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Comparative audit of independent sector centres and NHS hospitals published by RCS

20 October 2011

NHS patients undergoing elective operations in dedicated independent sector units report better outcomes than those seen by NHS Hospitals treating emergency and elective patients, according to a major new study released today (Wednesday, 19 Oct 2011) by the Royal College of Surgeons [RCS] and London School of Hygiene & Tropical Medicine. But researchers also found these differences reflect that those patients seen by independent sector treatment centres [ISTCs] tend to be younger, in better health before their operation and from more affluent areas than those seen by NHS Hospitals.

The Patient Outcome in Surgery [POiS] Audit looked at four common procedures – hip replacements, knee replacements, varicose vein treatment and inguinal hernia repair – and included responses from 25,000 patients treated at 16 ISTCs and 53 NHS providers across the country in 2008/2009. Among the findings were:

  • For hip and knee replacement, NHS hospitals dealt with almost double the proportion of sicker patients (rated by the internationally recognised ASA classification system* as Grade III or worse).
  • NHS hospitals took a higher proportion of patients with two or more co-morbidities for all four procedures – almost double for inguinal hernia.
  • For varicose vein surgery, patients at NHS hospitals were three times more likely to need a further operation than at independent providers.
  • For hernia operations, NHS hospital patients had a 40 per cent higher risk of reporting a poor operation after adjustment for case-mix than at independent providers.
  • NHS hospital patients were more likely to live in the poorest areas (percentage stating they lived in the bottom fifth ranking areas judged by the ‘Index of Multiple Deprivation’**) across all four operations.
  • Across all units and procedures, there was a huge increase in patient satisfaction with their condition following the operation compared to before.

The RCS believe that completely separate emergency and elective operating rotas would ensure both types of patient get care optimised rather than mixed operating lists.

Professor Norman Williams, President of the Royal College of Surgeons said:

"This study suggests that patients treated at units dedicated to elective surgery experience improved outcomes. However, it also showed that independent sector providers have taken younger, fitter patients and we need to guard against any drift that could destabilise hospitals. Sicker patients have needs that only a comprehensive hospital can provide."

Jan van der Meulen, Professor of Clinical Epidemiology at London School of Hygiene & Tropical Medicine, said:

"Independent sector treatment centres treat only non-emergency cases.  The separation of elective surgical care from emergency services is likely to have a positive impact on the quality of care, irrespective of whether the elective surgery is carried out by a private company or the NHS."

The POiS Audit is the first large scale study to compare patient reported outcome measures [PROMS] from operations conducted in NHS and ISTCs and was originally established due to concerns from surgery and the Health Select Committee that there was a lack of data from private providers. The methodology pioneered by this report has been taken on by the Department of Health for the NHS PROMS Programme. 

The report can be viewed here.