Independent sector treatment centre

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Independent sector treatment centres (ISTCs) are private-sector owned treatment centres contracted within the English National Health Service. They are sometimes referred to as 'surgicentres'.

ISTCs are normally co-located with NHS hospitals. They perform common elective (i.e. non-emergency) surgery and diagnostic procedures and tests in the same way as NHS hospitals. Typically they undertake 'bulk' surgery such as hip replacements, cataract operations or MRI scans rather than more complex operations such as neurosurgery.

ISTCs work on pre-arranged central government bulk contracts nominally at or below the national tariff [1] on which NHS hospitals can charge commissioning NHS Primary Care Trusts. These contracts include a profit margin and the treatments are paid for in advance by central government whether or not the numbers paid for are taken up and regardless of success rates. The rationale is that the waiting times for patients are cut by separating routine elective surgery and tests from emergency work.

A critique of this development is that difficult and expensive work is left for the NHS hospitals to do, increasing their marginal costs and making them appear less 'efficient'. Recent opinion printed in the British Medical Journal (BMJ vol 332 11 March 2006) has also suggested that treatments may be proportionally less successful in ISTCs due to the employment of inexperienced or less fully trained staff with less backup than the NHS facilities. This could result in the NHS having to fund difficult revision operations (insofar as they can be so revised) and would defeat the object of the exercise. Evidence for this is however debatable at present.

The NHS Plan originally conceived of opening eight treatment centres by 2005, but by August 2005 at least 25 had been opened, with more being planned