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Diagnostic and Treatment Centres: the future of healthcare?

Tuesday 13th May 2003 at The Commonwealth Club, Northumberland Street, London.

Future Healthcare Network (FHN) held a joint seminar with Architects for Health which explored the Diagnostic and Treatment Centre (DTC) models being developed in public and private sectors, those emerging from whole system planning and the potential for this initiative to deliver modern services appropriate to local needs.

Presentations were given by representatives from the Cabinet Office, Department of Health (DoH) Independent Sector DTC Programme and trusts developing DTCs with a discussion lead by panel of experts. Issues that emerged included the potential of IT to support and enable whole system planning, the potential to develop planning in primary, acute and social care in an integrated way, and the potential to increase capacity to meet short term targets.

AfH member Roger Walters of Bickerdike Allen Partners comments on the event:

Public debate has recently focused upon Foundation Hospitals but delegates at the first joint AfM/FHN Meeting saw the radical side of NHS modernisation. The architects in the audience were not that surprised to find design again well down the agenda. However, many were surprised by the radical nature of the dtc component in the NHS Plan. This is a redesign of the existing service as well as "growing capacity".

DTCs are for elective surgery and may well come in a wide variety of shapes and sizes. Mostly, they will be for hip, knee and eye procedures but a wide range of different specialities will be covered; some are acute services orientated, others community or primary care focused. Some will be firmly within the NHS; others will be additional new capacity provided by the private sector. Some will be delivered and operated by UK providers but more are likely to be delivered by new foreign operators in order to address the medical and nursing staffing issues raised. Indeed, a feature of the meeting was the range of interesting questions raised by this modernisation.

This may well be a start of the break up of the NHS monopoly on acute provision within the NHS. Some competition is being introduced both to increase capacity and improve choice in a more consumer responsive service still free at the point of delivery. Improved access and reduced waiting times, lengths of stay and costs/procedure are also key objectives. The label 'surgery factory' does appear to be quite accurate. The justification for the role of the private sector here is to ensure that the new capacity is indeed additional capacity. It is design, build, finance and operate in every sense. It is about 'getting things done' with improved patient choice in a modernised NHS and ideally before the next election.

The presentation raised several interesting questions:

• to what extent is existing public and especially existing private capacity fully utilised
• what happens to many existing business plans when these new facilities come on stream
• to what extent do these new facilities release bed capacity in existing hospitals
• can these public and private dtcs really be kept so separate that there is no loss of NHS staff
• does this change surgical training and career opportunities within the NHS
• are there cross subsidies (which are at present hidden) which will make remaining. treatment more costly
• is a short term contract for providers sufficient to allow the development of quality facilities
• how is residual value handled in this context of 5 year concessions
• is standardisation really appropriate given the even shorter design time
• is telemedicine not already overtaking much of this programme already
• what are the new models of organisation: stay and day
• is this going to be a satisfactory patient experience
• is design innovation desired and how does this fit within the business and marketing strategy

This was a fascinating session. More questions than answers but there was no mistaking the clear intent. This programme would clearly benefit from wider public scrutiny given the issues raised. Some schemes may follow the pioneering example of Avanti's ACAD scheme at Central Middlesex Hospital but it seems ironic that such a promising start appears to being overlooked in the headlong rush for instant delivery.

Copyright is retained by individual speakers and AfH is grateful for permission to include the material on this site.

Roger Walters

SUMMARY

Diagnostic and treatment centres are a vital development in the strategy to address capacity issues in the NHS. Designed to carry out planned surgery and treatments, there are now emerging models for acute and primary, and public and private sectors.

What are they? And how will they optimise potential to deliver modern services appropriate to local needs?

The Future Healthcare Network held a joint event with Architects for Health in May 2003 to explore these issues with presentations from policy and practice.

Summary of the key issues from the event:

• Policy: DTCs are seen as a key component in health services reform, particularly in relation to patient choice.
• The independent sector: can offer a fast, innovative alternative method of procurement. By bringing clinical expertise from abroad, it has the potential to add workforce capacity. But it may meet with resistance from clinical professionals particularly since it is such a ‘top-down’ initiative.
• Newham Acute NHS Trust: the DTC is seen as a building block in redeveloping the whole site. It is increasing physical capacity in a stand alone facility that will enable and support other changes. Defined patient pathways are being developed and there are links with other stakeholders and initiatives such as LIFT. The model of separating elective and emergency care is one that is being developed in other acute settings.
• The Lymington Community Hospital: the PCT is developing a model that demonstrates the potential for DTCs to develop community hospitals in primary care settings.
• Primary care: this initiative demonstrated the potential for joined up IT and workforce between primary and acute trust, introducing the idea of virtual DTCs - or DT Services, as they were redefined!

Panel responses highlighted the following views:

• The Modernisation Agency regard the DTC programme as a vehicle for modernising services
• The entrepreneur described the potential for it as a consumer driven model
• The architect drew attention to insufficient planning time and skills amongst clients
• The trust remarked on the poor evaluation of options and lack of strategic integrated planning

AGENDA 1.30pm to 6.00pm

• Coffee and Arrival (15 minutes)
• Introduction and Welcome (5 minutes)
  Susan Francis, FHN and AfH
• What is a DTC? What are the policy issues? and the models? (20 minutes)
  Pippa Bagnall - Chair, Principal Advisor (Health)
  Prime Ministers Office for Public Services Reform
• Case Study: Independent sector (25 minutes)
  Ken Anderson, Head of the Implementation Team, Independent Sector DTC programme, DOH
• Case study: Newham Healthcare NHS Trust (25 minutes)
  Monica McSharry, Director of Service & Organisational Development, Newham Healthcare NHS Trust
• Case study: Lymington Community Hospital (25 minutes)
  Sue Howson, PFI Project Director, New Forest PCT
• Case study: Chorleywood Health Centre (25 minutes)
  Dr Russell Wynn Jones, GP
• Tea
• Panel Discussion (30 minutes)
  Using Design to change services
  Chris Higdon, National Programme Manager, DTC Programme, NHS Modernisation Agency
  An investment and entrepreneurial response
  Dr Michael Sinclair, Chairman, Yoomedia
  Implications for planning and design of buildings
  Chris Shaw, Architect, MAAP
  Making it happen: Capacity and timeframe
  Alison Evans, Assistant Director - Modernisation lead Greater Peterborough PCTs
• Discussion (45 minutes)
• Close with thanks (15 minutes)
  Paul Mercer, Secretary, Architects for Health
• Wine and canapés