Health Committee critical of ISTCs

In a press release issued this week (Monday 24 July), the House of Commons Health Select Committee laid out some of its main findings from its inquiry into Independent Sector Treatment Centres (ISTCs).

The Committee's conclusion is that the Department of Health has failed to provide the evidence to convince MPs that the benefits gained from contracting out operations to Independent Sector Treatment Centres (ISTCs) are greater than if they were done within the NHS.

The Health Select Committee, who support the separation of elective from emergency care but believe ISTCs may not provide better value for money compared with NHS Treatment Centres, or partnership arrangements made with private hospitals also went on to say that they believed these alternative options to ISTCs are more likely to improve integration between treatment centres and NHS hospitals and GPs, and may well be cheaper.

The Committee concludes that ISTCs have not made a major contribution to increasing capacity within the National Health Service.

The Committee believe that although waiting lists have declined since the introduction of ISTCs, this is likely to have been due to additional NHS spending and the intense focus placed on waiting lists.

Competition from ISTCs may have stimulated performance within the NHS, but the Committee received no convincing evidence that this was the case. They said:

'We were surprised that the Department made no attempt systematically to assess and quantify the effect of competition from ISTCs on the NHS. Given its importance, the Department should have ensured that this was done from the beginning of the ISTC programme in 2003.'

In a balanced report, the Committee also argues that, at present, there is no hard evidence to prove standards of care in ISTCs are lower from those in the NHS; it recommends that standardised data should be collected to compare standards. It is critical of the Department of Health for not collecting comparable data.

Given the difficulty in making comparisons, the Committee expressed its dismay at the strident and alarmist tone of some criticism of clinical standards in ISTCs on the basis of anecdotal evidence.

Similarly, the Committee believe that ISTCs have embodied good practice and introduced innovative techniques, but that good practice can already be found in NHS Treatment Centres and other parts of the NHS.

MPs support moves by the Department to enable NHS doctors to work in ISTCs but believes that it should go further.

They also argue that currently, ISTCs are poorly integrated into the NHS and are not doing enough to train doctors. The Committee support the Department's decision to include the provision of training as a contractual obligation for Phase 2 of the ISTC programme.

But they question the wisdom of further investment in ISTCs in Phase 2: The decision to maintain the commitment to spend £550 million per year despite changing circumstances has not been explained, and seems to sit uncomfortably with the Secretary of State's admission that "in other [areas] it has become clear that the level of capacity required by the local NHS does not justify new ISTC schemes.

The Committee are also concerned that the expansion of the ISTC programme will destabilise local NHS trusts, especially those with financial deficits.

They believe that in the long term, ISTCs could have a significant effect on the finances of NHS hospitals:  'Phase 2 ISTCs may lead to unpopular hospital closures under 'reconfiguration' schemes'. The report concludes that ISTCs should only be built where there is a local need and where the local health community agrees there is a need.

Commenting, Committee Chairman, Kevin Barron said:

"It is difficult to say how the ISTC's have affected either patients or the NHS, due to the lack of any systematic assessment. There is clearly an ideological issue about the use of the independent sector and I believe that this must end. The report lays down a number of suggested changes that could be made. There is no question that the separation of elective surgery from A&E lessens the potential for elective surgery to be disrupted or even postponed. It is now time for all sides to sit down and agree changes which would benefit the patients."

Notes

1. The title of the report is 'Independent Sector Treatment Centres' and is the Committee's Fourth Report of Session 2005-06 (HC 934-I). It can be downloaded from http://www.publications.parliament.uk/pa/cm200506/cmselect/cmhealth/934/934i.pdf

2. The Membership of the Committee is as follows Rt Hon Kevin Barron MP (Chairman) [L] Rother Valley, Mr David Amess MP [C] Southend West, Charlotte Atkins MP [L] Staffordshire Moorlands, Sandra Gidley MP [LD] Romsey, Mr Ronnie Campbell MP [L] Blyth Valley, Jim Dowd MP [L] Lewisham West, Anne Milton MP [C] Guildford, Dr Doug Naysmith MP [L] Bristol North West, Mike Penning MP [C] Hemel Hempstead, Dr Howard Stoate MP [L] Dartford, Dr Richard Taylor MP [IND] Wyre Forest.