Select Committee on Health Written Evidence


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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Prepared 25 July 2006