Independent sector treatment centres (ISTCs) are private-sector owned treatment centres contracted within the English National Health Service to treat NHS patients free at the point of use, like any other NHS hospital. They are sometimes referred to as 'surgicentres' or ‘specialist hospitals’.
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. Department of Health claims stated that by concentrating on a set type of procedures they are able to streamline the patient care pathway,[1] resulting in an improved patient experience[2] and help the NHS to quickly meet waiting time targets[3]; however, the majority of independent research conducted to date has contradicted these claims.
Wave I ISTCs currently work on pre-arranged central government bulk contracts nominally at or below the national tariff [2] 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.
Referral rates vary across the country, with some ISTCs performing as much 115% of their contracted volumes but with the average referral rate around 85%. According to the NHS Partners Network, which represents private providers working within the health service, GP referral rates are rising as patients report positive experiences back to their GPs.[4]
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. However, a subsequent study conducted by the researchers from London School of Hygiene & Tropical Medicine and the Royal College of Surgeons of England confirmed the high quality of care, concluding that “patients undergoing cataract surgery or hip replacements in ISTCs achieved a slightly greater improvement … than those treated in NHS facilities” and “Patients treated in ISTCs were less likely to report post-operative problems than those treated in NHS facilities…”(BMC Health Services Research 2008. 8:78).[5]
In the 2008 Healthcare Commission 2008 NHS Inpatient Survey,[6] ISTCs scored highly on a number of measures, including overall quality of care.[7]
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. A second Wave of ISTCs was completed in 2009 and those marked the end of the centrally planned centres.[8] Moving forward, local PCTs will make decisions on how best to work with their local ISTCs after the initial five year contracts have expired.[9]
In 2009 a British Medical Journal paper concluded that up to £927m of the £1.5bn first wave of ISTC contracts "may have been paid to ISTCs for patients who did not receive treatment".[10] This was based on a Scottish example and does not in fact reflect the experience of the English ISTC program, where referrals have been more inline with the expectations of the original contracts and continue to grow.