Select Committee on Health Written Evidence

Evidence submitted by Netcare Healthcare UK Limited (ISTC 27)

  1.  Netcare is a leading provider of high quality, accessible healthcare services, with established international operations. In 2005, our consultants treated 900,000 patients. In addition, 2.5 million people were seen by our GPs, and a further 400,000 by our dentists. Our UK operation was established in 2001, and provides highly specialised clinical services to patients under contract to the National Health Service. Existing contracts involve Netcare performing an estimated 90,000 procedures over five years.

  2.  Our services are designed to be entirely compatible with the NHS' basic purpose and values. They are free at the point of delivery, with clinical pathways and governance procedures that are built to ensure patients are consistently treated, to the highest standard of care, regardless of circumstances, condition or geography.

Q1  What is the main function of ISTCs?

  3.  In our experience, the main function of ISTCs has been to add capacity and support the achievement of the 18-week waiting time target, whilst enabling general practitioners and optometrists to offer a broader choice for patients. Many of the patients we treat are very elderly, and are waiting for procedures that will deliver valued and significant improvements to their quality of life. Through shortening the time they are required to wait, Netcare has been able, working closely with a large number of PCTs, to help these patients once again to enjoy a healthy, independent and full retirement.

Q2  What role have ISTCs played in increasing capacity and choice and stimulating innovation?

  4.  Since our first appointment by the NHS, Netcare has participated in waiting list initiatives in Morecambe Bay, London, Southport and Portsmouth. We are currently participating in the ISTC programme by using mobile operating theatres to offer cataract operations nationwide, and providing orthopaedic, ENT and general surgery in a fixed location in Greater Manchester. We recently completed our 20,000th cataract operation, and are planning to perform nearly 90,000 procedures over the five years of our existing contracts.

  5.  Our Greater Manchester Surgical Centre, Trafford, is a newly-built 48 bed facility employing almost 140 clinical personnel, providing inpatient and outpatient orthopaedic, ENT and general surgical services. Following final contract agreement in 2004, we assigned a multi-skilled mobilisation team to work quickly to ensure the facility was fully furnished, equipped and staffed, ready to open on time in May 2005. Our philosophy is to deliver outstanding healthcare in a clean and professional environment, enabling our patients, many of whom are very elderly, to enjoy a full and healthy retirement. In its first year of operation, we expect to carry out in excess of 8,000 procedures.

  6.  Our innovative approach, using mobile units, provides additional capacity and an independent solution in areas where local units do not exist or cannot be justified. This has been supported by the early use of an IT solution, "Choose and Book", a system which allows patients to choose our facilities and select a date convenient to them via their GP practice.

Q3  What contribution have ISTCs made to the reduction of waiting times and waiting lists?

  7.  Waiting times are managed through specific care pathways for high volume surgery. Once patients are referred to Netcare, the average waiting times have been as follows:

    —  Orthopaedic services— 4 weeks.

    —  Cataract procedures— 9 weeks.

  We understand that this represents a significant improvement to the conditions that were in place prior to the start of the two contracts. This has been made possible by committing significant investment in the development of an efficient IM&T solution for bookings, which is fully compliant with the NHS' National Programme for IT (NPFIT), and is seen as a pathfinder.

Q5  Does the operation of ISTCs have an adverse effect on the NHS service in their areas?

  8.  We have not detected any adverse impact upon other NHS service in any of the regions in which we operate. Our projects are complementary to the existing resource, and as an example, we have added 10% infrastructure at one of our locations but are contributing to an additional 20% activity. So that our activity can be seen in context, less than 3% of all NHS cataract treatments are currently performed by our mobile units.

Q6  What arrangements are made for patient follow-up and the management of complications?

  9.  All patients are followed up by Netcare. This can be up to one year after the procedure, for example with joint replacements. Complications, if clinically safe, can be treated by Netcare within the ISTC. Others are referred to NHS facilities under a service level agreement. To date less than 0.17% of patients have been referred to NHS facilities for treatment. Service level agreements provide access to, for example, critical care networks.

  10.  Complications are taken extremely seriously, and immediately referred to one of our medical directors to determine the appropriate course of action. Further treatment can include regular follow-up, surgery by the treating consultant or referral to a specialist within the NHS itself. On the rare occasions that a full review is merited, there will be a Joint Service Investigation undertaken by a panel chaired by an official from the commissioning authority and involving a distinguished independent clinician.

Q9  Are ISTCs providing care of the same or higher standard as that provided by the NHS?

  11.  We collect 280 data items related to cataract surgery, and these include all intra-operative and post-operative complications: final visual acuity compared with pre-operative visual acuity; and details of co-morbidities such as glaucoma, diabetic retinopathy, macular degeneration and amblyopia. The data is analysed on a daily basis to ensure that our outcomes are within agreed clinical parameters. In addition, 26 key performance indicators are presented to the Department of Health, many on a daily basis, and this information is used for measurement purposes. At our Greater Manchester ISTC, as part of our commitment to high standards, every orthopaedic patient is registered on the National Joint Registry. Based on these activities, we believe that our experience is in line with, or higher than, previous reported series, and that it is possible to provide a comparable service whilst delivering productivity gains and bringing new techniques and innovation to the NHS.

  12.  As well as clinical outcomes, we also monitor patient satisfaction closely, and ask every patient we treat to complete a detailed questionnaire. Based upon responses received, the weighted satisfaction with our ophthalmic service has been 97.3%. Questions include satisfaction with nursing attitudes, doctor attitudes, our pre-operative pathways, and the overall customer experience.


  13.  Based on our experience, our conclusion is that the government's early stage ISTC initiatives have demonstrated that the NHS can successfully partner with the independent sector to the benefit of patients, without compromising its core values. We support the continuing rollout of the programme, including the transfer of risk to the independent sector through reductions in guaranteed referrals. Moreover, the government's medium-term financial strategy suggests that the rate of increase in NHS funding will slow significantly beyond 2008. One implication of this is that it will be difficult to drive continuing improvement in capacity or waiting times by resources alone. This is likely to focus attention on innovative structural reforms, including patient choice, and partnerships with the independent sector for the provision of a variety of treatment services.

  14.  We would be delighted to welcome members of the Select Committee to view any of our operations. Please do not hesitate to contact me if this would be of interest.

Mark Adams

Chief Executive Officer


13 February 2006

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