Quality of care in independent sector treatment centres
BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d6936 (Published 04 November 2011) Cite this as: BMJ 2011;343:d6936All rapid responses
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Investment decisions in ISTCs and all other activity has to be informed by evidence of cost effectiveness. Chard et al offer some nice effectiveness data. Some initial ISTC contracts were paid at PbR tariff plus 15% Why is this not discussed to illuminate cost effectiveness? Time for the BMJ to stop publishing incomplete evaluations of policies such as ISTCs, competition and patient safety. Remember always that what is effective may not be cost effective and what is cost effective is always effective!
Competing interests: No competing interests
Research on outcomes in ISTCs is welcome, indeed essential. Chard's paper shows that some routine elective operations performed by cherry-picked surgeons on selected low risk patients do not have significantly better outcomes than those in standard NHS care. One may therefore ask what is the imperative for their introduction?
The data for cost comparison and the long term outcome data are missing. There is likely to be residual confounding by case mix.
It will not be cost-effective for ISTCs to acquire medical equipment, facilities and expertise for emergency complications in their elective patients. Emergency transfer is not an option I would expect to outperform integrated care in an NHS hospital.
Generalising the limited findings of this study to state that ISTCs provide "Quality of care...that seems to be as good as the NHS" is itself an ideological over-representation of the facts.
"ISTCs appear to be no better than NHS care, and the questions regarding safety and cost remain unanswered" may be a more accurate rendering of this evidence.
Competing interests: No competing interests
Re: Quality of care in independent sector treatment centres
We had always suspected that ISTC's would demonstrate substantially better surgical outcomes when compared to traditional NHS surgical providers. We suspected this because an ISTC is in business for nothing more than treating a small repertoire of cases for which they should be well rehearsed. In an ISTC, the surgeon and anaesthetist will readily find their patients preoperatively, rather than having to search all over the hospital which is what happens to surgical providers in the traditional NHS. In an ISTC the surgeon and anaesthetist cannot be distracted by needs of patients other than those on their operating list - In stark contrast to what happens in the traditional NHS model. Surgeons in ISTC's are unlikely to find their operating list disrupted to treat an emergency that needs urgent surgery. The attention of surgeons and anaesthetists in ISTC's is not distracted by them having to teach medical students and mentor junior medical staff. And on the wards of these ISTC's the nursing staff are focused only on the needs of those having some very specific surgery - no need to be distracted by patients with complex medical and social conditions.
Despite these tremendous advantages that an ISTC has over the traditional NHS model, ISTC’s fail to demonstrate any significant outcome benefit over the traditional NHS model. Separating emergency treatment from elective work has not shown the significant benefit that was expected. As such, we believe the concept of ISTC’s has failed. ISTC’s have shown themselves to be a busted flush. A busted flush with no reason to justify why they are allowed to cherry pick easy cases from traditional NHS surgical providers
Competing interests: No competing interests