As Labour and the Conservatives argue over who is or isn’t going to cut public sector spending after the next general election, it is worth having a look at a report produced by the employers’ organisation, the NHS Confederation.
Titled “Dealing with the Downturn” it predicts a possible five-year programme of NHS cuts of up to £15 billion. Job losses and lower availability of treatments are two likely outcomes as the NHS prepares itself for real term reductions.
It is particularly galling then that, after the colossal bank bailout which the NHS and other public services are expected to cover, one part of the government’s privatisation programme in the NHS, Independent Sector Treatment Centres (ISTCs), appear to be subject to neither austerity measures nor accountability.
The ISTC programme, worth £5 billion, was announced in December 2002. It allowed private healthcare companies a slice of the lucrative NHS market to provide treatments and diagnostics to NHS patients. The first wave of contracts are now coming to an end, revealing some alarming facts.
The first ISTC to complete a five-year contract comprised mobile cataract units run by Netcare. It is worth £41.7 million and is reporting only 81 percent utilisation.
The £86.1 million Greater Manchester Surgical Centre, also nearing completion, was reporting utilisation rates of only 61 percent last September.
Good, you might think – less of our money going to the private sector.
But the contracts for this first wave of ISTCs were designed so that no matter how many patients were referred to the centres, the NHS was obliged to pay for the total value in the contract.
They were also designed so that the NHS retains the risk – in other words, has to pay – for patients who do not turn up for treatment after being referred. The Health Service Journal estimates as much as £8 million may have been paid to Netcare for cataract patients who were never treated.
There is also concern over quality of care in ISTCs following catastrophic failures in basic procedure. The Eccleshill ISTC in Bradford, now run by healthcare company Circle, is under close scrutiny following the death of a patient during surgery for which the coroner’s verdict was misadventure aggravated by neglect.
The Healthcare Commission found in two separate reports that data quality from ISTCs was too poor to allow a proper assessment. All NHS facilities are required by law to make data returns. ISTCs are required to do so also – but haven’t.
There was no requirement on early ISTCs to train clinical staff. They perform the easiest operations – the type most useful in early training – but most ISTCs do not train doctors. There has consequently been a reduction in such opportunities in the NHS.
The claim that ISTCs have helped to drive down waiting times is disputed. The Royal College of Opthamologists attribute the fall in waiting times for cataract operations to separate changes instigated within the NHS.
The health committee also found ISTCs had made no major direct contribution to increasing capacity. Scandalously the Department of Health refused to disclose to the committee details of its own analysis of the effect ISTCs might be having on NHS facilities as well as witholding contract and cost detail on the grounds of commercial confidentiality.
Scotland’s first ISTC, also run by Netcare, is currently under review to see whether the contract should be extended beyond early next year. Local campaigners in Tayside used freedom of information legislation to force NHS Tayside to release the full cost detail of the ISTC contract.
This enabled the first independent assessment of an ISTC to be published in the British Medical Journal which found evidence that in the first year as much as £3 million may have been paid for nothing.
There is clearly no evidence that ISTCs are either value for money or efficient. They should be scrapped and the facilities, services and staff brought into the NHS where they belong.
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