ISTCs: additional evidence so far

James Gubb, 24 April 2008

Writing in the British Medical Journal in February 2008, Allyson Pollock and Sylvia Godden lambasted the quality of care provided in independent sector treatment centres (ISTCs). They are right to raise concerns over data quality and collection, but a report released this week by the LSHTM and the Royal College of Surgeons allay many of the fears they proclaim.

The report, based on a prospective cohort study of patient-reported outcomes (PROM) for 769 patients treated in six ISTCs and 1,895 treated in 20 NHS providers in England between 2006-07, suggests: ‘there is no widespread problem with poor quality care’.
In fact the study found that for all procedures, except hernia report, post-operative PROM scores in ISTC patients indicated better outcomes than NHS providers. This remained true for cataract surgery and hip replacements even after adjustment was made for pre-operative characteristics. What’s more, maintaining this adjustment, fewer patients in ISTCs reported a post-operative complication than those treated in the NHS.
The only blip was varicose vein surgery, where patients who underwent such a procedure in an ISTC were less likely to describe their operation as a success.
While no-one should be seeing the independent/private sector as a panacea, standards of care are, it seems, at least high enough to act as the competitive spur it was intended to be.