Intended for healthcare professionals

Views & Reviews Review of the Week

Too independent for patients’ own good?

BMJ 2009; 339 doi: (Published 07 October 2009) Cite this as: BMJ 2009;339:b4077
  1. Nicholas Clarke, consultant orthopaedic surgeon, Southampton
  1. nmpc{at}

    The private sector has helped cut NHS waiting lists, but at what cost, a primetime documentary asked last week. Nicholas Clarke questions whether the programme makers went far enough

    This disappointing programme investigated the use of independent sector treatment centres (ISTCs) within the NHS “brand.” The programme makers concentrated on the effectiveness of laparoscopic cholecystectomy, with mortality as the clinical outcome. It detailed a series of tragic deaths that will, of course, resonate with the public. Clinicians are already aware that this government’s strategy of using the private sector to treat NHS patients has been at the expense of clinical governance and information. The situation will not be helped by the superficial response and poor evidence provided by the health minister interviewed on the programme.

    The clinical scenarios described in the programme were indeed worrying. Laparoscopic cholecystectomy in a unit without a blood bank or laparotomy instrumentation is a clinical environment familiar to those who visit a developing country but not in the NHS. …

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