Synopsis of Key Questions Raised in Discussion
Q: Is the DTC "cherry-picking" the
easy cases, leaving the local NHS with complex and urgent cases,
thus diluting the benefits to the health economy as a whole?
A: Whilst it is true that the current contract
focuses on routine operations, the whole system benefits from
high elective through ut and greater productivity. The number
of cancelled operations has been reduced and the number of cases
on each operating list has gone up dramatically.
Q: Why could the NHS not have done exactly
the same thing without needing an independent sector partner involved?
A: The NHS can and does operate "fast
track" surgery centres along the same lines as BUPA Redwood.
Many of the benefits of Treatment Centres are gained from concentrating
exclusively on elective care, irrespective of who operates it.
However, BUPA believes there are additional benefits from allowing
the independent sector to run a proportion of these centres. These
are:
Organisations like BUPA bring a particular
expertise in running customer-focussed elective treatment and
diagnostic services. This is what we have been doing in our private
hospitals for over 20 years.The ISTC programme has enabled
us to transfer some to this experience to serve NHS customers.
The involvement of independent sector
providers increases the choice available to patients and GPs.
In our experience patients welcome the opportunity to choose a
BUPA-run facility which is free of charge and organised as part
of the local NHS provision. This choice promotes healthy internal
competition within the NHS which in turn will stimulate innovation
and a general improvement in standards of provision.
At a time when NHS management has
to cope with a myriad of challenges, the ISTC programme has brought
in organisations which are solely focussed on delivering quality
elective healthcare in a cost-effective way. Redwood has demonstrated-that
this focus from a dedicated BUPA management team has fostered
a strong partnership with clinicians and other staff, process
improvements and excellent patient satisfaction.
Q: How does the cost of Redwood compar with
the NHS Tariff?
A: Redwood was set up before the NHS int
oduced the policy of Payment by Results and before the launch
of the Wave One of the ISTC procurement. Because of this the arrangements
are unique and are not cirectly comparable to today's NHS tariff.
Particular differences are that the host Trust pays for the medical
staff and benefits from a profit share arrangement. Nevertheless,
BUPA and the Trust has calculated that if reasonable adjustments
are made to take account of these features, the cost of Redwood
in 2005-06 is broadly comparable to that which would have been
incurred if the contract were priced at the prevailing local NHS
tariff rate. BUPA expects that at the end of this contract period
we will operate Redwood in line with NHS tariff without it creating
material difficulties.
Q: Is it the case that Redwood works becaise
of the unique circumstances of the local situation so it is not
a solution to the objections levelled against the wider ISTC programme?
A: No. BUPA thinks that the Redwood model
could be applied elsewhere as a way to bring the independent sector
to play a much bigger role in NHS elective provision. The key
principle is that ISTCs must fork in partnership with the local
NHS health economy. It was difficult for the Wave One ISTCs largely
due to the misguided application of the policy of Additionlity.
This problem has been addressed in Phase Two ISTC contracts so
there i no reason why schemes on the Redwood model cannot be developed
elsewhere.
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