Independent Sector Treatment Centres (ISTC)

Dr Phibes is pretty much an apolitical animal, and there aren't too many things that really annoy me. However, the way in which ISTCs have appeared, promoted as providing CHOICE (that word again), really makes my blood boil.

What are ISTCs? They are privately run centres which have been contracted to do work for the NHS, such as hip and cataract operations.

The government say that they can cut down waiting lists by having all this extra capacity to do work in the ISTCs. They feel that my consultant colleagues deliberately run waiting lists long to encourage patients to go private, and that reducing waiting lists will stop this practice.

The first problem is that there is no new money. So whatever my PCT (Primary Care Trust) had to spend last year on certain operations, it has the same this year, i.e the same overall number of operations. Some of that has to go to the ISTCs. This means my local hospital has less money this year than last, and therefore can do less of these operations.

The local ophthalmology (eye) department is superb. Their waiting lists are very short, and very few people locally choose to go private. But still their budget has been cut, with a slice going to the ISTC.

The second problem is distance. The nearest ISTC to me is about 35 miles, while I have 2 DGHs within 5 miles. Time and time again patients will tell me that they don't want to travel for their care.

Thirdly is quality of work. The ISTC have very strict guidelines as to who they will operate on; in other words they cherry pick all the easy cases. Even so there have been problems. And who picks up the pieces when things go wrong- the local hospitals.

There is not a level playing field. ISTCs are paid more per case than the NHS despite the fact that they do the easy ones. They are also guaranteed payment whether they do the contracted number of cases or not. Many ISTCs are not working to full capacity.

My PCT are now telling me they are running out of money, so could I please send more people to the ISTC as it's already been paid for. Dr Phibes doesn't feel like helping to get the government out of a large hole of it's own making. This isn't CHOICE where I have to send patients 35 miles when they really want to be seen locally. Is it Dr Phibes' fault that ISTCs weren't thought through properly and aren't working to capacity?

But you can bet if I did send patients there, the government would be boasting how successful their scheme is.