NHS patients undergoing elective operations in dedicated independent sector treatment centres report better outcomes than those seen by NHS hospitals treating emergency and elective patients, claims a study.
The research, by the Royal College of Surgeons and London School of Hygiene & Tropical Medicine, finds that these differences are the result of ISTCs treating younger patients, from more affluent areas and who are in better health before their treatment than those seen in the NHS.
In 2002, the Department of Health started the procurement of ISTCs in England with the aim of reducing waiting times, give patients more choice, and encourage innovative models for the provision of non-emergency services. ISTCs, however, were heavily criticised by many surgeons for being ‘subsidised’, poorly integrated, cherry picking patients and delivering questionable quality.
A health minister of the time, Lord Warner, now a strategic advisor to PA Consulting Group, suggested surgeons were trying to resist ISTCs because they wanted to maintain waiting lists in order to swell their private practices.
The Patient Outcome in Surgery Audit (POiS) is the first large scale study to compare patient reported outcome measures from operations conducted in NHS and ISTCs, and was set up due to the Health Select Committee expressing concern that there was a lack of data from private providers.
POiS looked at four common procedures – hip replacements, knee replacements, varicose vein treatment and inguinal hernia repair – and included responses from 25,000 patients treated at 16 ISTCs and 53 NHS providers across the country in 2008/2009.
NHS hospital patients had a 40% higher risk of reporting a poor hernia operation after adjustment for case-mix than at independent providers. And patients undergoing varicose vein surgery at NHS hospitals were three times more likely to need a further operation than at independent providers.
POiS finds, however, that for hip and knee replacement, NHS hospitals dealt with almost double the proportion of sicker patients. NHS hospitals took a higher proportion of patients with two or more co-morbidities for all four procedures – almost double for inguinal hernia.
Furthermore, NHS hospital patients were more likely to live in the poorest areas across all four operations.
The RCS believe that completely separate emergency and elective operating rotas would ensure both types of patient get care optimised rather than mixed operating lists.
Jan van der Meulen, professor of clinical epidemiology at London School of Hygiene & Tropical Medicine, and lead author on the research, commented: “Independent sector treatment centres treat only non-emergency cases. The separation of elective surgical care from emergency services is likely to have a positive impact on the quality of care, irrespective of whether the elective surgery is carried out by a private company or the NHS.”
The study contradicts research conducted in 2009 which suggested revision rates on hip replacements at one ISTC were much higher than the average in the NHS.
Professor Norman Williams, president of the Royal College of Surgeons, said: “This study suggests that patients treated at units dedicated to elective surgery experience improved outcomes. However, it also showed that independent sector providers have taken younger, fitter patients and we need to guard against any drift that could destabilise hospitals. Sicker patients have needs that only a comprehensive hospital can provide.”
Read the full report.