3. SYSTEM REFORM
3.1.2 Could the Department provide a list
of all Independent Sector Treatment Centres (ISTCs) currently
in operation, or with contracts already signed, including (a)
name and location, (b) company running the ISTC, (c) services
contracted for, by type and volume (by Healthcare Resource Group
if possible), (d) value of contract per year, the period of the
contract and whether it is on a "take or pay" basis,
(e) the amount paid, and the contract utilisation to date, on
"take or pay" contracts and (f) a comparison of the
cost with the national tariff prices for providing the same type
and volume of services? (Q21)
Answer
1. The information requested is given in
tables 21a to 21c.
2. It is not possible to directly compare
the ISTC prices to tariff. To the extent that prices can be compared,
the Department estimates that on average wave 1 contract prices
are approximately 11% higher than the amount payable on the basis
of national tariff plus local market forces factor.
3. The Department estimates that on average
across phase 2, contract prices are approximately equal to the
amount payable on the basis of national tariff plus local market
forces factor.
4. In determining the above percentages,
the national tariff prices of both the procedure and all pathway
activities for that procedure plus local market forces factor
are compared to contract prices.
Table 21a
ISTC CONTRACTUAL INFORMATION—BY VOLUME
AND HEALTHCARE RESOURCE GROUP
|
| |
| |
| |
| | Total contracted procedures broken down by Healthcare Resource Group (HRG) Chapter
|
| Contract | Location
| Hospital name | Provider name
| Total
contracted
diagnostics
| Total
contracted
procedures
| General
surgery
| Orthopaedics | Nervous
system
| Ophthalmology | ENT
| Thoracic
procedures
| Digestive
system
| Urology | Gynaecology
| Renal
dialysis
|
|
| LP2 | Bradford | Eccleshill NHS Treatment Centre
| Nations Healthcare | 88,583
| 28,564 | 4,703
| 4,530 | -
| 407 | 1,015
| - | 10,567
| 4,168 | 3,175
| - |
| LP3 | Burton | Midlands NHS Treatment Centre
| Nations Healthcare | -
| 62,906 | 6,443
| 10,665 | 3,859
| 15,242 | 6,441
| 62 | 5,346
| 12,924 | 1,925
| - |
| LP4 | Trent and South Yorkshire
| Barlborough NHS Treatment Centre | PHG
| - | 21,563
| - | 21,563
| - | -
| - | -
| - | -
| - | -
|
| LP5 | Daventry | The Birkdale Clinic
| | -
| 5,155 | 144
| 392 | 319
| 3,841 | 217
| - | 242
| - | -
| - |
| LP7 | Shepton Mallet | Shepton Mallet NHS Treatment Centre
| UKSH | - |
56,242 | 2,000
| 22,242 | -
| 12,000 | -
| - | 20,000
| - | -
| - |
| LP8 | Greater Manchester |
Greater Manchester Surgical Centre | Netcare Healthcare
| - | 44,863
| 5,782 | 20,667
| - | -
| 14,351 | -
| 3,267 | 796
| - | -
|
| LP9 | Plymouth | Peninsula NHS Treatment Centre
| PHG | - |
16,512 | -
| 16,512 | -
| - | -
| - | -
| - | -
| - |
| GC4 | East Cornwall | Bodmin NHS Treatment Centre
