APPENDIX 1
SUMMARY RESPONSES TO SPECIFIC QUESTIONS FROM
THE TERMS OF REFERENCE
NHS Elect is able to provide a response to only
some of the specific questions set out in the terms of reference.
We have attempted to respond to these in the information provided
above. For ease of reference, we have also prepared this appendix
to provide some additional information and to cross-reference
the information given in the main body of this memorandum.
What role have ISTCs played in increasing capacity
and choice and stimulating innovation?
ISTCs have been important in increasing capacity
and choice for patients. Their role in stimulating innovation
has been limited (see paragraphs 4.1 to 4.2, above) as there is
little formal sharing between the IS and the NHS.
What contribution have ISTCs made to the reduction
of waiting times?
ISTCs have contributed to the overall reduction
in waiting times within the NHS.
Are ISTCs providing value for money?
Most ISTCs operate under the "dual-tariff"
syste million, with IS providers unable to deliver services within
national tariff and thus receiving a supplement to this via "dual-tariff".
ISTCs do not routinely provide training to NHS junior medical
staff and usually focus on treating patients without complex co-morbidities
(often because of a lack of high dependency/intensive care provision
on site), as detailed in paragraph 4.3 above. It would therefore
appear that, historically, ISTCs have received a higher cost-per-case
than NHS providers, while tackling a less complex case mix and
without the cost of training junior medical staff. We understand
that this may be changed in future procurements.
Does the operation of ISTCs have an adverse effect
on NHS services in their areas?
See paragraphs 3.2 and 4.3, above.
What arrangements are made for patient follow-up
and the management of complications?
See paragraph 4.3, above.
What role have ISTCs played and should they play
in training medical staff?
Existing ISTCs need to be regarded as a sustainable
change in the provision of health-care in the UK. They therefore
need to become involved in the training of medical staff, particularly
surgeons and aneasthetists. This is particularly pressing in some
areas where the ISTC is scheduled to provide a large part of the
straightforward elective case-load delivered in that locale. Junior
staff need to gain experience in operating on and caring for these
patients and it is therefore imperative that these ISTCs train
junior staff. This will also help ISTCs in demonstrating better
value for money, as at present they are not routinely providing
training for junior staff within their agreed tariff price.
Are ISTCs providing care of the same or higher
standard as that provided by the NHS?
The national ISTC programme does require the
ISTCs to monitor a wide range of standards relating to both patient
experience and clinical quality. The requirements here are impressive
and are more stringent than those requested of the NHS TCs. We
would expect that it is too early yet to use this data to assess
the quality of care provided, but this should be possible in the
near future. This would be particularly useful if NHS providers
decided to collect similar data to allow comparison and NHS Elect
strongly encourages its sites to improve data collection in line
with ISTC requirements.
What changes should the Government make to its
policy towards ISTCs in the light of experience to date?
It is our view that there needs to be more opportunities
for collaboration between the NHS and the IS, to support the sharing
of learning, improve the management and integration of patient
care and ensure that capacity is developed where it is most needed
and can be afforded. See all of above narrative.
What criteria should be used in evaluating the
bids for the Second Wave of ISTCs?
ISTCs should be created where is a clear need
for additional capacity or a need to use existing capacity (usually
within NHS facilities) in a new way to introduce choice and/or
stimulate innovation. Bids should be evaluated primarily according
to whether they deliver capacity that is needed to meet the December
2008 waiting time targets at a price affordable to the local NHS.
Additional consideration should be given to the commitment of
the ISTC provider to work with the local NHS (primary and secondary
care) to share experience and stimulate innovation across the
piece and to ensure that care provided to patients is seamless.
What factors have been and should be taken into
account when deciding the location of ISTCs?
To date, the policy has focused on ensuring
that IS services are developed in all areas of the country, largely
irrespective of levels of existing capacity. We need to move from
this to a commitment to develop ISTCs only where there is a need
for additional capacity to deliver waiting time targets. Where
there is a need to stimulate innovation or increase patient choice,
but no need for additional facilities, IS providers should be
asked to deliver services in collaboration with NHS colleagues,
using existing buildings.
How many ISTCs should there be?
Detailed work has been undertaken by the DH
on the levels of capacity needed to deliver waiting time targets
and, in particular, to ensure that by December 2008 no patient
waits more than 18 weeks from referral to treatment. This work
should be used to determine if there are any remaining gaps in
capacity which could be sensibly and affordably filled by ISTCs.
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