The Way We Live: Night shift surgeons will cut the wait

Like supermarkets and petrol stations, NHS operating theatres are extending opening times to cope with those who need their services at all hours. With the health service facing the longest waiting lists in its 50-year history, ministers are urgently seeking ways to fulfil their manifesto pledge to cut them. Jeremy Laurance, Health Editor, reports on how your operation may soon be an after-work appointment.

NHS hospital operating theatres are working longer days and cutting in-patient stays to deal with ministerial demands to shorten the queues of people waiting for treatment.

Some are running twilight operating lists between 6.30 pm and 9.30 pm to fit in routine patients who cannot be operated on during the day. Others are squeezing three operating sessions, instead of the normal two, into a 12-hour day beginning at dawn.

Several have substituted an "arrivals lounge" for the normal pre-operation overnight stay. Instead of occupying a bed, patients come in an hour before surgery, change into a gown in the arrivals lounge and walk into the theatre for surgery, cutting the average time they spend in hospital by half.

At the end of June, there were almost 1.2 million people waiting for treatment, a record, including 47,000 who had been waiting more than a year. The growing length of the waiting list is an embarrassment to Labour and the biggest blot on its early performance.

Frank Dobson, Secretary of State for Health, will tell the Labour conference in Brighton this week that the Government will not be able to reduce waiting lists in the short term because they were growing so fast in the last months of the Tory government that they will take time to turn around. But he will insist that the commitment will be achieved.

Medical organisations predict chaos this winter as financial pressures combine with seasonal illnesses to increase the burden on the service. "If there is a flu epidemic I think waiting lists will soar," said Jim Johnson, chairman of the consultants committee of the British Medical Association.

"Ministers have said we must give priority to emergencies and they have been more honest than the last government in admitting that you can't do the routine work and keep capacity spare for emergencies."

Doctors and NHS managers are considering ways of speeding treatment to increase throughput of patients at minimum cost. They point to the huge capital costs wrapped up in operating theatres and other facilities which are only used eight hours a day.

John Williams, consultant surgeon and spokesman for the Royal College of Surgeons, said: "There is no earthly reason why there should not be better facilities for operating from 5 pm to 10 pm or from 7 am to 9 am. We looked at it and we were interested how many trusts already did it. But you need the nursing and support staff, there are transport problems and medical staff are already working beyond their contracted hours."

A report to be published tomorrow will show that risks of surgery rise when operations are conducted out of hours, because they tend to be performed by junior surgeons without supervision. Mr Williams said that the report, by the National Confidential Enquiry into Perioperative Deaths (deaths within 30 days of an operation) will show that it is not safe to operate without adequate staffing. "The danger is that hospitals may try to do so," he said.

Derek Day, director of corporate affairs at the NHS Confederation said the idea of extended operating hours for routine cases had been discussed "as one way in which the service may change over the years". But Jim Johnson, of the BMA, said it could not be achieved without extra beds and extra resources. "Operating theatres are lying idle all over the country because there aren't the beds to put patients in."

Mr Johnson, a vascular surgeon at Halton Hospital, Cheshire, said in an ideal world it made sense to make better use of the existing expensive facilities. "We may have to move to a seven-day service and evening clinics. But it is nonsense to talk of it when we have not got enough to run the existing service."

Ministers are taking a close interest in progress at Leicester Royal Infirmary, one of two pilot sites in the country where ideas for boosting efficiency are being tried. Since 1994, the hospital has run 141 separate projects under a "re-engineering" scheme, so-called because it seeks to borrow ideas from industry which can be applied to the health service, and the number of patients treated in some specialties has been sharply increased.

In addition to the arrivals lounge innovation, women admitted for hysterectomies have had their stay cut from an average five days to two by the allocation of a personal nurse to supervise their care after discharge. Patients with suspected stomach ulcers now get all their tests at a single visit, compared with up to four previously, increasing throughput by a third at no extra cost. Peter Homer, the chief executive, said: "We have made significant improvements in quality and productivity."