Quality Of Care Issues

By: Laurence Vick

Publication of the Healthcare Commission's long-awaited report into the quality of care provided by independent sector treatment centres (ISTC's) has been delayed still further.

At a Commons debate on ISTCs in May health minister Andy Burnham said the report would be published in June. Explaining the delay to MPs at that time Mr Burnham blamed the NHS's beleaguered IT system and problems it had encountered in 'drawing down the data required." "The delay is due to the fact that the commission wishes to use the most up-to-date data from ISTCs," he said. Mr Burnham said there had been no delays in the information being provided by ISTCs and that the report would 'make an important contribution to ensure public confidence' in ISTC's.

During last month's debate Commons health select committee chair Kevin Barron told MPs that until there was evidence to support the work of ISTCs they continued to be a 'leap in the dark'. 'The Healthcare Commission was asked [by the Department of Health] to carry out a detailed comparison of the standards of care in ISTCs and those in the NHS,' he said. 'However, it is now many months down the road and we are still not there yet. This is disappointing.'

Mr Barron said his committee remained 'uncomfortable' with the government's pledge to spend ?550m a year on the ISTC programme. 'ISTCs may be making and may continue to make a valuable and considerable contribution to efficiency, innovation and choice in the health economy. However, the case cannot be made by default. We look to the government to make their case actively, improve the programme, collect the appropriate data and allow genuine quality to be assessed and therefore genuine choices to be made.'

A draft of the The Healthcare Commission's interim findings was reported in January as concluding that certain private sector operators may be compromising patient safety. The draft was reported to have been leaked in advance of a seminar with private sector representatives and appeared in a number of sources in January. See the links to the HSJ article below and Michelmores' news items on their website

Minister confident delayed ITSC report will restore public confidence, despite poor data - Click here for report on Health Service Journal, 17 May 2007.

Leaked report of Healthcare Commission fears over ISTCs 24.1.07 - Click here to go to article on Michelmores website.

A draft of the Government's own report on Independent Sector Treatment Centres (ISTCs) has concluded that certain private sector operators may be compromising patient safety.

The Healthcare Commission's report into the private sector treatment of NHS patients has been leaked in advance of a seminar with private sector representatives and appears in a number of sources in the media this week.

The paper reveals that the Government simply does not know how many patients have suffered substandard treatment in the ISTCs because the private sector is not undertaking adequate monitoring of outcomes. It is with some regret that we observe that our concerns over the substandard treatment and management of NHS patients in these centres have been echoed by the Healthcare Commission.

ISTCs carry out non-emergency treatment for NHS patients in private clinics that are funded by the NHS out of the public purse. The Times reports the startling figure that almost one in ten of these operations is now carried out by the private sector. They are staffed by clinicians from abroad because the Government does not want them to compete with the NHS by taking doctors and nurses out of NHS hospitals. However in the Government's zeal to reduce hospital waiting lists by encouraging GPs (with financial incentives) to refer the easier cases to the ISTCs, it is becoming clear that patients are being exposed to an increasing risk of substandard treatment.

Michelmores have direct experience of the poor outcomes of orthopaedic and ophthalmic treatment in ISTCs. We have been concerned about the standard of treatment from the very start of the initiative, having brought a number of successful negligence cases on behalf of clients who have had further complications and suffered significant injuries after what they believed was 'routine' treatment. We are encouraged that the issue is clearly now being taken seriously by the Healthcare Commission, but we are dismayed that such scrutiny has taken so long. We have been aware of these issues for a number of years and we reiterate our belief that it should not be the pressure of litigation that forces investigations such as this. There have been clear and distinct calls from patients that the treatment they have received in the ISTCs has not been acceptable from the very beginning. It is, in fact, the NHS that has to pay twice for such treatment when it goes wrong.

An issue that is closely related to the standard of care is the lack of adequate comparative data which means that the risk is not readily apparent to the regulators in everyday control of the ISTC initiative. A two-tier monitoring system has come about whereby the NHS and other established private hospitals are arguably subject to more stringent audit because they are compelled to provide detailed performance statistics. The ISTCs' data by contrast has been described in the report as "incomplete and of extremely poor quality".

We welcome the fact that the Healthcare Commission's draft conclusions show that this issue is being taken seriously at last. However, until the systems for recruitment, monitoring and audit are overhauled in their light to provide at least the same standard of quality control and audit as in the NHS, the only redress for the patients suffering at the sharp end of the ISTC experience is to bring legal action against the commissioning NHS Trust.


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