster’s dark secret: Adultery, homosexuality, sadomasochism and abuse of children were all seemingly lumped together

    Westminster’s dark secret

    Adultery, homosexuality, sadomasochism and abuse of children were all seemingly lumped together
    A History of the First World War in 100 Moments: Dulce et decorum est - a life cut short for a poet whose work achieved immortality

    A History of the First World War in 100 Moments

    Dulce et decorum est: a life cut short for a poet whose work achieved immortality
    Google tells popular music website to censor album cover art in 'sexually explicit content' ban

    Naked censorship?

    The strange case of Google, the music website and the nudity take-down requests
    Howzat! 8 best cricket bats

    Howzat! 8 best cricket bats

    As England take on India at Trent Bridge, here is our pick of the high-performing bats to help you up your run-count this summer 
    Brazil vs Germany World Cup 2014 comment: David Luiz falls from leader figure to symbol of national humiliation

    David Luiz falls from leader figure to symbol of national humiliation

    Captain appears to give up as shocking 7-1 World Cup semi-final defeat threatens ramifications in Brazil