| Ramsay | - |
26,495 | 215
| 40 | -
| 7,148 | -
| - | 14,984
| 182 | 3,926
| - |
| GC4 | East Lincolnshire | Boston NHS Treatment Centre
| Ramsay | 2,259
| 6,955 | 572
| - | -
| 3,401 | -
| - | 2,392
| 590 | -
| - |
| GC4 | North East Yorkshire and North Lincolnshire
| Clifton Park NHS Treatment Centre | Ramsay
| - | 8,638
| 581 | 7,621
| - | -
| - | -
| 436 | -
| - | -
|
| GC4 | Northumberland, Tyne and Wear
| The Cobalt NHS Treatment Centre | Ramsay
| - | 9,706
| 2,221 | -
| - | -
| - | -
| 7,485 | -
| - | -
|
| GC4 | West Lincolnshire | Gainsborough NHS Treatment Centre
| Ramsay | 200
| 5,647 | 447
| 996 | -
| 1,574 | -
| - | 1,464
| 1,166 | -
| - |
| GC4 | Southampton | New Hall NHS Treatment Centre
| Ramsay | - |
13,737 | -
| 13,737 | -
| - | -
| - | -
| - | -
| - |
| GC4 | North Oxford | Horton NHS Treatment Centre
| Ramsay | - |
15,970 | -
| 15,970 | -
| - | -
| - | -
| - | -
| - |
| GC4 | Thames Valley (Milton Keynes)
| Blakelands NHS Treatment Centre | Ramsay
| | 8,292
| 260 | 4,185
| - | -
| - | -
| 3,384 | 321
| 142 | -
|
| GC4 | Thames Valley (Reading)
| Reading NHS Treatment Centre | Ramsay
| - | 5,935
| 28 | 3,024
| - | -
| - | -
| 2,141 | 271
| 471 | -
|
| GC5E | Nottingham | Nottingham NHS Treatment Centre at QMC
| Nations Healthcare | -
| 116,743 | 30,148
| 9,565 | 12,709
| 741 | 6,120
| 1,248 | 43,893
| 75 | 12,244
| - |
| GC5 W | Cheshire and Merseyside
| Cheshire and Merseyside NHS Treatment Centre
| Interhealth | -
| 24,819 | -
| 24,819 | -
| - | -
| - | -
| - | -
| - |
| GC5 W | Kidderminster | Kidderminster NHS Treatment Centre
| Interhealth | -
| 9,002 | 10
| 8,347 | 645
| - | -
| - | -
| - | -
| - |
| GC6 | Maidstone | Mid Kent NHS Treatment Centre
| PHG | - |
44,742 | 2,458
| 4,142 | 334
| 90 | 270
| 2,276 | 29,690
| 112 | 5,370
| - |
| GC7 | North East London | North East London NHS Treatment Centre
| PHG | - |
49,592 | 2,252
| 18,138 | -
| 11,976 | 6,106
| - | 4,756
| 6,364 | -
| - |
| GC8 | Brighton | Sussex Orthopaedic NHS Treatment Centre
| Care UK | -
| 26,438 | 141
| 26,297 | -
| - | -
| - | -
| - | -
| - |
| GC8 | Havant | Havant NHS Diagnostic Centre
| Care UK | 54,117
| 554 | -
| 554 | -
| - | -
| - | -
| - | -
| - |
| GC8 | Medway | Will Adams NHS Treatment Centre
| Care UK | -
| 19,792 | 358
| 5,286 | -
| 1,530 | -
| - | 6,185
| 6,433 | -
| - |
| GC8 | Portsmouth | St Mary's NHS Treatment Centre
| Care UK | 135,117
| 31,688 | 6,926
| 4,010 | -
| 8,160 | -
| - | 12,592
| - | -
| - |
| GC8 | Wycombe | Mid & South Buckinghamshire NHS Diagnostic Centre
| Care UK | 74,880
| - | -
| - | -
| - | -
| - | -
| - | -
| - |
| OC123 | Ophthalmic Chain |
Cataract Initiative | Netcare Healthcare
| | 44,735
| - | -
| - | 44,735
| - | -
| - | -
| - | -
|
| D01 | London | London Diagnostics (Various Sites)
| InHealth Group | 1,000,510
| - | -
| - | -
| - | -
| - | -
| - | -
| - |
