News

Private treatment centres harming NHS

22 February 2008

The government programme of funding private treatment centres will contribute to NHS deficits, NHS service closure and staff redundancies, warn Edinburgh University researchers.

There is no good evidence that independent sector treatment centres have provided additional capacity, value for money, or high quality care, argue Professor Allyson Pollock and Sylvia Godden in a report published in this week's BMJ [1].

The independent sector treatment centre programme was presented as a way of cutting waiting times and saving money. But despite the lack of evidence to support the programme, the government is continuing with it.

The policy of the Department of Health in England is to use NHS funds to contract with for-profit multinational healthcare corporations to deliver clinical services, they explain. Department of Health policy statements have said that strategic health authorities will be judged according to their PCT's success in contracting with private providers.

Part of the DH policy is the £5bn independent sector treatment centre programme, which over the course of two phases (waves) aims to provide extra capacity to the NHS and reduce waiting times for elective surgery.

Yet, four years into the programme, the Department of Health has not gathered adequate data to justify the policy, say the authors.

They reviewed the available data and evidence in terms of the programme’s objectives and found a worrying failure to collect and publish data on performance.

For example, data on the number of available and occupied beds are collected annually from NHS trusts, but no such data are collected from independent sector treatment centres. Without this data, it is impossible to assess the contribution that these centres make to capacity, productivity, or efficiency.

A recent report by the Healthcare Commission found that incomplete and poor quality admissions and outpatient data from independent sector treatment centres limited their ability to assess quality of care.

Furthermore, the first research on the quality of work undertaken by private centres, published in October 2005, stated that data was so variable in quality and so incomplete as to render “any attempt at commenting on trends and comparisons between schemes and with any external benchmarks, futile.”

The Royal College of Surgeons of England also reported “increasing evidence” that these centres were unable to manage complications and patients were being readmitted to the NHS.

The failure on the part of the Department of Health to collect meaningful systematic data about quality of care heightens concerns about standards of care, write the authors. Data on workforce, contract performance and finances are also lacking.

The government’s assurance that staff employed by the private sector in treatment centres would be ‘additional’ rather than parasitic upon the NHS has not been honoured. It has reneged upon its original guarantees, so that more than a quarter of the staff employed by the private sector are NHS staff.

The Department of Health has refused to release financial information on private sector contracts, claiming commercial confidentiality. Risks are borne by the NHS, thus reducing the treatment centres' costs, but adding to those of the NHS.

Clinical negligence claims were transferred to the NHS and there is growing evidence that NHS funds are being diverted to the private sector for services they have failed to provide under the contract. This implies there is guaranteed payment but not guaranteed service. The NHS, however, is only paid per operation carried out.

The government’s failure to collect and publish meaningful relevant data on the productivity, performance, staffing and quality of private independent treatment centres, and its refusal to provide any data on their value for money is worrying, they say.

A GP with experience of a local private treatment centre told bjhc&im that the centre can cream off simple and profitable operations, removing a major source of income for the local NHS providers and could result in the competing NHS services becoming unviable. Also, patients who have problems with their operations go back to their GP and expect the NHS to then help them out.

Gerry Robinson, who made the BBC programme Can Gerry Robinson fix the NHS? broadcast in December last year, pointed out the absurdity of a clinic only two miles from Rotherham General Hospital competing for procedures ranging from minor surgery to diagnostics and depriving the Hospital of income.

Dr Jonathan Fielden, chairman of the BMA’s Consultants Committee, says: “This paper adds to criticisms from the Public Accounts Committee and the Healthcare Commission relating to the quality and cost effectiveness of these centres. We have repeatedly raised concerns that this is £5 billion wasted on ideology rather than evidence. The government seems to have been charmed by the private sector, but is unable to prove its effectiveness or value for money.

“The lack of integration and collaboration with local NHS services leads to fragmentation of care for patients, leaves the NHS picking up the pieces, and has a major impact on training future doctors — with long term consequences for the NHS.”

Professor Pollock cautions: “The policy of diverting scarce NHS funds into independent sector treatment centres is leading to fragmentation and financial instability and NHS beds and services are being closed to make way for the for-profit private sector. Despite assurances by the secretary of state for health, Alan Johnson, the available evidence suggests that the private sector is profiting at the expense of patients, the public, and the NHS.”

Reference

To top^