National data on the clinical quality of independent sector treatment centres is 'incomplete and of extremely poor quality', according to a review by the Healthcare Commission.

A draft of the review's conclusions, seen by HSJ, catalogues a number of concerns over the robustness of clinical quality data being reported by ISTCs.

The review, which was commissioned by chief medical officer Professor Sir Liam Donaldson, says:

  • 'the current nationally reported data on clinical quality is incomplete and of extremely poor quality';
  • 'effective governance is compromised by poor quality data';
  • 'the absence of good baseline data calls into question the feasibility of collecting this data in a systematic way in a short timescale'.

The review was announced by the health secretary last April when giving evidence to the Commons health select committee's inquiry into ISTCs. The MPs' report concluded in July that it was 'impossible' to say whether ISTCs had provided value for money, while lack of comparable clinical data with NHS providers meant the quality of care provided by the centres could not be judged.

The conclusions of the Healthcare Commission report stress its aim 'to improve accountability for the quality of care in the ISTC programme'.

The report urges the DoH to review recommendations already made by the National Centre for Health Outcomes Development to improve the quality of key performance indicators, and to ensure action is taken to make the changes. And it says the commission should be given access to this data on an ongoing basis.

It calls for an independent audit of data quality and it says there need to be clear processes to ensure patient-level data on outcomes of care is collected systematically.

The commission will present its findings to a seminar of external stakeholders, including representatives from the independent sector, next Tuesday, and plans to publish a full report on ISTCs in the summer.

Head of improvement Gary Needle told HSJ: 'Effective governance is compromised by the lack of good-quality data. It is a contractual requirement for organisations to fill in national data returns, but this is not happening in every case. Having this data is critical to effectively manage and regulate these services'.

The full report will include up-to-date hospital episode statistics data from ISTCs; a survey of 2,000 patients treated in ISTCs; the commission's ISTC inspection data; and strategies for better local integration between ISTCs and the NHS.

Announcing the review last year, Ms Hewitt said: 'Although ISTCs are required to meet exactly the same standards as NHS care, and are subject to the same rigorous monitoring regime, the review will be a timely and appropriate way to assess their work with the NHS so far'. And she told the select committee there needed to be a 'level playing field' with 'equivalent information across all providers'.

'At the moment we are in the position where in some cases there is more detailed information coming from the independent sector treatment centres because of their contracts. In other cases we are getting more information from NHS hospitals - therefore patients are not given equivalent information.'

Healthcare Commission chief executive Anna Walker also gave evidence, warning that the inspectorate was not privy to all the information which flows between the DoH and ISTCs.

She said that although as part of the DoH's contractual arrangements with ISTCs 'there is a very significant flow of outcome information', the government and the Healthcare Commission did not 'automatically get all that information'.

This week, committee member Dr Richard Taylor described the commission's findings as 'worrying'. The independent MP told HSJ that there was a 'desperate need' for 'absolutely accurate feedback' to compare the outcomes of ISTCs and NHS organisations.

'We were hoping that better statistics and data would come out of the review, but if the Healthcare Commission can't get at the figures as well it's pretty worrying'.

Dr Taylor restated the committee's original conclusion, calling for an independent review of ISTCs. 'We have got to get to the bottom of what is happening,' he said.

British Medical Association consultants committee chair Dr Jonathan Fielden called on the National Audit Office to examine the ISTC programme.

'When the government is pumping millions of pounds into this programme it is vital to ensure that there is accurate, good-quality data'.

Independent sector adviser for the Royal College of Nursing Valerie Smith agreed with the review's finding that national reporting from ISTCs was incomplete.

'We need greater transparency in terms of both the value for money and the quality of care that ISTCs bring, not least in supporting the patient choice agenda,' she said.