Independent Sector Treatment Centre
Encyclopedia
Independent sector treatment centres (ISTCs) are private-sector owned treatment centre
s contracted within the English National Health Service
to treat NHS patients free at the point of use, like any other NHS hospital. They are sometimes referred to as 'surgicentres' or ‘specialist hospitals’.
ISTCs are normally co-located with NHS hospitals. They perform common elective (i.e. non-emergency) surgery
and diagnostic
procedures and tests in the same way as NHS hospitals. Typically they undertake 'bulk' surgery such as hip replacements, cataract
operations or MRI scans rather than more complex operations such as neurosurgery
. Department of Health claims stated that by concentrating on a set type of procedures they are able to streamline the patient care pathway, resulting in an improved patient experience and help the NHS to quickly meet waiting time targets; however, the majority of independent research conducted to date has contradicted these claims.
Wave I ISTCs currently work on pre-arranged central government bulk contracts nominally at or below the national tariff http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4127649&chk=YwGemZ on which NHS hospitals can charge commissioning NHS Primary Care Trust
s. These contracts include a profit margin and the treatments are paid for in advance by central government whether or not the numbers paid for are taken up and regardless of success rates. The rationale is that the waiting times for patients are cut by separating routine elective surgery and tests from emergency work.
Referral rates vary across the country, with some ISTCs performing as much 115% of their contracted volumes but with the average referral rate around 85%. According to the NHS Partners Network
, which represents private providers working within the health service, GP referral rates are rising as patients report positive experiences back to their GPs.
A critique of this development is that difficult and expensive work is left for the NHS hospitals to do, increasing their marginal costs and making them appear less 'efficient'. Recent opinion printed in the British Medical Journal
(BMJ vol 332 11 March 2006) has also suggested that treatments may be proportionally less successful in ISTCs due to the employment of inexperienced or less fully trained staff with less backup than the NHS facilities. This could result in the NHS having to fund difficult revision operations (insofar as they can be so revised) and would defeat the object of the exercise. However, a subsequent study conducted by the researchers from London School of Hygiene & Tropical Medicine
and the Royal College of Surgeons of England
confirmed the high quality of care, concluding that “patients undergoing cataract surgery or hip replacements in ISTCs achieved a slightly greater improvement … than those treated in NHS facilities” and “Patients treated in ISTCs were less likely to report post-operative problems than those treated in NHS facilities…”(BMC Health Services Research 2008. 8:78).
In the 2008 Healthcare Commission 2008 NHS Inpatient Survey, ISTCs scored highly on a number of measures, including overall quality of care.
The NHS Plan originally conceived of opening eight treatment centres by 2005, but by August 2005 at least 25 had been opened, with more being planned. A second Wave of ISTCs was completed in 2009 and those marked the end of the centrally planned centres. Moving forward, local PCTs will make decisions on how best to work with their local ISTCs after the initial five year contracts have expired.
In 2009 a British Medical Journal
paper concluded that up to £927m of the £1.5bn first wave of ISTC contracts "may have been paid to ISTCs for patients who did not receive treatment". This was based on a Scottish example and does not in fact reflect the experience of the English ISTC program, where referrals have been more inline with the expectations of the original contracts and continue to grow.
Treatment centre
Treatment centres are medical institutions in the United Kingdom which provide routine diagnostic and surgery procedures to day-case and short-stay patients. By diverting these patients away from hospitals, they aim to reduce waiting lists by allowing hospitals to concentrate on emergency and more...
s contracted within the English National Health Service
National Health Service
The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...
to treat NHS patients free at the point of use, like any other NHS hospital. They are sometimes referred to as 'surgicentres' or ‘specialist hospitals’.
ISTCs are normally co-located with NHS hospitals. They perform common elective (i.e. non-emergency) surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
and diagnostic
Diagnosis
Diagnosis is the identification of the nature and cause of anything. Diagnosis is used in many different disciplines with variations in the use of logics, analytics, and experience to determine the cause and effect relationships...
procedures and tests in the same way as NHS hospitals. Typically they undertake 'bulk' surgery such as hip replacements, cataract
Cataract
A cataract is a clouding that develops in the crystalline lens of the eye or in its envelope, varying in degree from slight to complete opacity and obstructing the passage of light...
operations or MRI scans rather than more complex operations such as neurosurgery
Neurosurgery
Neurosurgery is the medical specialty concerned with the prevention, diagnosis, treatment, and rehabilitation of disorders which affect any portion of the nervous system including the brain, spine, spinal cord, peripheral nerves, and extra-cranial cerebrovascular system.-In the United States:In...
. Department of Health claims stated that by concentrating on a set type of procedures they are able to streamline the patient care pathway, resulting in an improved patient experience and help the NHS to quickly meet waiting time targets; however, the majority of independent research conducted to date has contradicted these claims.
