Evidence submitted by NHS Partners Network
(ISTC 29)
KEY POINTS
— The NHS Partners Network is an alliance
of independent healthcare organisations—private and not-for-profit—which
provide diagnosis, treatment and care for NHS patients through
the Department of Health's procurement programmes.
— Our centres have performed almost
100,000 elective and diagnostic procedures for the NHS since the
Government launched its programme in 2003.
— The main function of ISTCs is to
provide high quality diagnostic and elective surgery procedures
for NHS patients and, by increasing available capacity, provide
greater choice for NHS patients.
— ISTCs have played a significant direct
and indirect role in increasing capacity and choice am stimulating
innovation.
— ISTCs have made and continue to make
a significant contribution to reducing waiting times and waiting
lists across the NHS.
— ISTCs are providing value for money
for the NHS.
— The operation of ISTCs has a positive
effect on local NHS services.
— Our members operate strict patient
follow-up procedures and undertake to deal with complaints quickly
and diligently to resolve problems.
— Our members are keen to become more
involved and better integrated in the training of NHS staff.
— All our medical staff are employed
and accredited under protocols approved by the Department of Health
in consultation with the relevant Medical Royal Colleges and the General
Medical Council.
— ISTC providers are subject to a more
robust clinical quality regime than conventional NHS 4 providers.
— The health needs of local NHS patients
should be the determining factor with regards the number of ISTCs
that should be put in place as well as the availability of capacity
to reduce waiting times and the necessity of extending plurality
of provision to support greater patient choice.
INTRODUCTION
1. The NHS Partners Network is an alliance
of independent healthcare organisations—private and not-for-profit—which
provide diagnosis, treatment and care for NHS patients through
the Department of Health's procurement programmes.
2. Our members are as follows: Alliance
Medical, BMI Healthcare, BUPA, Capio, Clinicenta, Mercury Health,
Nations Healthcare, Netcare UK, Nuffield Hospitals, Partnership
Health Group and UK Specialist Hospitals (UKSH). We are all leading
national and international independent sector healthcare companies,
with extensive experience of managing elective surgical centres
and diagnostic facilities.
3. Our centres have performed almost 100,000
elective and diagnostic procedures for the NHS since the Government
launched its procurement programme in 2003.
4. Our aim is to ensure that patients, doctors
and the public have a better understanding of how new and traditional
healthcare providers are working together in partnership for the
benefit of NHS patients.
5. We support the NHS, in principle and
in practice, and believe that the principles behind the government's
reform programme—extending patient choice, encouraging innovation
and stimulating competition—are integral to the development
of higher quality NHS provision into the future.
What is the main function of ISTCs?
6. The main function of ISTCs is to provide
high quality diagnostics and elective surgery procedures for NHS
patients and, by increasing available capacity, extend greater
choice to NHS patients. Treatment centres deliver high volumes
of activity in a range of routine treatments and diagnostics.
They serve to separate emergency from elective procedures which
reduces the number of cancelled operations.
What role have ISTCs played in increasing capacity
and choice, and stimulating innovation?
7. ISTCs have played a significant direct
and indirect role in increasing capacity and choice and stimulating
innovation. At the end of 2005, 20 facilities were in place as
part of the Government's ISTC programme. We anticipate a further
11 ISTCs opening in 2006/07 with the combined total treating over
170,000 NHS patients a year,
8. So far our centres have carried out almost
100,000 procedures (both surgical and diagnostic) including cataract
removal, hip and knee replacements and MRI scans since the programme
was launched.
9. We provide patients with pre-booked appointment
times with many procedures carried out as day case procedures,
enabling patients to return home the same day, freeing up hospital
beds for other NHS patients.
10. ISTCs underpin the Government's patient
choice policy, through which NHS patients can now choose from
different providers for hospital treatment procedures. Since December
2005, under Department of Health policy, NHS patients have been
able to choose from a menu of 4-5 different providers when their
GP decides that they need to be referred for hospital treatment
or diagnostic procedures. As well as NHS Treatment Centres, in
some cases these choices include an independent sector provider.
11. We also offer NHS patients additional
choice—in terms of where their procedure is carried out,
often close to home; and when their initial appointment and procedure
takes place. Patients therefore have a real choice about where
and when they are treated.
12. Increased choice encourages providers,
including those in the traditional NHS, to develop more innovative
working practices and patient-centred facilities. We are having
a positive impact on the local health economy. Our centres offer
the most innovative working practices and procedures including:
use of regional rather than general anaesthetic for primary joint
replacement to lower patient risk and reduce length of stay; stocking
smaller ranges of prostheses allowing theatre staff to become
more proficient and productive; more effective pain management
techniques; double reading of post-operative test results.
What contribution have ISTCs made to the reduction
of waiting times and waiting lists?
13. NHS waiting times and waiting lists
have reduced considerably since the introduction of the ISTC programme
in 2003. ISTCs do not claim to be the sole reason for this reduction
but we have made and continue to make a significant contribution
to reducing waiting times and waiting lists across the NHS. Since
2003, ISTCs have carried out almost 100,000 elective and diagnostic
procedures. Our patients wait less time for many routine operations
and diagnostic procedures than in conventional NHS facilities
and are less likely to have their operations cancelled for non-clinical
reasons because of the separation of elective procedures from
emergency cases. We have performed almost 100,000 procedures in
our centres so far and, by providing additional local capacity,
we have also assisted NHS facilities to meet their own 6 month
waiting times targets.
