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Private sector vital for Government plans for patient choice

Published on 15/12/05 at 04:56pm

Patients are to be given more choice in their care as the NHS undertakes an ambitious set of reforms intended to set it up for the next twenty years.

Giving patients a choice of at least four hospitals from January, and a choice of any hospital by 2008, is a central part of a two-year programme designed to make long-term improvements to the health service.

The private sector will make a vital contribution to driving waiting lists down, in the form of a greater use of independent sector treatment centres (ISTCs).

Health Secretary Patricia Hewitt said: "We need to offer more choice after diagnosis as well as at referral. We want to build on the direct payments and individual budgets that are starting to give people far more choice over their care."

The raft of reforms will try to incentivise underperforming hospitals to improve through the introduction of payment by results and make GPs more accountable for their budgets.

But it is the expanded role in the plans for treatment centres and the controversial ISTCs in particular that has angered doctors.

A survey by the BMA found that although treatment centres benefited patients, doctors thought they damaged the long-term future of the NHS.

NHS clinical directors contacted by the BMA said the impact of privately run treatment centres was of particular concern. No respondents thought ISTCs had a positive impact on their trust and less than half thought NHS-run centres did.

The BMA questioned 177 NHS trust clinical directors in anaesthetics, ophthalmology and orthopaedics - the three specialties where most use is made of treatment centres. Of those respondents, 91 had a treatment centre in their trust catchment area.

NHS clinicians originally conceived the concept of treatment centres to offer fast-track surgery for routine procedures, freeing up hospitals to deal with the more complex clinical cases. There are currently 37 NHS treatment centres and 14 run by the independent sector.

The BMA accepts they have helped reduce waiting time and improve access and its survey found that 70% of clinical directors thought patients had benefited from them.

Chairman of the BMA's consultants committee Dr Paul Miller said: "Our survey shows that while treatment centres can benefit patients and have a positive impact on the NHS, their success depends on the unit being properly integrated with the NHS, where local clinicians can be involved in the planning and running of the clinical service."

Clinical directors' concerns about ISTCs range from the quality and continuity of care offered to the way they are allowed to cherry-pick the easiest clinical cases and the cost of the treatment they provide.

The Health Secretary acknowledged the contentiousness of making more use of the private sector to achieve NHS targets, but said there was no other way to improve the service.

"I know the second wave of independent sector procurement is controversial, but I also know that the only way to achieve the 18-week target will be to achieve an enormous increase in diagnostic capacity both in the NHS and independent sector. We won't abolish waiting lists without it," she said.

Deputy chair of the BMA's consultants committee Dr Jonathan Fielden said: "The impact of treatment centres on training is a huge problem and mortgages the future quality of the NHS if we can't train our doctors."

Earlier this year the NHS orthopaedic ward in Southampton was forced to close after patients were transferred to an ISTC in order to meet government targets for operations carried out by non-NHS providers.

The consequences of moving a huge block of elective surgery work away from the hospital pushed it to the brink of losing its training capabilities, Dr Fielden said.


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