Letters Quality of care in ISTCs

Research on outcomes is essential

BMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d7697 (Published 29 November 2011) Cite this as: BMJ 2011;343:d7697
  1. Nick G Mann, general practitioner1
  1. 1Well Street Surgery, London E9 7TA, UK
  1. drnickmann{at}o2.co.uk

Research on outcomes in independent sector treatment centres (ISTCs) is welcome, indeed essential. Chard and colleagues’ 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.1 2 Why then was this system introduced?

Data on cost comparison and 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 unlikely 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 an over-representation of the facts.2 “ISTCs seem to be no better than NHS care, and questions regarding safety and cost remain unanswered” might be a more accurate rendering of this evidence.


Cite this as: BMJ 2011;343:d7697


  • Competing interests: None declared.