Intended for healthcare professionals


Surgeons claim independent centres produce poor results

BMJ 2006; 332 doi: (Published 16 March 2006) Cite this as: BMJ 2006;332:623
  1. Adrian O'Dowd
  1. London

    The NHS is acting as a safety net for patients who receive inferior treatment at independent sector treatment centres that have yet to prove themselves, MPs have been told. Worries about the quality of independent sector treatment centres (ISTCs) were voiced by various doctors' representatives to the health parliamentary select committee last week at the first session of oral evidence in the committee's inquiry into these centres.

    England has 20 independent sector treatment centres, with 10 more planned. The first centre opened in October 2003 under a partnership agreement between the NHS and the private sector to carry out specific procedures to help with the NHS's lack of capacity and waiting lists.

    Ian Leslie, the president of the British Orthopaedic Association, told the committee, “I have not, from any of our members, found one group who have said that things have improved as a result of a localised ISTC.”

    Mr Leslie admitted that evidence of bad practice was merely anecdotal, but he added, “There is now enough evidence gathering out there. My colleagues see the bad results coming back. Bad results perhaps in eye surgery and hernia surgery occur rapidly.

    “In orthopaedic surgery, they occur over five years, maybe 10 years, so we are seeing dislocation rates and revision rates, and if one is seeing that with our patients, it is no wonder we are being negative about the way it is being done.”

    In evidence that closely mirrored the words of another orthopaedic surgeon, Professor Angus Wallace, in the BMJ last week (2006;332: 614, 11 March, Mr Leslie said: “You can say these ISTCs have been successful in waiting lists, but at a price—both a monetary one, and also there are a lot of patients out there who are having problems as a result of that innovation.”

    The president of the Royal College of Surgeons of England, Bernard Ribeiro, told the committee, “The fact is there is a lack of will to follow through by having these centres in the NHS because it's government policy to contest, challenge the NHS, put independent sector treatment centres nearby, and see whether the NHS hospital nearby will deliver, and if it can't deliver, then it goes down.”

    The BMA, in written evidence submitted to the inquiry, said that it was concerned that, because of the “current lack of robust audit data on outcomes” the public and the NHS were unable to assess properly the quality of services or whether they were value for money.

    Civil servants, also giving evidence, said that there had been no destabilisation of existing NHS services as a result of the treatment centres but said that training was an issue. Bob Ricketts, head of demand side reform for the Department of Health, said, “If you are moving out many of the frequent but simpler procedures that junior medical staff train on, then that is an area we need to make sure we don't inadvertently destabilise. That is why we have been in discussion with the Royal Colleges around how do we actually manage training.”

    The inquiry continues.


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