No good evidence that private treatment centres are value for money

Feb 22 2008

There is no good evidence that independent sector treatment centres have provided additional capacity, value for money, or high quality care, argue researchers in this week's BMJ.

Despite this, the government is continuing with the programme. But Professor Allyson Pollock and Sylvia Godden from the University of Edinburgh warn that this will contribute to NHS deficits, NHS service closure and staff redundancies.

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.

Part of this 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 these 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 were 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 DoH 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.

Furthermore there is growing evidence that NHS funds are being diverted to the private sector for services they have failed to provide under the contract, they warn.

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.

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.”

Click here to view full paper: http://press.psprings.co.uk/bmj/february/ac421.pdf

Click here to view full contents for this week's print journal: http://press.psprings.co.uk/bmj/february/contents2302.pdf