Intended for healthcare professionals


Independent sector treatment centres: learning from a Scottish case study

BMJ 2009; 338 doi: (Published 30 April 2009) Cite this as: BMJ 2009;338:b1421
  1. Allyson M Pollock, professor and director,
  2. Graham Kirkwood, research fellow
  1. 1Centre for International Public Health Policy, University of Edinburgh, Edinburgh EH8 9AG
  1. Correspondence to: A M Pollock allyson.pollock{at}
  • Accepted 16 March 2009

The value for money of work contracted out to independent sector treatment centres has been hard to assess. Allyson Pollock and Graham Kirkwood look at data from the only such centre in Scotland.

The ISTC programme: time for an overhaul

Since 2000, the Department of Health has had an explicit policy of using NHS funds to contract out some elective surgery and associated clinical services to the private for profit sector. This policy of commercialisation is known in England as the Independent Sector Treatment Centre (ISTC) programme, under which the government intends that the private health care industry will provide elective surgery and other clinical services at a projected total cost to the NHS of over £5bn ($7.3bn, €5.6bn).1 To date the government has contracted for £2.7bn worth of services.2 The core objectives of the programme are to assist the NHS in reducing waiting times, support the shift from primary to secondary care, expand the options for patient choice in the provision of services, promote innovation, and build relationships between the NHS and the private sector.3

The policy has been extraordinarily difficult to evaluate because few data are publicly available.4 Parliamentary and academic assessments of the value for money and effectiveness of the policy have been hindered by the refusal of the Department of Health to make the contracts public on the grounds of commercial confidentiality.1 Because crucial data have not been submitted by the private sector to Hospital Episode Statistics, quality and performance also remain unevaluated.5 6 In July 2006 the House of Commons Health Committee concluded that lack of data made an assessment of the programme impossible, and in July 2007 the Healthcare Commission could not report on quality of care because ISTCs failed to return and comply with Hospital Episode Statistics data requirements, a situation that continues.1 …

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