Published: 03/02/2005, Volume II4, No. 5941 Page 22

Dr Glenn Robert, senior research fellow, University College London

The HSJ survey of acute and primary care trust chief executives regarding the independent treatment centre programme (news, page 5, 20 January) highlights many of the issues we discovered in our own research in eight NHS treatment centres over the last two years.

This has revealed the range and scale of the struggles and successes of managing or working in an NHS treatment centre.

First, it is important to note that while NHS treatment centres are often discussed as a single coherent entity, on the ground there is considerable variation. Our case studies range from a single ward to a£20m hospital extension providing over 100 new beds.

Despite this, there is almost universal agreement for the principle of separating elective and emergency care that underpins both the ITC and NHS treatment centre programmes.

And yet, far from wishing to enter into partnership, many staff in the NHS centres we are studying are hostile to ITCs, which they see as privileged to such an extent by the government as to undermine their own long-term survival.

Perhaps the clearest disagreement between the government line and the front line relates to the debate about capacity. As your survey suggested, several of the NHS treatment centres we are studying face huge uncertainty about fluctuations in numbers of patients they are likely to treat and the case-mix of those patients. Many NHS treatment centres are already doing far less work than planned and operating at significant financial deficits.

There is a marked difference between claims from the top that there is no overcapacity and the experience of staff on the ground who are experiencing it on a daily basis. In some local parts of the NHS, poor strategic planning and topdown implementation have left only contradiction, frustration and uncertainty.

However, while the national policy has the initial appearance of prescription - a blueprint for treatment centres with 'core characteristics' - frontline NHS staff are able to improvise. As NHS treatment centres develop, we are seeing new meanings emerge that are more relevant to local situations. Despite everything, the long-term success or otherwise of NHS treatment centres may yet still be determined locally.