Website of the Department of Health

Independent sector (IS) Treatment Centres

Why are these TC services being provided by the private sector and not the NHS?

We are expanding capacity within the NHS through a range of measures, including NHS TCs and treating UK patients overseas. But we still need to do more if we are to meet the target of a maximum wait of six months for elective surgery by 2005. There is simply not enough capacity in the current system so we are looking to the independent sector to provide additional resources.

Will these IS TCs be staffed and run by overseas doctors and nurses?

In some cases, yes. We have examined a large number of leading independent healthcare organisations from across the world and invited proposals for running these IS TC units. We will also be receiving proposals from UK independent healthcare organisations that also have capacity to handle this work.

Won't this be very expensive compared to the cost of NHS staff?

IS TC services are being secured under a competitive tendering process, which will ensure that the NHS secures value for money and high quality services.

How will you ensure that the quality of care in these IS TCs meets NHS standards?

All IS TCs will be subject to stringent UK medical controls and legislation. They will also be monitored regularly by the local chain board, PCT and trust to ensure that they are meeting the quality, hygiene and service levels that will be agreed from the outset. We will also undertake patient satisfaction surveys to ensure that patients are satisfied with their treatment.

Will NHS patients have to pay anything for treatment at these new independent sector TCs?

No. The IS TCs will operate under the NHS principle of treatment being free at the point of delivery.

Will NHS patients have a choice about whether they have their operations done in the IS TC or in the current General Hospital?

The NHS is currently working towards offering all NHS patients the following choices:

Patients will be supported in making their choices. A new electronic booking system will, by December 2005, enable GPs and other primary care professionals to book a patient's hospital and other appointments quickly and conveniently from the surgery. Waiting times and other necessary information about the choices will be incorporated in the booking software.

In some instances a new IS TCs could be sited some distance away from where patients live. In some cases patients might not be able to afford the travel costs and in others it will cause problems for families and relatives wishing to visit the patient. Will there be help with travel costs for patients?

The IS TCs will be located in a way that provides good access for a large number of patients across the region. Most operations will be carried out at a pre-booked time and will allow patients to travel to and from the TC in the same day, which avoids the need for visitors. Research suggests that many NHS patients are very willing to travel some distance if this means that they can have their treatment carried out more quickly and on a scheduled day and time. In cases of extreme financial hardship the patient could obtain assistance for travel via their local Social Security office.

Will NHS staff be made redundant as a result of these operations being moved to the new IS TC?

No, all of the activity being carried out in the IS TC will be additional to that already planned via other NHS units. The IS TC is helping us to reduce the waiting times for people waiting for operations.

Will NHS staff be allowed to work in these new IS TCs?

IS TCs will use mainly additional staff. However, in some cases, where a structured arrangement is agreed between the local NHS commissioners and the provider, NHS staff may work in an IS TC - this may, for example, be on a secondment basis.

In some cases the NHS is transferring activity into the IS TC. Isn't this an about turn from the Government's policy of providing additional activity?

The IS TC programme is designed to provide additional activity to reduce waiting times. Where a local NHS commissioner decided to transfer activity into an IS TC this will 'free up' the NHS facility to handle additional work, and reduce pressure on areas such as A&E, therefore creating additional capacity.

Is this the beginning of the privatisation of the NHS and people having to pay for their treatment?

No. The Government is committed to the principle of the NHS, which is to offer treatment free at the point of delivery, and this scheme is just one of the many initiatives designed to modernise the service and reduce waiting times. The Government has said that it is encouraging a situation where a number of providers, rather than just the NHS, will deliver healthcare itself.

How long are these independent providers contracted for, and what happens when that time is up?

The initial contracts are for five years, and at the end of that period the TC will either revert back to the NHS and continue running, or, if appropriate, the contract with the independent provider will be extended.

Will the IS TCs be seen as an NHS service or a private one?

The IS TCs are delivering NHS services, free at the point of delivery and available according to clinical need, not ability to pay. It is essential that this is clear to patients. Therefore IS TCs will carry NHS branding. While it is accepted that providers may wish to add their own identity this should be supportive of the main NHS brand, and not dominate, so that patients will have a clear understanding that they are receiving treatment from an NHS provided facility.

What will be the competence of the overseas doctors working in IS TCs and how will they be regulated?

All of the IS TCs will be run by healthcare providers who have extensive experience of running high-quality diagnostic and surgery facilities in other countries that have sophisticated healthcare systems. As part of the stringent clinical evaluation process bidders are required to give evidence of surgical experience in the specified procedures and details of clinical outcomes and patient satisfaction results.

