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Some independent treatment centres have a high cancellation rate, audi
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     Several independent sector treatment centres in England have high rates of cancellation of clinical procedures, a study shows, even though most are reaching their targets. One of the schemes running the centres had been the subject of a high number of complaints from patients, says the report of the audit, which was conducted by the independent National Centre for Health Outcomes Development.

    The preliminary audit of the performance of the controversial centres looked at four schemes run by five independent sector providers. These schemes had been operating for more than six months and had treated the most patients of the 20 independent sector schemes that have been set up so far. Thirty nine NHS treatment centres are in operation, and another seven are in development.

    The schemes are part of a major drive by the government to cut waiting lists. Under the programme a number of specialist treatment centres have been set up, some run by the NHS and others by the independent sector. More than ?bn ($5.2bn; €4.5bn) is being pumped into the independent sector treatment centres programme, which is expected to treat 1.7 million patients by 2010.

    Results from the audit were "encouraging," said the report. It also pointed out that the "robust" quality assurance measures put in place for these schemes were more ambitious and demanding than for NHS organisations.

    Most schemes appeared to hit most performance targets with some ease. Capio, for instance, which performs orthopaedic, ophthalmology, and general surgery, reported just three non-clinical cancellations out of more than 13 000 admissions.

    Ninety nine per cent of patients of Netcare, which operates two mobile ophthalmology units, were satisfied with the service, showed satisfaction forms filled in by 10 000 patients between April 2004 and June 2005.

    But the Partnership Health Group, which carries out orthopaedic treatments in Trent and South Yorkshire, had a clinical cancellation rate of 2.71%¡ª four times higher than the 0.65% "threshold level," the level agreed in the contract as an acceptable target. In addition, in a 15 month period 70 patients had to return to theatre because of problems with their initial operation, and the number of complaints from day patients and inpatients was much higher than the number in other schemes.

    At Birkdale Clinic, which carries out ophthalmology treatment and endoscopies in Daventry in Northamptonshire, the non-clinical cancellation rate was three times higher than the target level. The overall clinical cancellation rate was twice the target, and in 14 of the 21 months recorded the target rate was exceeded.

    The audit notes that the fact that all the figures in the report were provided by the organisations themselves constrains any judgment on performance. It recommends an independent valuation by comparing sample audits with case notes.

    The health minister Norman Warner welcomed the report. He said it showed that the concerns expressed about the programme had not materialised in practice.

    But the BMA called for independent comparisons to be made between independent sector treatment centres and the NHS to allow proper choice for patients. Jonathan Fielden, deputy chairman of the BMA’s consultants committee, said that doctors remained worried about the adverse effects of the treatment centres?programme on existing NHS facilities and on the training of future doctors.

    The NHS Confederation, which represents NHS trusts, is urging a fresh examination of the effect of the centres, particularly on case mix and doctors?training.

    "It is important to ensure we have a level playing field so that independent sector providers compete with the NHS on an equal basis," said a spokesman for the confederation. "This means transparency and fairness in the criteria by which successful bidders for the next wave of independent sector treatment centre schemes are chosen."(London Andrew Cole)