1 Introduction
We from the college and specialist associations have
for the last 10, 12, 15 years been talking about separating emergency
from elective work. Currently some 64% of consultant general surgeons
are on call for emergencies when they are doing elective work.
The NHS has to deal with emergencies at the same time as it does
its elective work […] if you separate elective from emergency
you will get good treatment.[1]
(Mr Bernard Ribeiro, President of the Royal College
of Surgeons of England)
1. The separation of elective from emergency care
by establishing treatment centres has been promoted by clinicians
in England since the early 1990s. The first treatment centre in
England opened in 1999. In April 2002, the Department of Health
announced a programme of NHS Treatment Centres to create additional
elective surgery and relieve pressure on the acute sector. This
was followed in December 2002 by a decision to commission a number
of independent sector treatment centres (ISTCs) to treat NHS patients
for relatively simple, high-volume surgical procedures. The first
ISTC began operating in 2003.
2. In March 2005, the Government announced that it
was launching a second and substantial phase of procurement of
additional elective surgery and diagnostic capacity from the independent
sector. This was contentious for a number of reasons: for example,
several professional groups had been concerned about the quality
of care provided by the ISTCs and there were doubts as to whether
the ISTCs provided value for money. In January 2006, we announced
an inquiry into ISTCs. In addition to examining public concerns
about the programme, we were keen to see what lessons should be
learned from Phase 1 and applied to Phase 2, and what the long-term
future of ISTCs should be. Our terms of reference were:
- What is the main function of
ISTCs?
- What role have ISTCs played in increasing capacity
and choice, and stimulating innovation?
- What contribution have ISTCs made to the reduction
of waiting times and waiting lists?
- Are ISTCs providing value for money?
- Does the operation of ISTCs have an adverse effect
on NHS services in their areas?
- What arrangements are made for patient follow-up
and the management of complications?
- What role have ISTCs played and should they play
in training medical staff?
- Are the accreditation and appointment procedures
for ISTC medical staff appropriate?
- Are ISTCs providing care of the same or higher
standard as that provided by the NHS?
- What implications does commercial confidentiality
have for access to information and public accountability with
regard to ISTCs?
- What changes should the Government make to its
policy towards ISTCs in the light of experience to date?
- What criteria should be used in evaluating the
bids for the Second Wave of ISTCs?
- What factors have been and should be taken into
account when deciding the location of ISTCs?
- How many ISTCs should there be?
3. We held four evidence sessions between 9 March
and 26 April 2006, hearing from independent healthcare providers,
medical professional groups including several Royal Colleges,
trades unions, regulatory bodies and academics, as well as the
Secretary of State for Health, the Rt Hon Patricia Hewitt MP,
and officials from the Department of Health. To clarify the progress
being made on Phase 2 of the ISTC Programme we held a fifth evidence
session on 28 June.
4. We visited three treatment centres in April 2006,
representing three different models: Redwood Diagnostic and Treatment
Centre, run by BUPA in partnership with the local NHS and using
a mixture of BUPA and seconded NHS staff; the Will Adams NHS Treatment
Centre at Gillingham, a conventional Phase 1 ISTC operated by
Mercury Health; and the Woodland NHS Treatment Centre at Darent
Valley Hospital, an NHS-run treatment centre. In addition, members
of the Committee visited ISTCs in or near their constituencies.
In March 2006 we visited St Görans Hospital in Stockholm
which is run by Capio Healthcare, an independent healthcare company,
and provides a full range of services to state-funded patients.
5. We are extremely grateful to our specialist advisers;
Professor Nick Bosanquet, Professor of Health Policy at Imperial
College, London; Seán Boyle, Senior Research Fellow at
the LSE Health and Social Care research centre, London School
of Economics; and Professor Sir Ara Darzi, Clinical Professor
at the Division of Surgery, Oncology, Reproductive Biology and
Anaesthetics at Imperial College, London, for their very helpful
advice and support during this inquiry.
1 Q 96 Back
|
