Independent Sector Treatment Centres – a waste of OUR money

Apologies for not posting for a bit. A nasty bout of norovirus was to blame – I recommend not getting this!

Secretary of State for Health Alan Johnson likes to face both ways at once in public, when it comes to privatisation of the NHS. Late last year, he dropped some planned ‘Independent Sector Treatment Centres’ – but approved others. At the same time he moved swiftly on with the privatisation of primary care (i.e. GPs and other community based health services).

There’s an interesting summary here of Allyson Pollock’s latest research on Independent Sector Treatment Centres: http://www.bjhcim.co.uk/news/2008/n802034.htm

The private sector likes running ISTCs. They’re able to cherry pick the younger and healthier  patients and the low-cost surgical procedures like cataract operations and knee replacements. NHS providers, by contrast, bear the cost of complex patients and of training staff.  The NHS has spent £5 billion so far on ISTCs  – and big business has made an awful lot of money. Of course, we can’t be told the detail of private sector contracts or profits, because of ‘commercial confidentiality’.

Pollock and her colleague review the evidence around ISTCs. Interestingly, ISTCs have conspicuously failed to collect data on their performance. The NHS has to – ISTCs just don’t bother. So we spend £5 billion of public money, without any clear idea of what we get in return. It is impossible to reliably assess the quality of care, because they won’t tell us! Anecdotal evidence, though, is of worse patient outcomes.

ISTCs were meant to provide ‘additional capacity’ – just supplementing the NHS a bit, rather than replacing it. In fact, they poach staff from the NHS, and – by taking away NHS ‘business’ – threaten the viability of NHS hospitals. They also get paid whether they do the work or not – a very neat trick.

Astonishingly, ISTCs even manage to land the NHS with liability for clinical negligence claims, even though it’s the private sector provider that has made the clinical mistake.

I’ve been looking at Darzi’s proposals for London healthcare this weekend. Interestingly, a lot of the plans seem to be about bundling up services into packages that will be attractive to the private sector. Virtually all high-volume planned surgery will be stripped out of hospitals and carried out at new ‘elective centres’. Darzi isn’t explicit about these being private sector enterprises, but they look exactly like ISTCs with a slightly different name.  The NHS continues to be broken up at frightening speed.

And Alan Johnson’s real views on privatisation? Here’s a quote from a Ministerial Statement issued in November 2007, and a good one to remember the next time we’re told he’s very careful and cautious about privatisation:

The Independent Sector is playing an important and increasing role within the NHS, providing high quality treatment and choice for patients, and innovation, dynamism and contestability for existing NHS providers.”

He’s right about the ‘increasing role’, but dangerously wrong on absolutely everything else.

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