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Evidence of ‘two-tier NHS’ as private sector treat healthier patients

Patients seen by independent treatment centres (ISTCs) tend to be younger, in better health before their operation and from more affluent areas than those seen by NHS hospitals, new research has shown.

GP leaders said the study by the London School of Hygiene and Tropical Medicine supported fears that the private sector was ‘cherry-picking' easier work and leaving the NHS to deal with the more complex and costly operations, and warned of a ‘two-tier NHS' is developing.

The research, led by Professor Jan van der Meulen at the London School of Hygiene and Tropical Medicine, found that ISTCs were typically treating a ‘favourable case mix profile'.

The BMJ study compared characteristics of patients and outcomes after elective surgery in ISTCs with those undertaken by NHS providers, and looked at patients undergoing hip or knee replacement, hernia repair, or surgery for varicose veins in 25 ISTCs and 72 NHS centres.

Patients in ISTCs were healthier than those in NHS centres, had less severe symptoms, and were more affluent, the research found.

After adjusting for these differences, patients undergoing joint replacements in an ISTC had slightly better outcomes than patients treated in NHS centres in terms of symptoms, disability and health related quality of life. However, the researchers stress that such differences were minor and unlikely to be clinically significant.

There were no significant differences in outcomes after surgery for hernia repair or varicose veins. 

Professor van der Meulen told Pulse: ‘We found that ISTC patients tended to have less severe symptoms and that they more often came from more affluent areas. ISTCs were expected to treat patients with a more favourable case mix profile and this is in line with their contracts.'

Critics have argued that contracting arrangements favour private providers who only take on the simpler work – for example many would not treat NHS patients with mental health conditions for example.

The GPC told Pulse the study was evidence of the development of a ‘two-tier NHS'.

GPC deputy chair and Leeds GP Dr Richard Vautrey said: ‘This is clear evidence of a two tier NHS developing, with one service for the relatively fit and well and another service for the elderly, vulnerable or those with more complex problems.'

‘This is something the BMA has repeatedly warned about and is one of the reasons we continue to have significant concerns about the health bill.'