Independent sector treatment centres (ISTCs) are private-sector owned treatment centres contracted within the English
National Health Service
The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...
to treat NHS patients free at the point of use. They are sometimes referred to as 'surgicentres' or ‘specialist hospitals’. ISTCs are often co-located with NHS hospitals. They perform common elective (i.e. non-emergency)
surgery
Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...
and
diagnostic
Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine " cause and effect". In systems engine ...
procedures and tests. Typically they undertake 'bulk' surgery such as hip replacements,
cataract
A cataract is a cloudy area in the lens of the eye that leads to a decrease in vision. Cataracts often develop slowly and can affect one or both eyes. Symptoms may include faded colors, blurry or double vision, halos around light, trouble w ...
operations or
MRI
Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body. MRI scanners use strong magnetic fields, magnetic field gradients, and radio waves ...
scans rather than more complex operations such as
neurosurgery
Neurosurgery or neurological surgery, known in common parlance as brain surgery, is the medical specialty concerned with the surgical treatment of disorders which affect any portion of the nervous system including the brain, spinal cord and peri ...
.
The
NHS Plan 2000
The NHS Plan 2000 was a ten year plan of the Blair ministry for the National Health Service (England). It combined a commitment to substantial investment with some quite radical changes. The most controversial aspect of the plan was the introducti ...
originally conceived of opening eight treatment centres by 2005, but by August 2005 at least 25 had been opened, with more being planned. 46 NHS treatment centres opened between 2003 and 2009, treating approximately 300,000 patients a year with high rate of patient satisfaction (>94%).
Contracts
Wave I ISTCs worked on pre-arranged central government bulk contracts nominally at or below the national tarif
on which NHS hospitals can charge commissioning NHS
primary care trust
Primary care trusts (PCTs) were part of the National Health Service in England from 2001 to 2013. PCTs were largely administrative bodies, responsible for commissioning primary, community and secondary health services from providers. Until 31 May ...
s. These contracts included a profit margin. Additional costs associated with the programme, up to a ceiling of 25% over and above the NHS Equivalent Cost, were paid for by central Government. Treatments were paid for in advance by central government whether or not the numbers paid for were taken up and regardless of success rates. The rationale was that the waiting times for patients are cut by separating routine elective surgery and tests from emergency work.
Referral rates varied across the country, with some ISTCs performing as much 115% of their contracted volumes but with the average referral rate around 85%. Pressure was put on local GPs to refer patients to the centres, rather than to NHS hospitals, because the
primary care trust
Primary care trusts (PCTs) were part of the National Health Service in England from 2001 to 2013. PCTs were largely administrative bodies, responsible for commissioning primary, community and secondary health services from providers. Until 31 May ...
s had to pay for activity whether or not it was used. According to the
NHS Partners Network
The Independent Healthcare Providers Network (IHPN), formerly known as the NHS Partners Network, is a representative body for independent sector healthcare providers in the United Kingdom.
It was formed in 2005 to provide a voice for private heal ...
, which represents private providers working within the health service, GP referral rates were rising in 2009 as patients report positive experiences back to their GPs.
In 2009 a ''
British Medical Journal
''The BMJ'' is a weekly peer-reviewed medical trade journal, published by the trade union the British Medical Association (BMA). ''The BMJ'' has editorial freedom from the BMA. It is one of the world's oldest general medical journals. Origi ...
'' 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". 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 in line with the expectations of the original contracts and continue to grow.
Debate
The Department of Health claims stated that by concentrating on a set type of procedures they are able to streamline the patient care pathway, resulting in an improved patient experience and help the NHS to quickly meet waiting time targets; however, the majority of independent research conducted to date has contradicted these claims.
A critique of this development is that more difficult and expensive work is left for NHS hospitals to do, increasing their marginal costs and making them appear less 'efficient'. An article by
Angus Wallace in the
British Medical Journal
''The BMJ'' is a weekly peer-reviewed medical trade journal, published by the trade union the British Medical Association (BMA). ''The BMJ'' has editorial freedom from the BMA. It is one of the world's oldest general medical journals. Origi ...
BMJ vol 332 11 March 2006 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
The London School of Hygiene and Tropical Medicine (LSHTM) is a public research university in Bloomsbury, central London, and a member institution of the University of London that specialises in public health and tropical medicine.
The inst ...
and the
Royal College of Surgeons of England
The Royal College of Surgeons of England (RCS England) is an independent professional body and registered charity that promotes and advances standards of surgical care for patients, and regulates surgery and dentistry in England and Wales. The ...
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). ISTC contracts typically exclude referrals of older, fatter and sicker patients, so comparisons with results in NHS hospitals who deal with these more difficult patients is difficult.
In the 2008 Healthcare Commission 2008 NHS Inpatient Survey, ISTCs scored highly on a number of measures, including overall quality of care.
A British Medical Journal study in 2011 concluded: " Patients undergoing surgery in ISTCs were slightly healthier and had less severe conditions than those undergoing surgery in NHS providers. Some outcomes were better in ISTCs, but differences were small compared with the impact ISTCs could have on the provision of elective services.". Their findings supported the idea that separating elective surgical care from emergency services could improve the quality of care.
Providers
The
NHS Plan 2000
The NHS Plan 2000 was a ten year plan of the Blair ministry for the National Health Service (England). It combined a commitment to substantial investment with some quite radical changes. The most controversial aspect of the plan was the introducti ...
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. It was then for local PCTs to make decisions on how best to work with their local ISTCs after the initial five-year contracts have expired. This list of providers was current in 2006. Some of the centres subsequently changed hands.
