Published: 15/08/2002, Volume III, No. 5818 Page 4 5

Managers and clinicians involved in the overseas treatment pilots were far less happy with the schemes than the patients who used them, according to a report published by the Department of Health this week.

The report commissioned from York health economics consortium into the treatment of 190 NHS patients earlier this year in French and German hospitals, says managers questioned their impact either on waiting lists or problems of limited capacity.

Four out of five patients were 'very satisfied' by overseas care, despite one patient enduring a 15-hour coach trip back from Germany. There were few medical complications and the clinical standards were deemed to be high by those who took part.

But interviews with the managers and clinicians involved found the£1.1m pilots funded by the Department of Health were 'not very successful' in either creating capacity or having a significant impact on waiting lists and waiting times.

'There was a strong view that resources should have been invested locally and that the projects were not cost effective, ' the report said. It reported concerns about patients enduring long and inconvenient journeys, the complexity of travel arrangements, different clinical teams undertaking surgical procedures, the way patients were managed in the long term and the 'perversity of not investing such large sums of money in local health economy'.

The three pilots were run by Isle ofWight, Portsmouth and South East Hampshire health authority;

West Sussex HA and East Surrey HA; and East Kent HA.Originally, the schemes were designed to treat 300 patients. But just 190 patients were actually treated: 153 hip or knee patients and 37 cataract patients.

The report blamed poor 'buy in' from local NHS GPs and consultants, lack of funding and a 'conservative approach' when deciding which patients would be suitable for treatment.

The NHS Alliance said enthusiasm among commissioners was limited. Chair Dr Michael Dixon said: 'The vast majority of primary care trusts will see this having very little relevance to them. It is of benefit to a tiny number of patients with a small range of clinical conditions - conditions that allow patients to travel long distances.'

NHS Confederation policy manager Gary Fereday said: 'We think it was always clear that this would be a very limited way of tackling waiting lists. In the longer term, what is needed is greater investment in NHS capacity.'

Peter West, director of the York health economics consortium and one of the authors of the report, said: 'I do believe that overseas treatment can have its place.

'I am sure for those patients stuck on the end of waiting lists that they are grateful to be treated, but I would want to look carefully at the reasons for the waiting lists in the NHS in the first place.'

lpaul. smith@emap. com www. doh. gov. uk/international/ overseastreatment. htm