Skip to main content

Independent sector treatment centres unlikely to be providing value for money

Independent sector treatment centres (ISTCs) were established by the previous government to increase the capacity for elective surgical procedures. The new centres were expensive and there are concerns about the value for money they provide. An article from York University published in the August issue of the Journal of the Royal Society of Medicine concluded that NHS hospitals were treating more complex patients than independent treatment centres. The article provides new information on private sector treatment centres that will help inform the policy of the coalition government. The article highlights the need for much tighter regulation of all units providing NHS services to ensure that they deliver high quality care, provide value for money, and meet minimum standards for data collection.

Other key findings from the article are that private sector treatment centres manage only a very small proportion of NHS-funded elective workload; their clinical coding is much poorer than that of NHS hospitals; and they tend to treat people with less complex health needs. Private sector providers were generally given much better financial terms than NHS providers. The rationale for this was never very clear as, in a free market, we would expect all providers to compete on equal terms. Furthermore, because workload in private sector treatment centres is only a small fraction of that in NHS units, this suggests that the private sector providers will have very limited impact on areas such as access to treatment and waiting times.

It is also very disturbing that 36% of patients in private sector units were allocated to an uncoded Healthcare Resource Group (HRG), compared to just 1% in NHS units. These data are important to hospitals and ISTCs, as they provide essential information for clinical management and audit. For example, the data are commonly used to monitor mortality and readmission rates. They are also used extensively in national level analyses, for example, to monitor patient safety (e.g. see http://www.ncbi.nlm.nih.gov/pubmed/20110288). If the data are not of high quality with accurate coding, this limits their usefulness considerably and could have a major impact on public health.

The authors highlight that the private sector units are not operating at the capacity that was planned for them. In some areas, this has led to pressure on GPs to refer more patients to them instead of to NHS units. This seems to go against the government's desire to offer patients a choice in where they are referred for specialist treatment. For example, see http://bit.ly/9XcpCG. The key conclusion from this article is that ISTCs should be made to compete on a level playing field with NHS hospitals. If they are not able to match NHS hospitals on price and quality, then, where possible, their contracts should be terminated.

Comments

Popular posts from this blog

Improving discharge planning in NHS hospitals

Factors that need to be considered in discharge planning that have been identified in previous projects include:

Ensuring that discharge arrangements are discussed with patients, family members and carers; and that they are given a copy of the discharge summary.Adequate coordination between the hospital, community health services, general practices, and the providers of social care services.There is a follow-up after discharge of patients at high risk of complications or readmission - either in person or by telephone - to ensure that the discharge arrangements are working well. Medicines reconciliation is carried out. This is the process of verifying patient medication lists at a point-of-care transition, such as hospital discharge, to identify which medications have been added, discontinued, or changed from pre-admission medication lists.Ensuring that any outstanding test results at discharge are obtained and passed on to primary care teams; and ensuring there are clear arrangements …

What will Brexit mean for the NHS?

On the 29 March 2017, the Prime Minister of the UK Theresa May, formally notified the European Union (EU) Council President, Donald Tusk, of the UK’s intention to leave the EU. Theresa May’s letter to Donald Tusk triggers a two-year process during which the UK will have to negotiate both the terms of its exit from EU and the arrangements that will replace those we have had for over 40 years with the other member states of the EU. The consequences of the United Kingdom’s departure from the EU (commonly referred to as ‘Brexit’) will be wide-ranging and will affect all areas of UK’s society, including the National Health Service (NHS).

For the NHS, Brexit comes at a time when it faces many other major challenges. These include severe financial pressures, rising workload, increased waiting times for both primary care and specialist services, and shortages of health professionals in many key areas (such as in general practice and in emergency departments). The NHS also faces challenges fr…

Can GPs issue private prescriptions to NHS patients?

The NHS prescription charge in England is currently £8.60 per item. At this level, many commonly prescribed drugs will cost less than the prescription charge and so some NHS patients may occasionally ask if they can have a private prescription rather than an NHS prescription.

In the past, some GPs have been advised that they could issue both an NHS FP10 and a private prescription, and let the patient decide which to use. But the British Medical Association's General Practice Committee has obtained legal advice that said under the current primary care contract, GPs in England may not issue a private prescription alongside or as an alternative to an NHS FP10 prescription. In any consultation where a GP needs to issue an FP10, the concurrent issue of a private prescription would be a breach of NHS regulations.

The issuing of a private prescription in such circumstances could also be seen as an attempt to deprive the NHS of the funds it would receive from the prescription charge. Fur…