| D05 | West Midlands ( Terminated )
| West Midlands Diagnostics (Various Sites) |
Mercury | 120,099
| - | -
| - | -
| - | -
| - | -
| - | -
| - |
| D8N | PET CT North | PET CT North (Various Sites)
| Alliance | 48,148
| - | -
| - | -
| - | -
| - | -
| - | -
| - |
| D8S | PET CT South | PET CT South (Various Sites)
| InHealth Group | 42,678
| - | -
| - | -
| - | -
| - | -
| - | -
| - |
| E01 | Avon, Gloucestershire & Wiltshire
| Avon, Gloucestershire & Wiltshire (Various Sites)
| UKSH | 4,629
| 125,246 | 9,735
| 31,949 | -
| 23,340 | 24,676
| - | 11,708
| 8,087 | 15,750
| - |
| E05 | Cumbria & Lancashire
| Cumbria & Lancashire Electives (Various Sites)
| Ramsay | 6,821
| 46,106 | 4,162
| 33,683 | -
| 19 | 3,496
| - | 4,745
| - | -
| - |
| E06 | Cheshire & Merseyside
| Cheshire & Merseyside Elactives (Various Sites)
| Spire | 783
| 21,410 | 5,981
| 1,879 | 169
| - | 5,189
| - | 2,580
| 4,517 | 1,095
| - |
| E08 | Greater Manchester |
NHS Clinical Assessment and Tretament Service (CATS) (Various Sites)
| Care UK | 558,471
| 36,947 | 6,336
| - | -
| - | -
| - | 29,379
| 1,232 | -
| - |
| E09 | Hampshire & Isle of Wight
| Southampton NHS Treatment Centre | Partnership Health
| 21,704 | 101,602
| 8,546 | 23,641
| 630 | 6,094
| 20,802 | -
| 7,013 | 25,095
| 9,781 | -
|
| E15 | Northumberland, Tyne and Wear
| SPIRE Hospital Washington | Spire
| 746 | 17,206
| 3,943 | 9,985
| - | -
| 1,185 | -
| 765 | -
| 1,328 | -
|
| E16 | Various Main Renal Units
| Renal Dialysis (Various Sites) | Fresenius
| - | 853,615
| - | -
| - | -
| - | -
| - | -
| - | 853,615
|
| Contractual total |
| |
| | 2,159,747
| 1,907,417 | 104,393
| 344,439 | 18,665
| 140,297 | 89,869
| 3,586 | 225,013
| 72,333 | 55,207
|
| 853,615 |
| |
| |
| |
| |
| |
| |
| |
|
|
| Source: |
NHS Contracting, DH
|
| Footnotes: |
| 1. The contracted activity is indicative only and can vary significantly from actual activity through substitution of higher or lower value procedures across the contract term.
|
| 2. All information provided has been based on the most up to date information at the time of submission.
|
| 3. The specialties are referenced to HRG Chapter. "General Surgery" includes HRG Chapters E, G, J, K, P, Q and S. HRG information is available at www.ic.nhs.uk/casemix.
|
| 4. The Department works with sponsors and providers to ensure optimum utilisation of the contracts. This includes changing the case mix to respond to local need and working with providers and PCTs to recover previous under-utilised activity where possible.
|
Table 21b
ISTC CONTRACTUAL INFORMATION—BY VALUE AND CONTRACT
LENGTH
|
| |
| |
| |
| |
| |
| |
| |
| |
| |
| £ million |
|
| Contract | Location
| Contract term | Contract basis
| Total nominal
contract value
(£ million)
| 2003-04 | 2004-05
| 2005-06 | 2006-07
| 2007-08 | 2008-09
| 2009-10 | 2010-11
| 2011-12 | 2012-13
| 2013-14 | 2014-15
| 2015-16 | 2016-17
