MPs find no evidence of improved value from independent treatment centres

There is no evidence that the Department of Health's independent treatment centre programme represents value for money or performs better than the NHS, according to a damning report.

Published on Tuesday by the influential Commons health select committee, the report concludes that the government's flagship programme to introduce competition in healthcare has failed to make an impact on NHS productivity.

'Waiting times have declined since the introduction of ITCs, but it is unclear how far this has happened because the NHS has changed in response to the ITCs or because of additional NHS spending and the intense focus placed on waiting list targets over this period,' it says.

It is highly critical of the DoH's failure to 'systematically' assess the effect of competition from ITCs on the NHS and states that given the level of importance and likely impact on the programme such assessment should have been introduced from the start of the scheme.

It continues: 'The decision to maintain the commitment to spend£550m per year despite changing circumstances has not been explained, and seems to sit uncomfortably with the secretary of state's admission that &Quot;in other [areas] it has become clear that the level of capacity required by the local NHS does not justify new [ITC] schemes&Quot;.'

The report raises questions about the need for ITCs in some areas. 'We [committee MPs] were told that ITCs would only go ahead where local health communities considered them appropriate, but there is concern about the pressure put on such communities by the department,' it says.

The report further criticises the lack of comparable clinical data between ITCs and the NHS and concludes that without such information patients are not offered an 'informed choice' about where to have treatment. But it warns against the 'strident and alarmist tone' of criticism of clinical standards, 'on the basis of anecdotal evidence'.

Committee chair Kevin Barron told HSJit was 'ludicrous' that the government had made no attempt to make a systematic assessment of the effect of the ITC programme on the NHS.

'Is the reduction in waiting times down to what the NHS has done or is it because of the independent sector? On the face of it we do not know,' he said.

He said that in the second-wave procurement there had to be a 'dialogue' in order to understand why ITCs were being introduced.

'Although the DoH showed us the mechanism for how they assess the independent sector's bids for value for money we were not shown any figures because of commercial confidentiality. This makes it very difficult for us to assess if ITCs are value for money,' he added.

The report also criticises the government's apparent confusion over the scale of the wave-two ITC programme.

When health secretary Patricia Hewitt gave evidence to the committee in April she said that private sector healthcare providers had been invited to bid for 24 elective schemes.

However, the report quoted from an HSJinvestigation which showed that of the original 24, seven had subsequently been scrapped, to question the size of the programme (news, page 5, 27 April).

The report says that the DoH was forced to 'concede' in a letter to the committee that the second-wave programme would 'probably only consist of 17 schemes'.

In response to the report Unison head of health Karen Jennings called for an immediate halt to the wave-two ITC programme.

'It is a criminal waste of taxpayers' money that most of these centres are working at less than 50 per cent capacity, but still get paid the full contract price.

' It is time for the government to own up to the fact that ITCs are a failed experiment resulting from its cavalier attitude to policy development,' she said.

NHS Confederation chief executive Dr Gill Morgan said: 'There are clear lessons from the report about the planning of major policies and initiatives by government departments.

'Many of the difficulties of the ITC programme could have been avoided if proper independent advice and evaluation of the proposed programme had been taken at the planning stage. We need to make sure that future large-scale projects of this kind have clear objectives and are thoroughly evaluated for their benefits to patients and the NHS as a whole,' she added.

Health minister Lord Warner said: 'It is still relatively early days, but we agree that greater integration with the NHS is essential so that the full benefits of this programme can be realised. We listen to the NHS locally and in response have made some changes to second-wave schemes.'