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Independent Sector Treatment Centres

Capacity could be increased because there are occasions when theatre lists are not used completely because of a shortage of beds in NHS hospitals. I am absolutely in favour of separating emergency and elective services so that that does not happen, but, if they are not separated, and if orthopaedic surgeons are kicking their heels, this would be a useful place for them to fill in. Training, quality, audit and follow-up would all be improved with closer integration. There is criticism of cherry-picking, but minor cases will be seen in treatment centres in any case. Provided that NHS surgeons are dealing with them, they will get some of the easier work—the work that is better for training. It is absolutely inexplicable, if we go back a bit, that NHS Elect was set up to do just what the ISTCs are doing but within the NHS. It was set up, but I believe that within eight months there was the first wave of ISTCs, some of which stabbed NHS Elect centres in the back. I believe that the NHS centre at Ravenscourt Park hospital found itself in great difficulties because of competition from the independent sector. We have a weird set-up in Kidderminster, in that part of our treatment centre is NHS and part is independent. Sadly, because of a total lack of integration, there is competition between the local NHS orthopaedic consultants and the ones working in the independent sector, so there are barriers to referral to the ISTC. That would not happen if there were integration and if ISTCs were part of the whole system. I want to move on to phase 2 treatment centres, which I find quite worrying. Apparently there is no sign of the Government increasing the number of NHS treatment centres, yet the Department is negotiating contracts for some 20 new ISTCs. I was interested in the Select Committee Chairman’s comments that there will be none in Yorkshire, and I wonder whether there is a geographical split. Perhaps in some areas doctors and trust managers are less resistant, and the Government are finding it easier to put ISTCs in place. The ISTCs will have quite an effect—1.4 million operations in five years at a cost of £3.75 billion—and I cannot believe that they will not have some effect on NHS provision. I wonder if tariffs will take into account the greater severity and complexity of the work that will be done in the NHS. I was slightly encouraged by one of the points in the Government’s response. They say that strategic health authorities can decide whether they want ISTCs. I hope that they really will be allowed to decide whether they need one. I would like to ask the Minister whether the Government have faced up to the consequences of a further push towards ISTCs. I refer him to a recent paper by Professor Chris Ham of the Health Services Management Centre in Birmingham. It is entitled, ““When politics and markets collide””, and it makes interesting reading. Professor Ham is a well-respected health service design consultant. Under the sub-heading, ““The Next Stage of Health Reform””, he states:"““The expansion of patient choice, the introduction of additional private sector capacity and the implementation of payment by results will create further instability in a system that is already finding it difficult to balance its budgets…The economics of providing care could also be affected if district general hospitals are less able to subsidise the costs of complex treatments by providing high volumes of elective and diagnostic care, should more of this care migrate to the private sector.””" That is quite a warning. There may be some hope, in that the Government are showing themselves a little more amenable to arguments against allowing that to happen. It was proposed that clinical assessment, treatment and support services would hand vast chunks of work to the private sector, particularly in the north-west, in just six specialties—orthopaedics, rheumatology, general surgery, ear nose and throat, gynae, and urology. However, there has been active opposition and cogent arguments from patients and professional groups. To my absolute amazement—I hope that the Minister will not be quite so surprised—those arguments have been listened to. Rheumatology has been removed from the list because the eight-week target can be met without it. In Health questions a couple of weeks ago, it emerged that Chorley hospital is being allowed to provide CATS services within the NHS and without going to private providers. If Chorley can do it, why cannot everyone else? What is special about Chorley? There is also something called ICATS, which I always thought stood for independent CATS. However, it does not; it stands for integrated CATS, which means that the service is integrated with the NHS. That is happening in Oldham, which shows that the NHS can do it, if it is allowed to. Paragraph 50 of the Government response states:"““ISTCs will only be introduced in health economies in which the SHA supports the case for them, and is committed to managing the capacity and financial consequences of ISTC implementation, particularly any impacts on existing NHS providers of elective care.””" I strongly commend that paragraph to the Minister and ask him to act on it. I have talked for long enough, so, in conclusion, I will mention costs. Paragraph 56 of the Government response explains some of the extra costs borne by private providers and hence why they are more expensive. That is surely a reason for concentrating on the NHS; if it is cheaper why the dickens do we not just concentrate on it? The National Audit Office has been mentioned already, and paragraph 58 of the Government response says that the NAO is considering an investigation. I would be grateful to know if that is so because that is how we would find out the answers to the questions posed by the hon. Member for City of York, which were absolutely relevant and crucial. Paragraph 8 of the Government response is where I think the hon. Gentleman got the statement:"““Utilisation of ISTCs is high at 84%””." The response goes on to state"““and we are able to benchmark this against NHS performance.””" What NHS performance? NHS performance in NHS treatment centres or bed occupancies in acute hospitals? In one Committee session, I remember a previous Secretary of State for Health got completely tied up between bed occupancies in acute hospitals and bed occupancies in treatment centres.