Published: 10/03/2005, Volume II5, No. 5946 Page 32

Recent substantial reductions in waiting lists for elective surgery are largely attributed to the impact of NHS and independent treatment centres.

But the focus has been on the administrative and financial problems of a few centres and their alleged destabilisation of the NHS.

There is no way back. These elective facilities must be used so that resources are not wasted.

Patients appreciate being treated in more streamlined environments.

The workforce is becoming accustomed to them.

This is probably the single most notable improvement in elective surgical care that the NHS has ever witnessed.

The problem is not clinical or financial, rather organisational. NHS treatment centres are currently under the wing of a nearby trust, essentially 'owned' by the organisation that has in the past failed to run elective care in a streamlined fashion.

Hospitals and treatment centres are buildings and can be managed by either the NHS or the independent sector.

What is important is how they are structured as organisations.

Treatment centres should all be run independently, with shareholding, from the traditional NHS structures. This is why ITCs are perceived to be more successful.

Making treatment centres independent from trusts (irrespective of who runs or funds them) will provide the framework to collaborate rather than compete. NHS Elect was created in 2002 to help achieve just that.

It is the lack of independence that has led to conflict, with trusts holding onto patients rather than sending them to treatment centres.

HSJ's survey of trust chief executives (news, pages 5-9, 20 January) projected great negativity towards the ITC programme. But if consultant surgeons were asked their opinions on banning private practice, the consensus would be clear.

Asking managers what they think of a system that leads to greater competition and would take away work is not useful.

Optimism is needed to encourage success.

We must stimulate the NHS to create a management structure that works side-by-side with the independent sector and has the ability to increase and decrease activity depending on supply and demand.

Only then will resources be used sensibly to meet the need of the elective surgical waiting list with the least possible waste.

Sir Ara Darzi is professor of surgery at Imperial College and adviser for surgery to the Department of Health.

An HSJ conference on 16 March will explore how acute trusts can prosper in the age of patient choice and payment by results. The keynote presentation is by DoH head of access policy development and capacity Bob Ricketts.