All surgeons working in IS TCs will be registered with the General Medical Council on their specialist register. This policy has been discussed with, and is supported by, the Royal College of Surgeons of England.

The current practice within the NHS is that many procedures are performed by surgeons who are not on the specialist register, but work 'under the supervision' of a surgeon on the specialist register.

In IS TCs, the only instance where a surgeon will be allowed to work 'under supervision' is for training purposes, which will need to be under a specially-agreed contract with the independent provider.

How will IS TCs cope with complications?

Contracts will reflect arrangements which sponsors and Bidders consider appropriate to the case mix of patients who will be referred to an IS TC. If, for example, an IS TC treats patients with respiratory and cardiovascular problems as well as the condition for which they are referred, in-patient, recovery facilities and staffing will reflect this. Nevertheless, patients may experience adverse events even with the best care. All IS TCs will be required to have facilities and trained staff to resuscitate and stabilise any patient who suffers an adverse event and systems in place so that the patient can be transferred to a suitable healthcare facility. All IS TCs will be expected to be able to deal with typical surgical problems to at least the same standard as NHS providers.

What are the arrangements for clinical governance of IS TCs ?

All IS TCs will have to meet strict contract management criteria, which will monitor clinical outcomes, hygiene and patient satisfaction. They will also be subject to NHS peer reviews by local clinicians. The Royal College of Surgeons is also urging its members to encourage individual surgeons working in IS TCs to take part in local surgical audit meetings and to become involved with other events designed to encourage shared learning and stimulate professional development. Providers will also be expected to have in place quality assurance and quality improvement systems which may be different from the clinical governance arrangements typical in the NHS but will have the equivalent effect.

What opportunities will there be for training in IS TCs ?

The DH is very conscious of the need for training of junior doctors and IS TCs could offer this opportunity. All of the independent sector providers who will be running IS TCs are able to provide this facility and are very willing to train and coach junior doctors in this way.

Will the setting up of IS TCs mean less money for other NHS surgical facilities in a local health economy?

The IS TC contracts will be funded from local PCT budgets, and the services delivered are part of the overall requirements of local delivery plans. The strategic and tactical use of budgets is a matter for discussion between local trusts, PCTs and strategic health authorities. IS TCs will provide much-needed extra capacity to meet the demand for elective surgery.

How will IS TCs integrate with other new initiatives and policies being introduced into the NHS such as foundation hospitals and NHS TCs?

IS TCs are an important strand of the policy within the whole 'Growing Capacity' initiative. Strategic health authorities and PCTs will be utilising the IS TC programme as part of their overall strategic plans for the local and regional health economy. The Modernisation Agency is also working with the NHS to ensure that all of these new initiatives are integrated for maximum benefit.

If IS TCs handle all of the relatively straightforward cases, won't this put undue pressure on the local NHS acute hospitals who will be left to deal with only complicated cases?

IS TCs and NHS-run TCs are designed to handle an increasing number of procedures, particularly where there are longer waiting lists, such as cataracts and orthopaedics. Local PCTs, in discussion with clinicians, will decide the case mix that will be handled in these units. Although TCs will handle a large number of less technically demanding procedures, they are also designed to handle more complicated operations, and in some instances will be the unit of choice for a more demanding case. The final case mix for both TCs and existing NHS acute hospitals will need to be decided on a local basis, but by introducing much-needed capacity into the system we can relieve some of the pressures that currently exist.

How will you ensure that NHS staff aren't poached into these new IS TC units which could pay more money and offer attractive working conditions?

All IS TC providers are being asked to provide staffing solutions that create additional capacity in terms of using new non-NHS staff. It is envisaged that many of the staff will be overseas teams who will be working for the providers on a contracted package basis, and providers will not be seeking local NHS personnel. Providers are acutely aware of the underlying need to provide additional resources and are not intending to poach NHS staff.

In certain circumstances NHS staff will be allowed to work in IS TCs under a structured agreement, such as a secondment or local charging system. In these instances they will remain employees of the NHS and retain all their salary and pension rights.

What rights will NHS patients have if they are treated in an IS TC?

Patients will enjoy the same rights as they do in any other NHS hospital or healthcare facility. If a patient has a complaint it will be dealt with, in the first instance, by the IS TC and all complaints will be monitored by the local PCT to ensure a satisfactory outcome.