Are ISTCs providing value for money?
14. We believe that, on a like for like
basis, our costs are comparable with NHS Trusts and represent
value for money.
15. The September 2005 Laing and Buisson
Market Review 2005-06 claims that the introduction of ISTCs is
already exerting a downward pressure on specialists fees.
Does the operation of ISTCs have an adverse effect
on NHS services in their areas?
16. The operation of ISTCs has a positive
effect on local NHS services. A local ISTC provides additional
capacity and choice for local NHS patients and encourages conventional
NHS providers to adopt efficiency and productivity improvements.
What arrangements are made for patient follow-up
and the management of complications?
17. All our member organisations operate
strict patient follow-up procedures. The contracts we have with
the Department of Health specify the details of the "patient
pathway" from GP referral, through conclusion of the treatment
to the method and quality of post-discharge patient care. The
contract sets out clearly that patients should normally be treated
for post-operative and post-discharge complications in the ISTC.
18. The Department of Health operates a
performance management process including a patient complaint procedure,
monitoring of post-operation visit rates, and liaison with local
conventional NHS providers.
19. In the event of complications or adverse
incidents, or if a patient is dissatisfied with the standard of
care they receive, all our members undertake to deal with complaints
quickly and diligently to resolve problems, learn from mistakes
and avoid repetition. Redress is provided to patients who feel
their experience was not as it should have been.
20. All our patients receive a comprehensive
patient information pack on arrival which includes information
on the provider, the patient care pathway including follow-up
and complaints. This information is explained in more detail in
advance of any procedure.
What role have ISTCs played and should they play
in the training of medical staff?
21. Junior doctor training is provided in
some of the Wave 1 ISTC projects. The facilities and training
programmes replicate those available in traditional NHS providers.
22. The facilities, equipment and innovative
practices allow medical staff to train and experience new ways
of working, new procedures and techniques as well as management
of care pathways.
23. The ISTC providers who form the NHS
Partners Network wish to place on record our enthusiasm to be
more involved and better integrated in the training of NHS staff.
Are the accreditation and appointment procedures
for ISTC medical staff appropriate?
24. All ISTC medical staff are employed
and accredited under protocols approved by the Department of Health
in consultation with the relevant Medical Royal Colleges and the
General Medical Council.
25. ISTCs meet a higher standard of medical
accreditation than conventional NHS providers as only doctors
who are listed on the specialist register for their specialty
can practise in ISTCs. Traditional NHS providers can and do also
employ doctors to perform procedures who are not trained or qualified
to this level.
Are ISTCs providing care of the same or higher
standard as that provided by the MIS?
26. The highest standards of clinical care
for patients are our first priority. ISTC providers are subject
to a more robust clinical quality regime than conventional NHS
providers.
27. Our contracts with the Department of
Health require that we have robust clinical governance arrangements
in place. Clinical pathways and standards are defined during the
contract negotiations and monitored through Key Performance Indicators
as part of the contract management. ISTCs are subject to independent,
external review at least once a year by the Healthcare Commission
and quarterly by a Joint Service Review Board.
28. The Preliminary Overview report, published
in October 2005, by the National Centre for Health Outcomes Development
concluded that "there is a robust quality assurance system
in place, more ambitious and demanding than that for the National
Health Service organisations" and that the KPI data to be
collected and provided by the ISTCs "extends beyond that
used by the NHS".
29. We carry out detailed patient satisfaction
surveys; the findings have been very positive to date and patients
are supportive of being treated by an independent provider.
What implications does commercial confidentiality
have for access to information and public accountability with
regard to ISTCs?
30. Commercial confidentiality requirements
are necessary to protect commercial sensitivities of each provider
and to allow a fair and proper public procurement process. The
Freedom of Information Act allows for information to be released,
subject to exemption provisions. ISTC cost assumptions are transparent
and publicly available throughout the procurement process.
What changes should the government make to its
policy towards ISTCs in the light of experience to date?
31. The NHS Partners Network does not take
policy positions and it is therefore inappropriate for the Network
to make recommendations about future government policy.
What criteria should be used in evaluating the
bids for the second wave of ISTCs?
32. It is not appropriate for the NHS Partners
Network to comment on the criteria which should be used to judge
between competing bidders for future waves of ISTC.
What factors have been and should be taken into
account when deciding the location of ISTCs?
33. It is not appropriate for the NHS Partners
Network to comment on the decisions in relation to the location
of individual ISTCs provided by our member organisations.
How many ISTCs should there be?
34. There should be no artificial cap on
the number of ISTCs which are put in place to diagnose and treat
NHS patients. The Government has a manifesto commitment to reduce
waiting times from the door of the GP's surgery to the door of
the operating theatre to 18 weeks. The ISTC programme can make
a major contribution to helping to meet this goal by treating
more NHS patients, more quickly to the highest standards. The
determining factor should not be a set total number of ISTCs but
the health needs of NHS patients, the availability of capacity
to reduce waiting times and the necessity of extending plurality
of provision to support greater patient choice.
NHS Partners Network
13 February 2006
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