Wave I ISTCs currently work on pre-arranged central government bulk contracts nominally at or below the national tariff http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4127649&chk=YwGemZ on which NHS hospitals can charge commissioning NHS Primary Care Trust
NHS Primary Care Trust
An NHS primary care trust is a type of NHS trust, part of the National Health Service in England. PCTs commission primary, community and secondary care from providers. Until 31 may2011 they also provided community services directly. Collectively PCT are responsible for spending around 80% of the...
s. These contracts include a profit margin and the treatments are paid for in advance by central government whether or not the numbers paid for are taken up and regardless of success rates. The rationale is that the waiting times for patients are cut by separating routine elective surgery and tests from emergency work.
Referral rates vary across the country, with some ISTCs performing as much 115% of their contracted volumes but with the average referral rate around 85%. According to the NHS Partners Network
NHS Partners Network
The NHS Partners Network represents independent healthcare providers delivering NHS services and is one of the networks belonging to the NHS Confederation, an independent membership body for the full range of organisations that make up today's National Health Service.The members of the NHS...
, which represents private providers working within the health service, GP referral rates are rising as patients report positive experiences back to their GPs.
A critique of this development is that difficult and expensive work is left for the NHS hospitals to do, increasing their marginal costs and making them appear less 'efficient'. Recent opinion printed in the British Medical Journal
British Medical Journal
BMJ is a partially open-access peer-reviewed medical journal. Originally called the British Medical Journal, the title was officially shortened to BMJ in 1988. The journal is published by the BMJ Group, a wholly owned subsidiary of the British Medical Association...
(BMJ vol 332 11 March 2006) has also suggested that treatments may be proportionally less successful in ISTCs due to the employment of inexperienced or less fully trained staff with less backup than the NHS facilities. This could result in the NHS having to fund difficult revision operations (insofar as they can be so revised) and would defeat the object of the exercise. However, a subsequent study conducted by the researchers from London School of Hygiene & Tropical Medicine
London School of Hygiene & Tropical Medicine
The London School of Hygiene & Tropical Medicine is a constituent college of the federal University of London, specialising in public health and tropical medicine...
and the Royal College of Surgeons of England
Royal College of Surgeons of England
The Royal College of Surgeons of England is an independent professional body and registered charity committed to promoting and advancing the highest standards of surgical care for patients, regulating surgery, including dentistry, in England and Wales...
confirmed the high quality of care, concluding that “patients undergoing cataract surgery or hip replacements in ISTCs achieved a slightly greater improvement … than those treated in NHS facilities” and “Patients treated in ISTCs were less likely to report post-operative problems than those treated in NHS facilities…”(BMC Health Services Research 2008. 8:78).
In the 2008 Healthcare Commission 2008 NHS Inpatient Survey, ISTCs scored highly on a number of measures, including overall quality of care.
The NHS Plan originally conceived of opening eight treatment centres by 2005, but by August 2005 at least 25 had been opened, with more being planned. A second Wave of ISTCs was completed in 2009 and those marked the end of the centrally planned centres. Moving forward, local PCTs will make decisions on how best to work with their local ISTCs after the initial five year contracts have expired.
In 2009 a British Medical Journal
British Medical Journal
BMJ is a partially open-access peer-reviewed medical journal. Originally called the British Medical Journal, the title was officially shortened to BMJ in 1988. The journal is published by the BMJ Group, a wholly owned subsidiary of the British Medical Association...
paper concluded that up to £927m of the £1.5bn first wave of ISTC contracts "may have been paid to ISTCs for patients who did not receive treatment". This was based on a Scottish example and does not in fact reflect the experience of the English ISTC program, where referrals have been more inline with the expectations of the original contracts and continue to grow.
Books
- Player, Stewart and Leys, ColinColin LeysColin Leys was employed as an academic at various universities of Oxford , Makerere , Sussex, Kivukoni College in Dar es Salaam, Tanzania; Nairobi , Sheffield, and Queen's University, Canada, where he is an emeritus professor of Political Studies .He also holds an honorary professorship at...
(2008), CONFUSE AND CONCEAL: The NHS and Independent Sector Treatment Centres, Merlin Press
External links
- Department of Health Information on Treatment Centers
- CBI ISTCs and the NHS: Sticking plaster or real reform?
- Comment on ISTCs by the Royal College of PhysiciansRoyal College of PhysiciansThe Royal College of Physicians of London was founded in 1518 as the College of Physicians by royal charter of King Henry VIII in 1518 - the first medical institution in England to receive a royal charter...
- ISTC marketing sustainability analysis prepared in 2004 by Department of HealthDepartment of Health (United Kingdom)The Department of Health is a department of the United Kingdom government with responsibility for government policy for health and social care matters and for the National Health Service in England along with a few elements of the same matters which are not otherwise devolved to the Scottish,...
- Report on ISTCs by UNISONUNISONUNISON is the largest trade union in the United Kingdom with over 1.3 million members.The union was formed in 1993 when three public sector trade unions, the National and Local Government Officers Association , the National Union of Public Employees and the Confederation of Health Service...
, (August 2005). - Report on ISTCs in Medical News Today, (17 February 2006)