ISTCs and the disgraceful wasteful marketplace of doom

As with many recent government health reforms that have revolved around ideological nonsense and the enrichment of various groups with close political links, there has been no effort from the start to monitor the safety or performance of ISTCs from the very start. It is only thanks to some excellent local units that we are starting to discover just how much damage has been caused by these devastating reforms. This is without doubt only a small iceberg tip.

It is worth reading the full article and observing just how poor the record of these ISTCs is. The ISTCs have shown to be doing joint replacements that are failed at a rate of around 20% at three years, this is about twenty times the national NHS average rate, this is blatantly negligent and it doesn't need a statistician to tell one this. It is worth noting that this bodged surgery is costing the NHS a fortune to put right, add this to the fact that the ISTCs are often getting paid way more than the NHS for the same work. They are dangerous and bad value for money, the market is a clear failure in this context. The DoH is as always in complete denial as it is just pushing through ideological rubbish at the expense of patient care:

"Patient safety is top priority with all contracts with the independent sector. The Department of Health requires all Independent Sector Treatment Centres to have robust policies and procedures in place. All ISTCs operate under standards monitored by the Care Quality Commission, the independent health watchdog. The CQC... have not raised concerns with the Department about the safety of ISTCs."

What a lie and what a cop out. Like many new government reforms such as Walk in Centres and the contracting out of OOH (out of hours) work to private firms the effects in terms of patient care have not been monitored at all, it is a national disgrace. For example at ISTCs they are employing ' consultant' colleagues from other EEA states and many of these consultants have never worked in the UK before. They will, therefore, be working outside their comfort zone. They are often appointed with nothing like the formalities of an NHS Advisory Appointments Committee and sometimes appointments have even been agreed over the 'phone without any interview or meeting. This is dangerous practice and should be a risk management ' red flag '. Many of these consultants are not members of the respective UK academic college and are working in isolation from UK colleagues.

Millions of pounds of cash are still being dished out to ISTCs and there are simply not the systems in place to monitor just what they are doing in terms of harming patients. This is unacceptable, when those at the top of the political tree keep going on about standards and governance, why are these expensive unregulated disasters still being rolled out? Any changes to care delivery should be rigorously piloted and monitored to ensure that standards are not being compromised, this simply has not happened for the plethora of awful reforms we have seen in the NHS in recent years.

Whether it be your paramedic refusing genuinely sick people trips to hospital having been empowered by a short dumbed down course in being a doctor, your EEA GP with a limited command of English being flown in to do GP OOH work for a cost cutting private firm, your walk in centre quack pretending to be a GP and mobilising their Fisher Price (TM) stethoscope after a two week course in medical diagnosis or your EEA Orthopaedic specialist having a go at joint replacements in an ISTC with techniques which they have never done before, there is no excuse for this erosion of standards. The damage done is very hard to quantify as there has been no attempt to monitor the impact of any of these changes to practice, some things like Orthopaedic outcomes can be more easily eye balled retrospectively as has happened with the Cardiff ISTC but the vast majority of outcomes are almost impossible to measure without well though out prospective analysis, something it appears the government has avoided at all costs because it knows that this marketisation is doing harm to patients. The dumbing down continues.