|
|
| LP2 | Bradford | 58 Months
| Take or Pay | 37.96
| 0.00 | 0.00
| 7.87 | 7.84
| 7.63 | 7.99
| 6.62 | 0.00
| 0.00 | 0.00
| 0.00 |
| |
|
| LP3 | Burton | 60 Months
| Take or Pay | 77.87
| 0.00 | 0.00
| 0.00 | 11.32
| 15.45 | 15.81
| 15.89 | 15.22
| 4.18 | 0.00
| 0.00 |
| |
|
| LP4 | Trent and South Yorkshire
| 60 Months | Take or Pay |
98.37 | 0.00
| 0.00 | 19.02
| 19.02 | 19.84
| 20.38 | 20.11
| 0.00 | 0.00
| 0.00 | 0.00
| |
| |
| LP5 | Daventry | Terminated
| Take or Pay | 4.87
| 1.39 | 1.93
| 1.55 | 0.00
| 0.00 | 0.00
| 0.00 | 0.00
| 0.00 | 0.00
| 0.00 |
| |
|
| LP7 | Shepton Mallet | 60 Months
| Take or Pay | 110.88
| 0.00 | 0.00
| 14.98 | 20.77
| 21.96 | 23.09
| 23.93 | 6.16
| 0.00 | 0.00
| 0.00 |
| |
|
| LP8 | Greater Manchester |
60 Months | Take or Pay | 86.14
| 0.00 | 0.00
| 11.81 | 16.96
| 17.68 | 18.77
| 18.86 | 2.06
| 0.00 | 0.00
| 0.00 |
| |
|
| LP9 | Plymouth | 60 Months
| Take or Pay | 59.46
| 0.00 | 0.00
| 10.52 | 11.49
| 12.01 | 12.47
| 11.90 | 1.07
| 0.00 | 0.00
| 0.00 |
| |
|
| GC4 | East Cornwall | 51 Months
| Take or Pay | 25.41
| 0.00 | 0.00
| 2.50 | 5.49
| 5.67 | 5.88
| 5.86 | 0.00
| 0.00 | 0.00
| 0.00 |
| |
|
| GC4 | East Lincolnshire | 59 Months
| Take or Pay | 9.25
| 0.00 | 0.00
| 2.18 | 1.83
| 1.72 | 1.77
| 1.74 | 0.00
| 0.00 | 0.00
| 0.00 |
| |
|
| GC4 | North East Yorkshire and North Lincolnshire
| 50 Months | Take or Pay |
42.24 | 0.00
| 0.00 | 2.89
| 9.56 | 10.26
| 10.82 | 8.71
| 0.00 | 0.00
| 0.00 | 0.00
| |
| |
| GC4 | Northumberland, Tyne and Wear
| 58 Months | Take or Pay |
10.72 | 0.00
| 0.00 | 2.34
| 1.99 | 2.08
| 2.16 | 2.15
| 0.00 | 0.00
| 0.00 | 0.00
| |
| |
| GC4 | West Lincolnshire | 60 Months
| Take or Pay | 6.21
| 0.00 | 0.00
| 1.45 | 1.23
| 1.17 | 1.21
| 1.14 | 0.00
| 0.00 | 0.00
| 0.00 |
| |
|
| GC4 | Southampton | 60 Months
| Take or Pay | 42.67
| 0.00 | 0.00
| 9.67 | 8.22
| 8.62 | 8.94
| 7.22 | 0.00
| 0.00 | 0.00
| 0.00 |
| |
|
| GC4 | North Oxford | 65 Months
| Take or Pay | 80.90
| 0.00 | 0.00
| 6.22 | 18.37
| 15.60 | 15.55
| 15.95 | 9.21
| 0.00 | 0.00
| 0.00 |
| |
|
| GC4 | Thames Valley (Milton Keynes)
| 45 Months | Take or Pay |
12.30 | 0.00
| 0.00 | 1.81
| 3.10 | 2.41
| 2.50 | 2.49
| 0.00 | 0.00
| 0.00 | 0.00
| |
| |
| GC4 | Thames Valley (Reading)
| 60 Months | Take or Pay |
14.80 | 0.00
| 0.00 | 3.22
| 2.75 | 2.88
| 2.98 | 2.97
| 0.00 | 0.00
| 0.00 | 0.00
| |
| |
| GC5E | Nottingham | 60 Months
| Take or Pay | 208.76
| 0.00 | 0.00
| 0.00 | 0.00
| 0.00 | 20.14
| 38.60 | 43.32
| 44.97 | 45.77
| 15.97 |
| |
|
| GC5 W | Cheshire and Merseyside
| 60 Months | Take or Pay |
112.33 | 0.00
| 0.00 | 0.00
| 16.20 | 22.40
| 21.83 | 23.86
| 23.94 | 4.09
| 0.00 | 0.00
| |
| |
| GC5 W | Kidderminster | 60 Months
| Take or Pay | 27.16
| 0.00 | 0.78
| 4.80 | 4.98
| 5.43 | 5.93
| 5.24 | 0.00
| 0.00 | 0.00
| 0.00 |
| |
|
| GC6 | Maidstone | 59 Months
| Take or Pay | 37.00
