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Independent Sector Treatment Centres

The hon. Gentleman raises an important point, and of course we keep such matters under review. He is right to say that the relaxation does not extend to shortage professions and specialties—for obvious reasons; if it did, we would go back to the wave 1 problems that I described. Orthopaedic surgeons are not on the current phase 2 list of shortage professions, which should address the hon. Gentleman’s concern. The specialties covered by the list include pathology, audiology, cardiology, sleep and respiratory physiology, categories of radiologists and radiography, neurophysiology, cardiac physiology and anaesthetics. The list, which is kept under review, is on the NHS employers’ website. I am sure that that would interest the hon. Gentleman, whom I also call my hon. Friend. He should be assured that the list is kept under review. Obviously, the changing nature of the UK labour market and the emerging training situation are relevant, and I hope that they will inform further consideration of the issue. The hon. Member for Westbury asked whether the list was grade-specific or based on geography. The list is based on a sample survey of 25 trusts across the country. However, it is neither geography-specific nor grade-specific, except in the case of nurses; only senior nursing grades are on the shortage lists. As I said, the list is kept under review by the Department’s work force team. I deal now with training, an important issue mentioned by many hon. Members today. We welcomed the Committee’s support for the approach to training for phase 2 schemes. We recognise that the training of NHS staff within ISTCs is particularly important, and have taken action to ensure that local training of junior doctors is not compromised. In the second phase of ISTCs, all schemes will have activity available to postgraduate deans and higher education institutes for training purposes. Independent providers will be expected to appoint directors of postgraduate training to work with the postgraduate medical education and training board and local deaneries to oversee training provision within ISTCs across a range of clinical professions. Whether training takes place in an ISTC facility rather than the NHS will, of course, remain a decision for the postgraduate medical education and training board and deans who are responsible for the commissioning of training. Nevertheless, I hope that the move will be welcomed. NHS training in an ISTC setting will be directed and overseen, as it is now, in NHS settings. The higher education institutions, the royal colleges and the other bodies involved in facilitating and overseeing NHS training will retain their existing roles. In the longer term, it is intended that relationships be developed locally so that professional development occurs seamlessly across the local health economy partners, to the overall benefit of patient care. Concerns about quality have been raised today, but I assure Members that patient safety is paramount in ISTCs, as in the NHS. I was pleased to note that the Committee commented on the alarmist tone of some of the criticisms of clinical standards in ISTCs. Efforts continue to be made to undermine confidence on that issue, and they are not in the public interest. ISTC providers are contractually obliged to deliver clinically safe, high-quality care along agreed patient care pathways. ISTCs are monitored against 26 key performance indicators to ensure that quality services are delivered, including clinical quality, patient experience and productivity. All ISTCs are regulated under statute by the Healthcare Commission and are further inspected on an ongoing basis. All surgeons working in ISTCs must be registered on the General Medical Council’s specialist register before they perform surgery. As many hon. Members have mentioned, the chief medical officer has asked the Healthcare Commission to review the quality of care provided by ISTCs, and we look forward to receiving its report. To update Members I should say that currently we expect to receive the report at the end of June. The delay is due to the fact that the commission wishes to use the most up-to-date data from ISTCs. To be honest, the problems have been with the IT system in drawing down the data required; I assure Members that they have not been due to any delays in information being provided by ISTCs. The report is due soon, and it will make an important contribution and ensure public confidence. The Committee rightly focused public attention on the matter, but I am confident that when the report is published it will further improve public confidence, although I am also sure that there will be issues to address. In the course of the debate, questions were raised about the evidence on whether ISTCs had improved innovation within the national health service and brought innovative practice to the UK. Let me give a specific example from the ISTC programme. At Shepton Mallet ISTC, the patient can see an orthopaedic surgeon, have diagnostic tests and book an operating slot all in one day, a process that would typically have taken months and at least three appointments in the past. That example has now been copied by Yeovil District Hospital NHS Foundation Trust, where managers say that the ISTC made their clinicians sit up and take notice. As a result, they too have established one-stop out-patient clinics for orthopaedic patients, reorganised the way in which they use their consultants’ time and slashed waiting lists. Those new approaches have helped Somerset primary care trust and Yeovil District Hospital NHS Foundation Trust radically to reduce waiting times, so much so that Yeovil is one of the trusts aiming to achieve the 18-week target from GP referral to operation by the end of the year, a year ahead of schedule. The introduction of the ISTC in Shepton Mallet has also driven down prices in the local private provider market. We believe that that is a concrete example of the ISTC programme having the desired effect. The hon. Member for Westbury raised a view from another side of the local health economy. I refer him to an article that appeared in the Health Service Journal on 29 March, by a consultant called Andy Mullins who concluded a quite robust defence of ISTCs with a telling point:"““The overall message is that independent sector involvement in the NHS is not threatening to the existing service unless it refuses to change. If the service responds and learns the efficiency and quality of the services will improve—as we as a nation will still be able to afford them in the coming decades.””" That is a telling point from inside the NHS and a good endorsement of the ISTC programme. I want to do justice to some of the other points raised by hon. Members, but I realise that time is running out. First, I want to pick up on the points raised by my hon. Friend the Member for City of York. I understand his strength of feeling, particularly because of the pressures on his local economy. However, to refer back to the figures for NHS spot purchasing, his local health economy, like every other, is not only expected to meet but will meet the 18-week target by the end of next year. The level of activity commissioned has to be consistent. In the process of scrutinising the local delivery plans for his strategic health authority, the Department is considering that point. I understand my hon. Friend’s frustration, but the Department has to get value for money across the country in conducting procurement exercises. That is why individual data that relate to any particular contract are not placed in the public domain. That would limit the Department’s ability to get maximum value for money when conducting future procurement exercises.