Private treatment centres harm NHS

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TREATMENT Centres run by the private sector are much more likely to have an adverse effect on their surrounding NHS trusts, finds new research published today by the British Medical Association (BMA).

A survey of clinical directors working in orthopaedics, ophthalmology and anaesthetics in NHS trusts in England was undertaken to find out the impact, if any, of treatment centres on the local health economy and to see whether patients were benefiting from the treatment centre programme.

The majority of respondents (70 per cent) said that patients had benefited from treatment centres, but only one in twenty thought there was a substantial benefit for patients seen in independent sector treatment centres (ISTCs) compared to almost a third in NHS-run treatment centres.

None of the respondents thought that ISTCs had had a positive impact on the facilities and services provided by their trust. This compares to 42 per cent of respondents who believed that NHS treatment centres had a positive impact, while 23 per cent said they had no impact at all.

Respondents described negative impacts as the distortion of NHS case-mix, resulting from the cherry picking of easier and cheaper operations by the treatment centres, a loss of potential income for the NHS and low staff morale.

The BMA survey indicates that NHS treatment centres, which are better integrated with the traditional health service, can have positive effects because clinicians are able to work together and services interact to provide enhanced care for patients.

Other key findings from the survey include:

Two out of three respondents report that they have never been consulted by the relevant primary care trust as to the suitability of patients chosen to be transferred to the treatment centre.

More than three-quarters of respondents report that they are aware of patients that have been rejected for treatment by the treatment centre.

Half of respondents express concern about the general quality of care provided by treatment centres overall, but with significantly greater concern regarding the quality of care in ISTCs than in NHS treatment centres.

The majority of respondents (80 per cent) say that there is either no formal arrangement for reporting concerns regarding patient care and clinical governance to ISTCs, or that they are unaware of it.

Two out of three respondents report that patients have been returned to NHS hospitals for aftercare and respondents indicate that patients are more likely to require re-admission to an NHS hospital following treatment in ISTCs than following treatment in NHS treatment centres.

Two out of five respondents agree that the education and training of junior doctors have been affected by the treatment centre and most foresee an adverse impact in the future.

The report states that the ‘following comments’ from respondents illustrate these concerns about the private treatment centres.

‘All the difficult cases are ignored by treatment centres.’

‘Treatment centres are cherry picking the easy cases. The more complex cases are referred to NHS hospitals and this has a huge impact on training.’

‘We are left with the complex cases and the elderly. . . . there are no small cases to train juniors.’

The report adds: ‘Three quarters of clinical directors in opthalmology report some degree of rejection of patients for treatment by treatment centres.’

It quotes respondents: ‘These patients typically have the most complex conditions or are very sick or overweight.’

‘We are constantly asked to see patients who have been turned down for cataract surgery.’

The survey found: ‘Two thirds of respondents report that they are aware of patients who developed complications following treatment in treatment centres and have required readmission to their trust. . .’

The survey report says: ‘Half of respondents are concerned about the general quality of care provided by the treatment centre.’

It adds: ‘Many respondents also comment on the high turnover of consultants working in the treatment centres and the impact that this has on the continuity of patient care. The following verbatim comments illustrate these concerns:

“Patients are not aware of the surgeon’s experience and are given only one follow up visit. There is no long term care for knee and hip replacements.”

“We have no information as to the qualifications of surgeons employed by treatment centres.”

“It appears that surgeons are operating outside their expertise”.’