| 0.00 | 0.00
| 0.00 | 2.66
| 6.69 | 7.18
| 7.55 | 7.96
| 4.97 | 0.00
| 0.00 |
| |
|
| GC7 | North East London | 60 Months
| Take or Pay | 109.43
| 0.00 | 0.00
| 0.00 | 5.02
| 20.81 | 21.64
| 22.00 | 22.57
| 17.39 | 0.00
| 0.00 |
| |
|
| GC8 | Brighton | 60 Months
| Take or Pay | 102.90
| 0.00 | 0.00
| 0.00 | 16.48
| 20.44 | 20.96
| 20.93 | 21.16
| 2.94 | 0.00
| 0.00 |
| |
|
| GC8 | Havant | 30 Months
| Take or Pay | 6.41
| 0.00 | 0.00
| 0.00 | 0.00
| 0.42 | 2.18
| 2.17 | 1.64
| 0.00 | 0.00
| 0.00 |
| |
|
| GC8 | Medway | 60 Months
| Take or Pay | 27.15
| 0.00 | 0.00
| 3.25 | 5.01
| 5.26 | 5.44
| 5.42 | 2.78
| 0.00 | 0.00
| 0.00 |
| |
|
| GC8 | Portsmouth | 59 Months
| Take or Pay | 66.08
| 0.00 | 0.00
| 4.65 | 12.41
| 13.13 | 13.38
| 13.36 | 9.16
| 0.00 | 0.00
| 0.00 |
| |
|
| GC8 | Wycombe | 60 Months
| Take or Pay | 10.82
| 0.00 | 0.00
| 1.76 | 1.97
| 2.07 | 2.15
| 2.14 | 0.73
| 0.00 | 0.00
| 0.00 |
| |
|
| OC123 | Ophthalmic Chain |
64 Months | Take or Pay | 42.59
| 2.00 | 11.42
| 10.75 | 5.79
| 6.09 | 6.53
| 0.00 | 0.00
| 0.00 | 0.00
| 0.00 |
| |
|
| D01 | London | 60 Months
| GFV (3) | 105.90
| |
| |
| 25.65 | 15.53
| 18.90 | 21.21
| 24.61 |
| |
| |
|
| D05 | West Midlands (Terminated)
| Terminated | GFV (3) | 20.15
| |
| |
| 20.15 |
| |
| |
| |
| |
|
| D8N | PET CT North | 60 Months
| GFV (3) | 50.28
| |
| |
| | 6.44
| 9.39 | 11.06
| 11.49 | 11.89
| |
| |
|
| D8S | PET CT South | 60 Months
| GFV (3) | 47.01
| |
| |
| | 6.63
| 8.80 | 9.70
| 10.69 | 11.20
| |
| |
|
| E01 | Avon, Gloucestershire & Wiltshire
| 72 Months | GFV (3) | 236.39
| |
| |
| |
| 11.53 | 37.61
| 38.97 | 39.98
| 41.02 | 42.09
| 25.19 |
|
| E05 | Cumbria & Lancashire
| 60 Months | GFV (3) | 117.84
| |
| |
| 5.15 | 21.99
| 24.54 | 25.03
| 25.80 | 15.33
| |
| |
|
| E06 | Cheshire & Merseyside
| 48 Months | GFV (3) | 42.02
| |
| |
| 7.86 | 10.46
| 10.73 | 11.10
| 1.88 |
| |
| |
|
| E08 | Greater Manchester |
84 Months | GFV (3) | 203.08
| |
| |
| | 1.43
| 26.15 | 29.51
| 30.30 | 29.50
| 29.70 | 30.40
| 26.10 |
|
| E09 | Hampshire & Isle of Wight
| 84 Months | GFV (3) | 183.65
| |
| |
| | 7.40
| 22.65 | 24.70
| 26.60 | 27.30
| 28.20 | 29.10
| 17.70 |
|
| E15 | Northumberland, Tyne and Wear
| 60 Months | GFV (3) | 47.98
| |
| |
| 5.00 | 9.35
| 10.06 | 10.32
| 10.60 | 2.65
| |
| |
|
| E16 | Various Main Renal Units
| 108 Months | GFV (3) | 110.16
| |
| |
| 0.99 | 6.65
| 8.83 | 11.01
| 12.14 | 13.35
| 14.51 | 15.83
| 16.93 | 9.93
|
| Contractual total |
| |
| | 2,635.13
| 3.40 | 14.13
| 123.25 | 210.46
| 312.49 | 363.55
| 438.36 | 358.23
| 271.61 | 196.97
| 129.40 | 117.41
| 85.92 |
| 9.93 |
| |
| |
| |
| |
| |
| |
| |
| |
| |
|
| Source: |
NHS Contracting, DH
|
| Footnotes: |
| 1. The total nominal contract value represents the total real contract value, adjusted for actual inflation to date, and HMT forecast inflation to contract expiry as at June 2009.
