Select Committee on Health Written Evidence


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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