Impact of treatment centres on the local health economy in England - report
December 2005
Introduction
Despite the Government’s recent emphasis on alternative providers of NHS care, little is known about the full impact of such providers, in particular treatment centres, on their surrounding
health economies. In response to this, the BMA undertook a survey of clinical directors from those specialities most likely to be affected.
A postal questionnaire was sent to the clinical directors in three specialties: anaesthetics, ophthalmology and orthopaedics. These three specialties are the focus of the initial wave of treatment centres across England. A total of 177 responses were received and, of those, 91 respondents report a treatment centre in their trust catchment area. Currently, there are 37 NHS-run treatment centres and 14 Independent Sector Treatment Centres (ISTC) offering a full service across England.
Given the small number of treatment centres currently in operation, the respondents to this survey represent a significant proportion of those clinical directors who will have a treatment centre in their local health economy. Furthermore, respondents are geographically distributed across 24 of the 28 English Strategic Health Authorities and represent 70 trusts. Table 1 shows the distribution of respondents according to specialty. Respondents are fairly evenly divided according to the three target specialties, although those from orthopaedics are slightly overrepresented.
The aim of the survey was to gather information regarding the impact, if any, of treatment centres on their local health economy, the integration of services and capture any potential concerns regarding clinical outcomes. Hence, the analysis reported here largely focuses on those respondents (n=91) who report the presence of a treatment centre in their local health economy. The report focuses on the experiences and opinions of clinical directors who have a treatment centre in their trust catchment area. Where appropriate the impact on individual specialties and from ISTCs and NHS treatment centres are reported separately.
Executive summary
- The majority of respondents agree that the treatment centre has benefited patients in terms of improved access and shorter waiting times, with NHS treatment centres being seen as benefiting patients more than ISTCs.
- Almost three-quarters of respondents report that their whole trust is affected by a treatment centre and four out of five report that their clinical directorate is affected.
- Two-thirds of 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. Rejections are more frequent from ISTCs and amongst orthopaedic patients.
- 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 that in NHS treatment centres.
- Over 80 per cent of respondents say that there was either no formal arrangement for reporting concerns regarding patient care and clinical governance to ISTCs, or that they are unaware of it.
- Two thirds of respondents report that patients have been returned to NHS hospitals for aftercare and respondents indicate that patients were more likely to require readmission to an NHS hospital following treatment in ISTCs than NHS treatment centres. Whilst referral back to the NHS trust is normally appropriate only a quarter of respondents report that they are able to discuss the care necessary with the doctor in the treatment centre.
- Over 50 per cent of respondents report that the treatment centre has a negative impact on the facilities/service provided by their trust. Whilst 42 per cent of respondents report a positive impact from an NHS treatment centre and only 34 per cent a negative one, 68 per cent report a negative impact from an ISTC and no one reports a positive impact. The effects include the cherry picking of patients and the resulting imbalance on case-mix, loss of potential income for the NHS and low staff morale. Only NHS treatment centres had a positive impact on services/facilities.
- Two out of five respondents agree that the education and training of junior doctors has been affected by the treatment centre and most foresee a definite impact in the future.
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