|
| 2. All information provided has been based on the most up to date information at the time of submission.
|
| 3. Guaranteed Fixed Value (GFV)—prices are split into two elements—base and activity costs. The guaranteed payment each period to the provider is based on the aggregate of the base costs multiplied by the GFV percentage defined within the contract. This percentage varies by contract and by contract year. The net result is lower guaranteed payments made to providers under these contracts in comparison to the Take or Pay contracts.
|
Table 21c
ISTC CONTRACTUAL INFORMATION—TAKE OR PAY CONTRACT
UTILISATION AND PAYMENTS TO DATE
|
| Contract | Location
| Hospital name | Provider name
| Contract
utilisation
to date
(31 May 2009)
| Contract payment
to date
(31 May 2009)
(£000s)
|
|
| LP2 | Bradford | Eccleshill NHS Treatment Centre
| Nations Healthcare | 85%
| 34,738 |
| LP3 | Burton | Midlands NHS Treatment Centre
| Nations Healthcare | 78%
| 44,942 |
| LP4 | Trent and South Yorkshire
| Barlborough NHS Treatment Centre | PHG
| 88% | 81,612
|
| LP5 | Daventry | The Birkdale Clinic
| | 97%
| 5,153 |
| LP7 | Shepton Mallet | Shepton Mallet NHS Treatment Centre
| UKSH | 99% |
85,306 |
| LP8 | Greater Manchester |
Greater Manchester Surgical Centre | Netcare Healthcare
| 61% | 68,224
|
| LP9 | Plymouth | Peninsula NHS Treatment Centre
| PHG | 101% |
48,521 |
| GC4 | East Cornwall | Bodmin NHS Treatment Centre
| Ramsay | 72%
| 20,484 |
| GC4 | East Lincolnshire | Boston NHS Treatment Centre
| Ramsay | 84%
| 7,798 |
| GC4 | North East Yorkshire and North Lincolnshire
| Clifton Park NHS Treatment Centre | Ramsay
| 89% | 36,468
|
| GC4 | Northumberland, Tyne and Wear
| The Cobalt NHS Treatment Centre | Ramsay
| 88% | 8,927
|
| GC4 | West Lincolnshire | Gainsborough NHS Treatment Centre
| Ramsay | 76%
| 5,302 |
| GC4 | Southampton | New Hall NHS Treatment Centre
| Ramsay | 79%
| 35,608 |
| GC4 | North Oxford | Horton NHS Treatment Centre
| Ramsay | 79%
| 39,421 |
| GC4 | Thames Valley (Milton Keynes)
| Blakelands NHS Treatment Centre | Ramsay
| 75% | 11,031
|
| GC4 | Thames Valley (Reading)
| Reading NHS Treatment Centre | Ramsay
| 93% | 12,340
|
| GC5E | Nottingham | Nottingham NHS Treatment Centre at QMC
| Nations Healthcare | 88%
| 25,522 |
| GC5 W | Cheshire and Merseyside
| Cheshire and Merseyside NHS Treatment Centre
| Interhealth | 94%
| 64,121 |
| GC5 W | Kidderminster | Kidderminster NHS Treatment Centre
| Interhealth | 86%
| 22,991 |
| GC6 | Maidstone | Mid Kent NHS Treatment Centre
| PHG | 97% |
17,766 |
| GC7 | North East London | North East London NHS Treatment Centre
| PHG | 78% |
51,136 |
| GC8 | Brighton | Sussex Orthopaedic NHS Treatment Centre
| Care UK | 98%
| 61,358 |
| GC8 | Havant | Havant NHS Diagnostic Centre
| Care UK | 53%
| 2,944 |
| GC8 | Medway | Will Adams NHS Treatment Centre
| Care UK | 52%
| 19,600 |
| GC8 | Portsmouth | St Mary's NHS Treatment Centre
| Care UK | 71%
| 45,795 |
| GC8 | Wycombe | Mid & South Buckinghamshire NHS Diagnostic Centre
| Care UK | 86%
| 8,992 |
| OC123 | Ophthalmic Chain |
Cataract Initiative | Netcare Healthcare
| 77% | 41,562
|
| | |
Contractual total |
| 85% | 907,664
|
|
| Source: |
NHS Contracting, DH
|
| Footnotes: |
| 1. All information provided has been based on the most up to date information at the time of submission.
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