What does the future hold for Independent Sector Treatment Centres in the NHS?
David Worskett is Director of the NHS Partners Network, an alliance of independent healthcare providers involved in partnership with the NHS. He talks to On Target about ISTCs and the challenges they face.
How is the NHS Partners Network involved in building and supporting partnerships between healthcare companies and the NHS?
The main role of the NHS Partners Network is to help the NHS and the independent sector understand each other’s requirements and develop the role of the sector within the NHS by improving formal and informal interfaces between the two.
It is important to perform this ‘bridging’ role because the use of the independent sector within the NHS is still relatively new and comes in a growing number of forms. These include Independent Sector Treatment Centres (ISTCs): hospital groups that are part of the extended free choice network and the new generation of primary care providers. Full ‘free choice’, which our members have been working hard to support and develop, only went live in April this year.
Part of our role is to help ensure that the mechanics of reporting statistics and information to give patients and GPs a sound basis for exercising choice are robust and efficient. We have set about this through a programme of harmonising the data and explaining it to the press and the public, and so helping people to get an accurate picture of the merits of co-operation and partnership between the traditional NHS and independent providers – with a clear emphasis on the benefits to patients.
What was the message to the private sector of the Government Health Select Committee Report on ISTCs published in 2006?
The most important issue is not what the message of the Select Committee was, but what the conclusions have turned out to be. The report was commissioned and compiled in the 2005–2006 parliamentary session, then released in mid-2007. A fair bit of water has passed under the bridge since then.
We now know ISTCs have contributed substantially to reducing waiting times. There is also now validated independent research from BMC health services showing that ISTCs deliver better outcomes for patients. The Healthcare Commission, through its regular reports and a sector-specific study, has confirmed that ISTCs offer better overall patient satisfaction rates, are rated as cleaner by patients, and have significantly lower rates of infection from hospital-acquired MRSA. There are a number of reasons for the latter, but the bottom line is that the ISTC delivery model offers patients a lower risk of infections.
In short, there is a growing body of evidence to support what ISTCs have to offer the NHS. NHS Partners Network members are determined to take this work forward not only through the ongoing ISTCs, but also through the steady expansion of the free choice network that has developed since the committee’s report. With these elements of choice in place, patients have the opportunity to choose the best treatment available and will increasingly ask for more choice, not less, as they realise its benefits.
What lessons have been learned by the healthcare industry from the first wave of ISTC provision?
There are many useful lessons that we can take from the first wave of the ISTC programme. The key lesson to take away – and one that is applicable throughout independent sector involvement in public service reform, I would argue – is that ISTCs work best when they are integrated and work in partnership with the rest of the local NHS. The other lesson is more straightforward but nonetheless important to repeat: doctors are using ISTCs more, and are referring to them with increasing enthusiasm as patient feedback comes through saying that they liked using them and received good care. It always comes back to the importance of focusing on the patient at all times.
How can the private sector most effectively overcome the organisational mistrust of ISTCs that exists within the NHS?
Dogma or preconceived ideas about what the independent sector is there for tend not to matter much to patients. They are more interested in how well the system works and in the quality of care they receive. Our members therefore do their best work when the relationships are strong between all relevant NHS organisations, with a shared commitment to the patient providing the unifying force in the system.
Such an atmosphere of trust and confidence cannot be created through the signing of a contract. People identify personally with each other when they are clear that they are working towards common goals.
What advice would you give to independent healthcare providers that are looking to set up ISTCs to treat NHS patients?
ISTCs are now recognised as a vital part of the modern NHS, and neither of the main political parties questions that. As procurement moves to a local level, firms entering the market need to be able to highlight added value in terms of efficiencies and quality of care.
Developing innovative models of care and services will also be essential. The divide between primary and secondary care is no longer a particularly useful way of splitting up and organising healthcare – quite the reverse in fact. New ways of working coupled with better use of technology mean that a key part of any new offering may well be to show how you can link primary care services to diagnostic or elective care capability.
This more integrated way of working is likely to be reflected in the upcoming Darzi review, and the independent sector could have a central role to play in providing ‘joined-up’ patient-centred care, using new configurations that many patients will find both convenient and attractive.