NATIONAL DELIVERY PLAN Policy concedes contradictions in independent sector strategy

Published: 17/03/2005, Volume II5, No. 5947 Page 7

A clash with the patient choice policy means the government is effectively to abandon the 'aspiration' for all primary care trusts to have 8 per cent of their work carried out by the independent sector by the end of this year.

The Department of Health delivery plan, A Patient-led NHS, signals the end of volume contracts with independent treatment centres.

But the change does not necessarily signal a slow-down in the use of ITCs. Rather it is an acknowledgement by the government that an insistence that PCTs should 'direct' patients to ITCs to fulfil volume guarantees included in contracts clashed with the idea of patient choice.

Earlier this year an HSJ survey showed widespread discontent with the ITC scheme (news, pages 5-9, 20 January). Nearly three-quarters of respondents said they did not think it represented good value for money.

Respondents said they were also concerned the government's prescriptive approach to introducing ITCs risked destabilising local systems as elective work is pulled out from NHS trusts and treatment centres so it can be passed on to ITCs.

Sir Nigel said the DoH had recognised the contradictions created by the clash with choice policy and would be replacing the volume guarantees with financial ones that would be underwritten by the DoH, not by PCTs. This approach will be taken with both the existing first-wave ITC contracts and those that will be procured under the imminent wave two.

Sir Nigel said the financial guarantee was already part of the existing contracts so the renegotiation was just 'a technical thing'.

NHS Confederation policy director Nigel Edwards welcomed the move: 'What he [Sir Nigel] is proposing seems consistent with his own policy and is what needs to happen locally. If you have got a policy which says PCTs control over 80 per cent of resources and make choices locally about what is required, what you do not do is have a central team that dishes out work to the independent sector.' But he said the decision to end volume contracts with ITCs meant some may end up with more than 8 per cent: 'There are risks as well. More work may go to the independent sector depending on how choice works in certain areas.' Finance consultant Noel Plumridge said: 'The independent sector needs volumes and assurances to make the initial investment worthwhile.

'They are meant to be facilities for doing straight forward procedures in huge volumes. They do not have to provide the services of acute hospitals and they do not have to treat all-comers, so their average costs can be lower.'