ISTCs cannot hide their performance anymore

I used to edit a magazine that printed something pointed about an independent sector treatment centre.

The ISTC promptly hired a fancy lawyer and threatened to take us to court for libel.

To cut a long story short, surgeons at the ISTC had made a series of rather obvious clinical mistakes. When they happened, they promptly packed the patients off to the local DGH to be sorted out.

The surgeon who wrote the article for us worked in the aforementioned DGH and knew the guys who were cleaning up the ISTC’s mess.

Based on this, he expressed some pretty strong opinions on the competency of the ISTC. The copy editor - me - knew the opinion was based on fact so we ran with it. It was a good piece.

Soon we were embroiled in a legal row. Lawyers were exchanging letters and the meter was running. The mistake I’d made was that while I knew we were right, proving it wasn’t going to be that easy. We should have taken our time, gathered more evidence and sought legal advice at the outset.

As it stood, we might have won in court but it would have been a long, protracted and costly business. But, more significantly, my employer wasn’t interested in toughing it out.

Instead I apologised in print and paid their legal fees. Ouch! I made sure the apology was as small as I could get away with and hid it deep within the magazine. A petty move I admit, but it made me feel better.

It was an object lesson in how ‘good’ lawyers can bully journalists and publishers through the threat of an expensive libel case, even when a story is true. You need the evidence up front so you can squash the legal challenge immediately.   

Anyway, ISTC rumours continued generally. Poor integration, low quality, unused resource, etc. Evidence did emerge on what a waste of money ISTCs have proved to be, largely due to the diligent work of academic Allyson Pollock.

Even now, when the government is saying that ISTC operators will in future have to compete on the same terms as other health providers, there are heavy costs to pay. The government, for example, is committed to buying the facilities in which the ISTCs work for £200m.

There was less evidence, however, about the quality of the care at ISTCs. This is surprising considering the current health secretary’s obsession with the issue. When quizzed, the Department of Health just point to positive satisfaction surveys.

That was until this week, when The Times reported that a group of Cardiff surgeons have examined the hip operations performed by their local ISTC - Weston-Super-Mare NHS Treatment Centre.

Of 113 hip operations on patients sent from their trust to the treatment centre between 2004 and 2006, two thirds showed clear evidence of poor surgical technique, such as poor cementing of the hip.

In the three years since the operation, 18% of patients had undergone revision or were awaiting an operation - 20 times the 0.9% NHS-wide revision rate at three years.

This isn’t a case of sour grapes on my behalf. My ‘libel’ experience was with a different ISTC. I just doubt that this ISTC is alone, as it’s unlikely that Stafford Hospital is the only one of its kind. Proper audit is needed. It seems that whenever we try to increase volume and reduce cost, particularly through the private sector, we run the risk of compromising quality.

Imagine what our existing NHS orthopaedic and ophthalmic units would look like had we invested the £5bn spent on ISTCs in them instead.

The whole programme needs either overhaul or closure, regardless of what their fancy lawyers say.

Read opposing views on ISTC performance.

Tags: Audit, ISTCs, Privatisation