Tuesday, January 30, 2007

The NHS, Burning our money II

Just in case you missed BBC Radio 4's Today program report on wasting money in the NHS, this is their report today. (Available as audio only)

The report covers private Independent treatment centers (ISTC's), like the Netcare one in Greater Manchester.

The main bone of contention with these is the way the contract has been negotiated. The first wave of contracts are for a fixed number of operations, in this case 44,863. They get paid for them whether they are carried out or not.

Part of the problem that these centers face in their early days is that they won't get all the referrals they could handle on day one. In fact according to comments from the man running the center, in the first 3 months they may have been operating at 25 to 30% capacity and are now running at 85% of capacity overall. That means that they have been paid for 15% of operations that have not happened.

In practice this is a waste of money, but the people running the Netcare center hope to get to running at over 100% of their contracted rates so as to make up the shortfall.

In the next wave of contracts these treatment centers will only get paid for the operations they carry out.

We will have to see how this policy pans out. All change costs money (something seldom factored in enough) and if this one is going to be about for 5 or 10 years, it may be worth it.

However I do have some clinical concerns about some ISTC units which only handle people for the operation and do not then go on to handle after care. You do hear reports of NHS clinicians slating "bad work". That may be fair or unfair, but unless the whole care and after care package are delivered by one provider you always face the danger of one blaming the other if things go wrong, leaving both the patient and the NHS bewildered as to what to do next.

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