Independent sector treatment centres: experience and spin

EDITOR—Independent sector treatment centres were recently praised by the Department of Health.1 Ophthalmologists have highlighted the problems experienced and predicted for cataract centres.2^–4 The government argument that independent centres provide value for money in elective surgery is unconvincing because it considers “spot purchasing” costs of “waiting list initiatives” rather than the costs of planned NHS care.1 Procurement may drain the NHS of funds that might otherwise be invested in comprehensive care in NHS hospitals.

Clinical quality in some ophthalmology schemes has also been a concern.2 3 Furthermore, cataract waiting times had come down before the mobile cataract independent sector treatment centres became operational.5

“Putting patients in charge of where they are treated means that all providers have to compete and this competition helps drive a patient-centred service.”1 But offering uncoordinated choice at fixed tariffs may make service planning and the financial viability of NHS providers difficult. Unlimited choice must be expensive. Experience suggests most patients want quick access to good local facilities. Cooperation—for example in clinical networks—rather than competition is thought to drive improved clinical quality. Quality may become a hostage to market forces when the bottom line is profit.

To date, no training in ophthalmology has been provided in independent sector treatment centres. No innovation has emerged from those for cataracts—rather, overseas teams have had to improve their standards to reach NHS ophthalmology standards.2 3 The much trumpeted innovation of mobility is of uncertain benefit to patients who often have to travel further to reach these mobile units than to receive conventional care locally. High volume NHS cataract surgery operating lists can, and often do, achieve the same numbers of patients treated per session as in the mobile units. However, NHS units also provide holistic and comprehensive ophthalmology care to all comers, and clinical training.

Reform and “self improvement” of NHS services is also urged.1 However, most of the process redesign now claimed existed in initiatives such as the “Action on Cataract” schemes.2 5 These self improvements are testimony to both the innovative skills of NHS ophthalmologists and the close collaboration between hospital and primary care. These professional leadership qualities may be lost in the fragmentation of the current procurement of the independent sector centres.