Evidence submitted by Mercury Health (ISTC
6)
INTRODUCTION
1. Mercury Health, a wholly owned subsidiary
of Tribal Group plc, is a UK business that supports the NHS by
creating additional capacity, thus enabling patients to be treated
earlier and to have greater choice, including access closer to
home.
2. We currently run three Treatment Centres
and will open a fourth in July this year. The centres are located
in High Wycombe, Gillingham (Kent), Portsmouth and Haywards Heath.
We provide a range of healthcare services including diagnostic
imaging, day and in-patient surgery and a minor injuries unit
and walk-in centre. Together, the centres cover a range of procedures
including MRI, ultrasounds, echocardiographs, hernia repairs,
endoscopies, cataract repairs and orthopaedic operations.
3. The Primary Care Trusts who commission
the services and the patients who have been treated are generally
supportive of the impact we have made on their local health community.
To date, 100%. of respondents to our patient satisfaction surveys
have said that they would recommend our centres to friends and
family.
What is the main function of ISTCs?
4. Assessing, diagnosing, treating and rehabilitating
NHS patients.
What role have ISTCs played in increasing capacity
and choice and stimulating innovation?
5. Our centres have increased the total
capacity in each location in terms of buildings, equipment and
staff so that more treatment has been made available for NHS patients.
In terms of innovation, we have established a new service providing
direct access to a wide range of diagnostics by GPs in High Wycombe
and we are building theatres in Haywards Heath with the technology
for remote teaching built in to the operating equipment (endosuites).
We are also able to offer NHS patients scheduled procedures at
pre-arranged times. Many of the procedures are day cases enabling
patients to return home more quickly freeing up beds for other
NHS patients and other procedures. We have so far seen 12,209
patients and expect to see another 80-100,000 in 2006-07.
What contribution have ISTCs made to the reduction
of waiting times and waiting lists?
6. The waiting times at Mercury Health facilities
are much shorter than the local NHS Trusts. We have been told
by local Trust and PCT CEOs that our presence in the community
has helped them motivate their medical staff to shorten waiting
times.
Are ISTCs providing value for money?
7. We believe they are. We will have invested
nearly £60 million in developing our new centres. Given this
level of investment and taking into account the fact that the
contract terms are more onerous than for NHS Trusts, that VAT
is unfavourably treated in comparison to the NHS, that pensions
costs have to be fully accounted and no income is obtained until
a centre is open, we are confident that the taxpayer is getting
very good value for money. If one also takes in to account the
"hidden" impact of the incentive ISTCs have given to
trusts to improve productivity and the fact that ISTC provision
is likely to reduce in cost in the future the programme has delivered
excellent value for money.
Does the operation of ISTCs have an adverse effect
on NHS services in their areas?
8. An ISTC is an NHS service. Local services
have, therefore, been enhanced and patient choice and access to
high quality services has improved. Some institutions will have
had to review their fixed cost base in the light of changed local
circumstances but this has been a normal feature of new service
development in the NHS over time and will often result in a more
efficient deployment of resources.
What arrangements are made for patient follow-up
and the management of complications?
9. Mercury Health follows up all patients
until they are fit for discharge back to the care of their GP.
If a complication develops that is appropriate to be treated in
the centre, the patient returns and is treated. If treatment is
required in another hospital the patient is transferred there
and Mercury Health covers the cost.
What role have ISTCs played and should they play
in the training of medical staff?
10. In three of our centres we have not
been asked to provide training opportunities but would be happy
to do so. At Haywards Heath, we will be providing a full training
facility for about 20 junior doctors at any one time in elective
orthopaedics. These doctors will also benefit from our association
with Hospital for Special Surgery, one of the leading orthopaedic
hospitals in North America. The Phase 2 procurement is expected
to require all ISTCs to provide training.
Are the accreditation and appointment procedures
for ISTC medical staff appropriate?
11. Yes. In fact the process for being appointed
as a doctor to Mercury Health is probably more onerous than being
appointed to an NHS provider. All our doctors are on the relevant
specialist register, are subject to full panel interview (that
includes an independent representative from the Royal College
of Surgeons) and are required to submit three references. No surgeon
who is not on the specialist register can operate in our centres,
as opposed to NHS providers who regularly use surgeons not on
the register.
Are ISTCs providing care of the same or higher
standard as that provided by the NHS?
12. We provide a level of care at least
as good as that provided by conventional NHS providers. We regularly
submit a set of clinical performance indicators which can be compared
with NHS provider performance over time. In contrast to most NHS
facilities, each of our centres is required to be approved by,
and registered with, the Healthcare Commission (HCC) before opening
and remain subject to close and detailed inspection by the HCC.
All our staff are qualified to at least the same level as NHS
staff (for example, all our surgeons are required to be consultant
grade) and we have a comprehensive system of clinical governance
to safeguard patients.
What implications does commercial confidentiality
have for access to information and public accountability with
regard to ISTCs?
13. Exactly the same implications as any
other public procurement.
What changes should the government make to its
policy towards ISTCs in the light of experience to date?
14. The procurement process should be simplified
to allow a greater range of providers, including the voluntary
sector, to bid for contracts. A "level playing field"
should be created to allow NHS Trusts to bid for these contracts
on the same terms as other bidders. This would need to address
the issues referred to above—VAT, pensions, regulation,
contract risk allocation and a range of smaller but relevant issues.
What criteria should be used in evaluating the
bids for the second wave of ISTCs?
15. Clinical quality, price and the ability
of the proposal to increase choice for patients and provide speedy
access to care close to home.
What factors have been and should be taken into
account when deciding the location of ISTCs?
16. ISTCs should be established close to
populations whose access to care either geographically or in terms
of waiting times is currently unacceptable.
How many ISTCs should there be?
17. Enough to meet the criteria above (paragraphs
15 and 16)
Mark Smith
Mercury Health
7 February 2006
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