Published: 11/11/2004, Volume II4, No. 5931 Page 6

The UK's first standalone elective treatment centre is facing the risk of closure because it does not have enough patients to treat.

The ambulatory care and diagnostic centre at Central Middlesex Hospital, London, was the first fast-track elective centre in the UK when it opened in 1999. In 2001, prime minister Tony Blair hailed the 'marvellous' centre as the model for 'a brand new type of hospital' which would 'work longer hours, including at weekends, and will involve much more day surgery'.

But this week ACAD general manager Nicky Bloom said the centre had performed just 6,439 operations since April, against a capacity of 23,000. The£3.4m in lost revenue means North West London Hospitals trust is now considering the centre's future.

Ms Bloom said 'stiff competition' from the Department of Health's independent treatment centre programme and other treatment centres had impacted on ACAD, which had already received fewer referrals than it expected under the London patient choice project.

And she said favourable treatment given to the independent sector under choice meant 'it is not a level playing field' for elective centres.

'[North West London Hospitals trust chief executive] John Pope is anxious that we make a decision on the future of ACAD by the end of the year, ' Ms Bloom said. 'We cannot cover the£1.2m annual fixed costs to keep the centre open as it is.'

Ms Bloom said the most likely decision is that the centre will be closed as a treatment centre and the facilities used by the trust to provide other services. She said the centre, which is part of NHS Elect, a consortium of four NHS treatment centres, had so far responded to the shortage of referrals by closing at weekends. She described its paediatric wards as 'virtually empty', and said 20 nursing staff have already been transferred to other parts of the trust because there was no work for them to do.

Ms Bloom blamed a number of factors for ACAD's failure to recruit enough patients.

She said the centre had tried to market itself to other strategic health authorities and primary care trusts to recruit extra patient lists, but had found little success.

'We are struggling to compete with the direct marketing [of ITCs by the government] and DoHbacked patient lists being offered to the private sector, ' she said.

The NHS Elect consortium also includes Hammersmith Hospitals trust's Ravenscourt Park Hospital, which is facing a similar situation and is currently reassessing its position as a treatment centre.

But this week the consortium announced that it would expand to include nine more NHS treatment centres, previously supported by the Modernisation Agency's NHS treatment centre programme, now winding up.

NHS Elect director Caroline Dove said the centres hoped that being part of the consortium would help them find ways to fill spare capacity and build up links with overseas providers.

University College London Hospitals foundation trust chief executive Robert Naylor, whose trust also has two treatment centres, commented that he was concerned NHS centres had 'never been on a level playing field'.

'Independent treatment centres are being established on longterm guaranteed contracts at enhanced tariff rates, ' he said.

'None of these kinds of opportunities have been given to NHS treatment centres.'

Mr Naylor described his trust's Heart Hospital and Middlesex treatment centres, alongside ACAD and Ravenscourt Park, as the 'pathfinders for the NHS treatment centre programme' but alleged that the programme was set up to fail, saying it could not compete against the independent sector and it had proved 'impossible to get patients transferred from other trusts'.

He added that NHS treatment centres were becoming less viable to run because they did not have the same income guarantees as their private-sector counterparts.

Mr Naylor confirmed that next year the Middlesex treatment centre, which carries out a range of orthopaedics and other general day-case surgery, will close with the rest of the site.