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ISTCs no major benefit

25th July 2006

25072006_minor_op1Q.jpgThe network of independent sector treatment centres (ISTCs) established in England to drive down waiting lists and increase choice, have not brought major benefit to the NHS, says the Select Committee on Health.

Waiting lists have fallen, says the report, but this is more likely to be due to extra money in the NHS than the impact of the ISTCs; the programme could lead to cuts in services at hospitals.

To date 21 ISTCs have been set up, although a number of NHS centres have also been established. The first treatment centre in England dedicated to elective procedures was opened at the Central Middlesex Hospital in 1999. In 2002, the Department of Health announced that it was creating a programme of similar NHS Treatment Centres as a systematic approach to the issue. At the end of 2002, the government commissioned a number of ISTCs to treat NHS patients who required relatively straightforward elective or diagnostic procedures.

The ISTCs carry out minor surgery, including hip operations, ear, nose and throat treatment and cataract operations.

The MPs said that the guaranteed levels of work given to the first phase of ISTCs meant they could end up starving NHS hospitals of patients and putting them at risk in the current financial climate. In phase two, launched in March 2005, ITCS could only be built where there was local need.

The report made a number of criticisms of the ISTCs, including that the centres were "poorly integrated" with the NHS and were not training doctors. Putting the extra money spent on ISTCs into the NHS may have been a cheaper and more efficient option, they argued.

The MPs also stressed, however, that there was no "hard evidence" to prove standards of care in ISTCs were lower than in the NHS, but that it was hard to make firm conclusions as there has been no attempt to assess and quantify the impact of the centres. Whilst ISTCs have embodied good practice and innovative techniques, innovation could also be found in the NHS.

BMA consultant leader, Dr Paul Miller, said "It is good that unlike the government, the Health Committee is listening to the BMA’s major worries about ISTCs." He added that "I am particularly pleased to see the Committee agrees that the Department of Health needs to go further in enabling NHS doctors to work and train in ISTCs."

Dr Gill Morgan, chief executive of the NHS Confederation, said that whilst the report had found problems with the implementation of ISTCS, it should not detract 'from the report’s finding that ISTCs are delivering free care to NHS patients to a standard comparable with the rest of the NHS.' However she added that "there are clear lessons from the report about the planning of major policies and initiatives by government departments."

King’s Fund chief executive, Niall Dickson, noted that ISTCS were at a very early stage in their development and that the introduction of treatment centres is generally regarded as a good thing, whether they are run by an NHS or an independent organisation. However, he concluded that monitoring and measuring was important from the outset - "otherwise policy formulation will constantly be driven by rhetoric not reality.?

Health Minister Lord Warner, responding to the report, said ISTCs have "increased choice, offered earlier treatments and driven down prices", adding that moves to gather information had already been made by  asking the Healthcare Commission to conduct an audit of the centres.

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