Treatment centres may destabilise NHS, doctors claim
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《英国医生杂志》
The introduction of NHS treatment centres, dedicated exclusively to elective surgery and diagnostic tests, means that patients are being seen and treated faster, according to a report released by the health secretary, John Reid, this week.
But the BMA has raised concerns that if such centres continue to siphon off patients, traditional hospitals may become unsustainable in the long run.
Waiting lists are at their lowest since records began, according to Mr Reid, or at least at their lowest since 1987, when the Department of Health first began collecting comparable data. They have been reduced by 144 000 in the last year, and the centres have been particularly useful in specialties which have historically attracted the longest waiting lists, such as orthopaedics and ophthalmology.
Twenty nine NHS run treatment centres have been opened around England since 2002, and another 17 are planned for next year. They are specialised units with a body of trained staff, which includes many newly developed posts, such as advanced nurse practitioner and healthcare assistant. The centres aim to give patients fast prebooked surgery and diagnostic tests.
The government also believes that the centres are a step on the road to providing patients with increased choice in selecting treatment. From December, all patients in England are meant to be offered a choice of four to five providers when their GP decides that treatment is necessary.
Although most health service commentators accept that the NHS needs to expand its capacity, many do not think that treatment centres are an unproblematic solution.
Nigel Edwards, director of the NHS Confederation, has warned, "Treatment centres give the health service the ability to treat patients faster than has been traditionally possible, because they allow the separation of the treatment of planned admissions from emergency cases. However, the removal of large amounts of elective work from existing hospitals can threaten the viability of the services that remain."
The BMA also warned that the health sector should respond cautiously to the government抯 claims. "The BMA has always welcomed the possibility of treatment centres cutting waiting times; however, from the start we have raised concerns that they would destabilise NHS hospitals?economies and this is exactly what is happening," said Dr Paul Miller, chairman of the BMA Joint Consultants Committee.
"We have heard of MRI scanners in NHS hospitals sitting unused while patients are scanned in mobile units in car parks outside. Hospitals will not be able to survive in a system of payment by results if workload is taken away. Patients get sick around the clock, seven days a week, and hospitals must be fully resourced and staffed to cope with their needs."
Dr Miller also questioned the way that the health secretary had chosen to interpret the government抯 figures, pointing out that although treatment centres may be seeing a higher volume of cases, hospitals are still required to provide training and deal with the most complicated conditions. It is therefore misleading to imply that treatment centres are somehow a more efficient way of providing care, or to overlook the fact that they need established NHS infrastructure to operate.(London Madeleine Brettingham)
But the BMA has raised concerns that if such centres continue to siphon off patients, traditional hospitals may become unsustainable in the long run.
Waiting lists are at their lowest since records began, according to Mr Reid, or at least at their lowest since 1987, when the Department of Health first began collecting comparable data. They have been reduced by 144 000 in the last year, and the centres have been particularly useful in specialties which have historically attracted the longest waiting lists, such as orthopaedics and ophthalmology.
Twenty nine NHS run treatment centres have been opened around England since 2002, and another 17 are planned for next year. They are specialised units with a body of trained staff, which includes many newly developed posts, such as advanced nurse practitioner and healthcare assistant. The centres aim to give patients fast prebooked surgery and diagnostic tests.
The government also believes that the centres are a step on the road to providing patients with increased choice in selecting treatment. From December, all patients in England are meant to be offered a choice of four to five providers when their GP decides that treatment is necessary.
Although most health service commentators accept that the NHS needs to expand its capacity, many do not think that treatment centres are an unproblematic solution.
Nigel Edwards, director of the NHS Confederation, has warned, "Treatment centres give the health service the ability to treat patients faster than has been traditionally possible, because they allow the separation of the treatment of planned admissions from emergency cases. However, the removal of large amounts of elective work from existing hospitals can threaten the viability of the services that remain."
The BMA also warned that the health sector should respond cautiously to the government抯 claims. "The BMA has always welcomed the possibility of treatment centres cutting waiting times; however, from the start we have raised concerns that they would destabilise NHS hospitals?economies and this is exactly what is happening," said Dr Paul Miller, chairman of the BMA Joint Consultants Committee.
"We have heard of MRI scanners in NHS hospitals sitting unused while patients are scanned in mobile units in car parks outside. Hospitals will not be able to survive in a system of payment by results if workload is taken away. Patients get sick around the clock, seven days a week, and hospitals must be fully resourced and staffed to cope with their needs."
Dr Miller also questioned the way that the health secretary had chosen to interpret the government抯 figures, pointing out that although treatment centres may be seeing a higher volume of cases, hospitals are still required to provide training and deal with the most complicated conditions. It is therefore misleading to imply that treatment centres are somehow a more efficient way of providing care, or to overlook the fact that they need established NHS infrastructure to operate.(London Madeleine Brettingham)