According to a study published on bmj.com today, the outcomes for individuals undergoing surgery in independent sector treatment centers (ISTCs) are slightly better than compared to patients undergoing surgery by NHS centers. However, the researchers, led by Professor Jan van der Meulen at the London School of Hygiene and Tropical Medicine, point out that these differences were minor and were not likely to be clinically considerable.

In addition they discovered that individuals in ISTCs are often younger, come from more affluent areas and are in better health prior to their surgery compared to individuals seen by NHS hospitals. The authors say, this supports the idea that quality of care could improve by separating elective surgical care from emergency services.

In order to reduce waiting times, encourage new models for the provision of non-emergency services and to give patients more options the Department of Health began the procurement of independent sector treatment centers in England in 2002.

However, concerns have been raised by clinicians and some politicians regarding the quality of care ISTCs provide and their damaging impact on surgical training and wider NHS service provision.

The investigators conducted a study in order to compare patients characteristics as well as outcomes after they chose to receive surgery in an independent sector treatment center compared to those who used NHS providers.

The investigation consisted of individuals undergoing hernia repair, surgery for varicose veins or knee or hip replacement in 72 NHS centers and 25 ISTCs.

They discovered that even though the differences were small, individuals who went to ISTCs were healthier, more affluent and had less severe symptoms compared to those who went to NHS centers.

After taking into account these differences, they discovered that there were no considerable differences in outcomes for hernia repair or varicose vein surgery between ISTCs and NHS centers. However, they did find that individuals undergoing hip or knee replacement in an independent sector treatment center had slightly better outcomes in terms of disability and health related quality of life, compared to those who underwent joint replacements in NHS centers. Although they stress that these differences were small and unlikely to be clinically significant.

The researchers explain:

“In line with their contracts, ISTCs treat patients with a more favorably case mix profile, but the differences before surgery are small and unlikely to be clinically significant.

Our results lessen concerns that ISTCs are “cherry picking” the more healthy patients and that they have a negative impact on service reconfiguration and surgical training. Our findings support the idea that separating elective surgical care from emergency services could improve the quality of care.”

Written by Grace Rattue