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DTC Case Study: Independent Sector

Ken Anderson, Head of the Implementation Team, Independent Sector DTC programme, DoH

Independent sector DTCs are important because they can help the NHS produce the increases in capacity needed to deliver service targets such as reductions in waiting times. They will also give the NHS some ‘breathing space’ which will help it to change. Lead times for conventional NHS projects mean traditional solutions to capacity problems cannot deliver.

Ken Anderson’s team is working with private sector providers to find the best ways of getting them involved. Priority areas of need are identified, but the team is also mindful of the need for economies of scale. Anderson is clear that the people who staff the independent sector DTCs should be ‘additional’ people, not staff taken away from existing health services. The DTCs will all be ‘branded’ as NHS facilities.

The core objectives of the DTC programme are to:

• improve access to elective care
• streamline the way the NHS provides diagnostic and elective care
• generate value for money gains by stimulating new models of service delivery.

DTCs should focus on streamlined day surgery.

DTCs (or ambulatory surgery centres as they are known in the US) have become popular in the US. Patients find them convenient, partly because they can schedule their treatment. It has also been found that post operative infection rates are lower. The first centre in the US opened in 1970; today more than seven million surgical procedures are performed each year in 3,300 centres. Types of surgery include ophthalmology, gastroenterology, gynaecology, orthopaedics, ENT and urology.

For the NHS, DTCs offer an opportunity to adopt best practice and increase short term capacity through new ways of working. There is not a prescribed model for a DTC; for example it could be on NHS property or in a shopping centre. There are no set ideas on structure as long as the DTC is fit for purpose. Trusts may even want to consider leasing a facility and learning from how this works before building a tailor-made DTC. In the US, mobile DTCs are used in some areas.

It is important to ensure that DTCs have shorter set up times than the NHS has been used to. The starting point should be the patient pathway, with the bricks and mortar regarded as the fabric that holds the pathway.

The case mix will vary from DTC to DTC, but each will be expected to support its case mix, for example by having imaging services that support its work.

DTCs represent a new way of engaging the independent sector, with long term contracts for services, a highly informed procurement process and the opportunity to learn from global best practice in procurement and supply chain management as well as in clinical terms.

Points from the discussion

• DTCs are (partly) being introduced to target waiting lists as they exist now. What happens when lists have been controlled?
• Should we look at separating specialities even further? For example, separating the two specialisms within orthopaedics to maximise productivity?
• Issue of politically driven programmes to set up DTCs – this may mean moving at a pace that is too quick, building in haste with construction starting before the design is finalised.
• Is a 30-year life too long for DTCs? Should we just build for 5 years? Contracts usually run for 5 years and then are subject to market testing again. It is best to think of the building as a facility to be used as wanted.
• Should buildings be tailor made, or could a warehouse, for example, be leased or spare office space used? Architect view expressed that flexibility is a good idea but limited concept in practice.
• There must be clear protocols with the independent sector: if it gets things wrong it must put them right and pay.

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