*
Capio
Capio is a private healthcare company that provides healthcare in medicine, surgery and psychiatry at health centers, specialist clinics and hospitals in Sweden, Norway, Denmark, Germany and France
France (), officially the French R ...
Healthcare Limited: Bodmin NHS Treatment Centre, Boston NHS Treatment Centre, Clifton Park NHS Treatment Centre (York), Gainsborough NHS Treatment Centre, Cobalt NHS Treatment Centre (North Tyneside), Blakelands NHS Treatment Centre (Milton Keynes), Banbury NHS Treatment Centre, Ashford NHS Treatment Centre (Surrey)
*Clinicenta Ltd - owned by
Carillion
Carillion plc was a British multinational construction and facilities management services company headquartered in Wolverhampton in the United Kingdom, prior to its liquidation in January 2018.
Carillion was created in July 1999, following a ...
: Hemel Hempstead Hospital. Lister Hospital (Stevenage)
*
Interhealth Canada
Interhealth Canada is an international provider of healthcare services specialising in orthopaedics and trauma. Its Head Office is located in Toronto with regional offices in Dubai, Kuwait and the United Kingdom. Wilson Parasiuk was a director fr ...
- Cheshire & Merseyside NHS Treatment Centre (Halton), Kidderminster Independent Sector NHS Treatment Centre
*Mercury Health Ltd a division of Tribal Group, sold to
Care UK
Care UK is a provider of residential care for older people. They operate more than 150 homes offering residential care, dementia care, and nursing care. The company formerly also operated a wider range of healthcare services until 2019 when ...
in January 2007: Mid and South Buckinghamshire NHS Diagnostic Centre, Portsmouth NHS Treatment Centre, Will Adams NHS Treatment Centre (Gillingham), Haywards Heath NHS Treatment Centre
*
Nations Healthcare Ltd
A nation is a community of people formed on the basis of a combination of shared features such as language, history, ethnicity, culture and/or society. A nation is thus the collective identity of a group of people understood as defined by thos ...
: Nations Healthcare Eccleshill NHS Treatment Centre (Bradford), Burton upon Trent NHS Treatment Centre, Nottingham NHS Treatment Centre
*
Netcare
Netcare Limited is a South African private healthcare company. It operates through a number of subsidiaries and employs just over 21 000 people.
The group offers a range of medical services across the healthcare spectrum and operates South ...
Healthcare UK Limited: Netcare ISTC—North Chain (Whitchurch), Netcare ISTC—South Chain, Netcare ISTC Greater Manchester Surgical Centre
Trafford General Hospital
Trafford General Hospital is a district general hospital in Davyhulme, Greater Manchester, England, managed by Manchester University NHS Foundation Trust.
History Early history
Work began on what was originally named Davyhulme Park Hospital, e ...
*
Partnership Health Group Limited
A partnership is an arrangement where parties, known as business partners, agree to cooperate to advance their mutual interests. The partners in a partnership may be individuals, businesses, interest-based organizations, schools, governments o ...
:
Bideford
Bideford ( ) is a historic port town on the estuary of the River Torridge in north Devon, south-west England. It is the main town of the Torridge local government district.
Toponymy
In ancient records Bideford is recorded as ''Bedeford'', ''By ...
NHS Treatment Centre, Partnership Health Group ISTC Boston Pilgrim Hospital, Partnership Health Group ISTC Lincoln, Peninsula NHS Treatment Centre (Plymouth), Barlborough NHS Treatment Centre (Chesterfield), Maidstone ISTC, North East London ISTC (Ilford)
*
Ramsay Health Care UK
Ramsay Health Care UK is a healthcare company based in the United Kingdom. It was founded by Australian businessman Paul Ramsay, who established its parent company: Ramsay Health Care, in Sydney, Australia, in 1964 and has grown to become a global ...
*
Spire Healthcare
Spire Healthcare Group plc is the second-largest provider of private healthcare in the United Kingdom. It is listed on the London Stock Exchange and is a constituent of the FTSE 250 Index.
History
Spire Healthcare was formed from the sale of B ...
*UK Specialist Hospitals Ltd bought by
Care UK
Care UK is a provider of residential care for older people. They operate more than 150 homes offering residential care, dementia care, and nursing care. The company formerly also operated a wider range of healthcare services until 2019 when ...
in February 2013:
Shepton Mallet NHS Treatment Centre
References
Books
* Player, Stewart and
Leys, Colin (2008), ''CONFUSE AND CONCEAL: The NHS and Independent Sector Treatment Centres'', Merlin Press
External links
Department of Health Information on Treatment CentersCBI ISTCs and the NHS: Sticking plaster or real reform?Comment on ISTCsby the
Royal College of Physicians
The Royal College of Physicians (RCP) is a British professional membership body dedicated to improving the practice of medicine, chiefly through the accreditation of physicians by examination. Founded by royal charter from King Henry VIII in 1 ...
ISTC marketing sustainability analysisprepared in 2004 by
Department of Health
A health department or health ministry is a part of government which focuses on issues related to the general health of the citizenry. Subnational entities, such as states, counties and cities, often also operate a health department of their ow ...
Report on ISTCsby
UNISON
In music, unison is two or more musical parts that sound either the same pitch or pitches separated by intervals of one or more octaves, usually at the same time. ''Rhythmic unison'' is another term for homorhythm.
Definition
Unison or per ...
, (August 2005).
Report on ISTCs in ''Medical News Today'' (17 February 2006)
Kings Fund briefing(1 October 2009)
{{DEFAULTSORT:Independent Sector Treatment Centre
National Health Service (England)