Tuesday, September 26, 2006


They are helping BritGov's battle with its public servants, but at a cost

Private health centres are being paid tens of millions of pounds by the NHS for operations that are not happening. Hardly any of the independent centres set up under generous contracts are meeting their targets, an investigation by Health Service Journal has found. But they still get paid, unlike NHS hospitals, which are paid on the basis of how many operations they do.

The 20 centres were open by March. Information gathered by the journal from public documents, freedom of information requests and parliamentary answers indicates that so far they are doing only 59 per cent of the operations for which they are contracted. The Will Adams Treatment Centre in Gillingham, Kent, is performing at the rate of 945 procedures a year, compared with the 3,954 needed to meet its targets. It carries out hernia operations and day-surgery orthopaedic, gastroenterology and urology procedures.

The Department of Health denies that there is a problem. The centres were set up with five-year contracts and a spokesman said that it was completely misleading to say that activity below 100 per cent represented a waste of money. That could be determined only at the end of the contracts, when it would be clear how many operations the centres had done.

Its own figures put a different gloss on the situation by including other short-term programmes launched to shift the backlog. When those are included, it says that the programme is working at 84 per cent of capacity. Independent sector treatment centres (ISTCs) are controversial because NHS traditionalists say that they take money away from health service hospitals, disrupting their finances. The first ISTCs were set up under contracts that guaranteed an income based on the number of patients they undertook to treat, regardless of whether that many were treated.

Overall, HSJ calculated that the 20 centres should be treating patients at the rate of 78,242 a year, assuming that the target numbers are averaged over the whole of the five-year contract. But in the period to March their treatment rate was 46,073 patients a year, 59 per cent of the target.

In defence of the centres, many have not been open long, and the numbers they treat have not had time to build up. The main cause of the shortfall appears to be a reluctance by doctors to refer patients to them. Attempts have been made to persuade GPs to increase referral rates, but one obstacle is that ISTCs are staffed largely by doctors from abroad who are not known personally to GPs. This may affect judgments and make it less likely that patients will choose to go there.

The centres are costing primary care trusts a lot of money. Local reports suggest, for example, that the underperformance of the Will Adams ISTC is costing Medway PCT 100,000 pounds a month. The trust’s deficit in 2005-06 was £2.4 million.

A survey by HSJ of 42 NHS chief executives found considerable disquiet. More than three quarters felt that their own finances had been damaged by the centres — including 7 per cent who called the effect disastrous. Almost 60 per cent doubted that the centres had added to NHS capacity, and question marks were raised about whether the NHS needed any extra capacity anyway.

The health department, and 10 Downing Street, are unlikely to be unduly alarmed by the findings. The hidden agenda behind the ISTCs was an attempt to break the power of surgeons in NHS hospitals to control waiting lists, and that seems to be succeeding. The policy to allow patients a choice as to where they are treated has had such a dramatic effect on waiting times that top advisers regret that it was not introduced much sooner.


NHS fails as an insurer once again

A new drug that could transform the lives of children with a rare genetic condition might be judged too expensive for the NHS. Hunter Syndrome was in the headlines last year when Andrew Wragg, 40, a former SAS soldier, was driven to despair by the decline of his son Jacob, 10, and smothered him with a pillow. The father, from Worthing, was cleared of murder and given a suspended sentence for manslaughter with diminished responsibility.

The fatal syndrome, suffered almost exclusively by boys, is caused by a defective enzyme that is unable to break down complex sugars produced as waste products in the body. These compounds, called mucopolysaccharides, accumulate in the tissues and organs and cause worsening physical and mental health problems.

The new drug, Elaprase, developed by Shire Pharmaceuticals, has been approved in the US and is expected to be licensed in Europe by the end of the year. Given by infusion, it improves breathing and movement. Parents of some Hunter children say it has transformed them. But it will cost at least 100,000 pounds per child per year, and as much as 300,000 for older, heavier patients who need bigger doses. Although the number of Hunter children in the UK is small — no more than about 100 — the cost of providing it for all of them could well be prohibitive.

A patients’ group has been lobbying ministers to confirm that the drug will be funded under a special scheme for children with rare diseases. Christine Lavery, chief executive of The Society for Mucopolysaccharide Diseases (SMD), said: “Funding for treatments for rare diseases similar to Hunter Syndrome is due to end at Christmas. We expect that to be extended. But there has been no promise that the DoH will fund the new drug for Hunter Syndrome. “All our questions and requests for clarification of the position have met with a lack of response, which leads us to fear the worst.”

Although not a cure the drug, which replaces the missing enzyme, may allow affected children to lead near-normal lives if the condition is picked up early. Dr Ed Wraith, a consultant at the Royal Manchester Children’s Hospital, said: “With this disease, there is damage to the heart, liver, brain and other organs which invariably leads to death well before the age of 20. The treatment is a major breakthrough and it would be a tragedy if the Department of Health didn’t provide the money.”

The Department of Health said: “No decision has yet been made on whether this expensive drug will be funded.” The same is likely to be the case north of the Border, where the Scottish Medicines Consortium has refused a related drug for a girl with a similar condition.

Bob Wragg, 64, grandfather of Jacob, said: “Thank God they have found a treatment at last.” His wife, Anne, a nurse, said: “A lot of people just don’t understand the torment that Andrew went through caring for Jacob and seeing him get worse and worse.” An adult sufferer of the syndrome, Colin Arrowsmith, 26, from Newcastle, has been receiving Elaprase weekly as part of a trial since February 2004. He had already defied doctors’ predictions that he would be dead by his early teens and until five years ago was able to live independently. He worked in the mailroom of an electricity company but was forced to give it up because his hips began to crumble. This forced him into a wheelchair and made him more reliant on his parents.

His mother, Barbara, said: “He was picking up lots of infections and his liver and spleen were very large. Since he began the weekly infusions his general health is better and his liver and spleen are no longer swollen. He has a lot more energy. “The treatment won’t reverse the damage done but we’ve been told that it should prevent further damage.”



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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