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Independent Sector Treatment Centres

This is my first debate in this or any other place where you have been in the Chair, Dr. McCrea. It is very nice to see you, particularly given the good news that has come out of the Province of late. I shall provide some background to the debate. Members know that the dates on the report and the Government’s response are somewhat dated: we published the report on 25 July 2006, and the response came in October. We made one or two observations, and we wanted to consider the subject, because back then, there was a general debate about independent sector treatment centres. One issue that we seized on quickly was the separation of elective from emergency procedures. We found out that clinicians had advocated separation since the 1990s. In 2002, the Government announced the creation of a series of NHS treatment centres to make systematic the approach to elective treatment, and later that year, the Department of Health decided to commission a number of independent treatment centres to handle NHS patients who required relatively straightforward or diagnostic procedures. I shall describe later what we found out about that issue. The Committee set out to discover the purpose of ISTCs. During the course of our inquiry, the rationale behind their creation varied in emphasis, but the stated purposes were fivefold:"““Increasing elective capacity available to the NHS in order to reduce waiting lists and times; Reducing the spot purchase price in the private sector; Increasing patient choice within the NHS; Encouraging best practice and innovation; Stimulating reform within the NHS through competition.””" We were surprised and dismayed at the Government’s poorly defined goals for the ISTC programme, and their rationale changed during the course of our inquiry. One of the most significant findings was an alarming absence of evidence, which consisted of two different problems: first, the Government refused on the ground of commercial confidentiality to give the Committee the information that they had collected on ISTCs, so although it was being collected, it was difficult for us to make a judgment about it; and secondly, there was a failure to collect proper data to assess the effectiveness of ISTCs. We found that both supporters and opponents of ISTCs were making claims that were not backed up by evidence. We concluded that treatment centres are a good idea. Separating elective and emergency procedures reduces the length of stay, helps reduce waiting lists and times and improves hospital organisations. We visited the centre to which my hon. Friend the Member for Dartford (Dr. Stoate) sometimes sends his patients, and it was a real eye-opener—first, to the situation inside the national health service. The centre is an NHS institution, brand new and effectively part of a brand new private finance initiative hospital. Our visit showed us the precise benefits of separation. One of our first and prime witnesses was the president of the Royal College of Surgeons, Bernard Ribeiro. In evidence, he explained to us that he could remember going to work as a surgeon expecting a list of seven patients in any one day, and that one day, when he was on his third patient, an accident happened on a local road. Everything was commandeered for the emergency, as we all accept, because an emergency is exactly that—an emergency. However, three or four of his patients did not have their operation that day, because elective and emergency surgery facilities were located together, in the same hospital. Why separation has not been the pattern throughout the lifetime of the NHS, I do not know. As somebody who thought he knew a bit about the NHS, it strikes me as obvious. Time and again, people have gone into hospital for elective surgery and had it postponed or delayed. Over the years and on a number of occasions, the issue of delays has been raised in the media and in debates in the House, but there have not been any systematic arrangements in the NHS to do what has been done in Dartford and other places. We concluded in the report that"““ISTCs have had a significant effect on spot purchase prices—" they have fallen substantially—"““and increased patient choice, offering more locations and earlier treatment.””" If someone had visited my constituency five years ago for a knee or hip operation, they would have been given a long wait for surgery. The Committee did not find that out; it is my own comment on the issue. Some consultants, however, would have offered patients surgery nearby, in an independent hospital in Sheffield, and within a few weeks, providing that the patient was prepared to pay the surgeon a few thousand pounds. That choice is rarely discussed, and it has now gone. It is not offered to my constituents anymore, and I am very pleased about that. They are offered surgery in NHS hospitals and in a neighbouring constituency’s ISTC. We concluded that ISTCs have demonstrated good practice and pioneered some innovative techniques. However, good practice and innovation can also be found in NHS treatment centres and elsewhere, so there is not any convincing evidence that NHS facilities are systematically adopting techniques that ISTCs have introduced. We were told that ISTCs would spread best practice, but we did not see any evidence of it. However, with the non-collection of evidence, we could not make real comparisons between the independent sector and the NHS. It was always going to be difficult. We concluded in the report that"““ISTCs have not made a major direct contribution to increasing capacity””" in the NHS. They represent a very small percentage of the overall capacity. I could not understand why ISTCs were not introduced in areas with high waiting lists, particularly when they were created to reduce elective surgery waiting times and lists. We tried to find out the reason behind elective surgery ISTCs. Was it the need to reduce waiting lists and to see patients quicker? Sadly, we could not find out. The threat of competition from ISTCs may have had an effect on the NHS, but again, we have only anecdotal evidence to support that assertion. The Government have failed to collect the data to allow them to quantify the changes. In my own view, owing to the political sensitivity of rolling out the independent sector in that way, it is amazing that systematic data collection was not undertaken so that direct comparisons could have been made between ISTCs and the NHS. The Committee also found two significant areas in which the ISTCs were problematic. They proved to be poorly integrated with the NHS, partly because of the policy of additionality, under which they cannot employ staff who have recently worked in the NHS. In a sense, that was to protect the national health service, so that a situation did not arise where clinicians were moving into the independent sector and we were unable to provide the service in the NHS. We therefore understand that point, too, although we did not think that there had been enough integration, even early. We visited one establishment, which was not an ISTC, but a BUPA-run centre at Redwood in Surrey. We saw NHS staff and BUPA staff working alongside one another, to the general good of patients there, without any of the animosity that everybody predicated would arise if the independent and national health service sectors were mixed. There are clear lessons to be learnt from such examples. We also heard from some witnesses that standards of care were poor in ISTCs, although those claims were not supported by quantifiable evidence. The Committee concluded that there were substantial failings in data collection; and one could not say that the claims were true, based on what people had said about the failings in standards. One of the national organisations representing surgeons actually told us that there were high levels of complications in ISTCs, because people were having elective surgery, but then having to get back into the NHS pretty quickly because the treatment had not been up to standard. Although that had been said by some eminent people and on websites, we found no evidence for it whatever. However, the ground shifted a little when those witnesses were challenged, because they moved from complications on to the issue of quality.