Issue - items at meetings - Sussex Orthopaedic Treatment Centre (SOTC)

Report of the Director of Strategy and Governance (copy attached)

9.1       This item was introduced by Wendy Carberry, Deputy Director, Contracts, NHS Brighton & Hove and by Pamela Mackie, General Manager, Care UK.

9.2       In response to a question from Mr Robert Brown on Care UK’s criteria for selecting patients, members were told that specialist treatment centres were invariably unable to treat a small number of patients – i.e. those with co-morbidities which meant they could only be safely treated in a large acute hospital environment.

9.3       Cllr Kitcat went on to ask whether this had an adverse impact upon other areas of the local health economy (e.g. upon local acute NHS trusts which will typically pick up the complex co-morbidities inappropriate for treatment at a specialist centre). Amanda Fadero, Interim Chief Executive, NHS Brighton & Hove, responded that it was important to focus on the totality of pathway management across the local health economy rather than on any single element in the pathway. Any financial stresses caused by the existence of the SOTC had to be weighed against the centre’s contribution to local elective orthopaedic capacity, and against the local health economy’s ability to deliver against the national 18 week waiting time targets (the SOTC is able to process cases more quickly than most general hospital based services). Ms Fadero noted that, although the 18 week targets had now been formally discontinued by the new Government, NHS Brighton & Hove was still committed to commissioning services to an 18 week timetable.

9.4       In answer to a question from Cllr Rufus on how the SOTC was reimbursed for activity, members were told that the SOTC contract, in common with all Independent  Sector Treatment Centre (ISTC) contracts, was nationally determined on a principle of ‘take and pay’ – i.e. that the SOTC was paid a set volume of procedures each year, whether or not it actually undertook all of this activity. Providing Care UK was able to undertake all the activity contractually required of it, the onus was therefore on NHS Brighton & Hove, as lead commissioner for the SOTC, to ensure that there were sufficient referrals into the SOTC to achieve value for money from the contract. Amanda Fadero, Interim Chief Executive of NHS Brighton & Hove, added that Care UK had been very flexible in terms of interpreting its contract.

9.5       In response to a query from Cllr Kitcat regarding the difference between the SOTC’s contracted activity (paid in full via the SOTC contract) and its actual activity, Ms Mackie agreed that there was a difference here across the year, and that this did translate into additional profit for Care UK. Ms Carberry stressed that this was typically not because the SOTC was unable to operate at full capacity, but because the number of patients seeking orthopaedic surgery varied from month to month, meaning that there were sometimes fewer patients requiring treatment than the contract pre-supposed. Care UK and NHS Brighton & Hove have been working to better control patient referral into the SOTC, and the Quarter 1 performance data for 2010-11 does indicate much better utilisation of theatre capacity at the SOTC.

9.6       Members also had more detailed questions they wished to ask about the SOTC. However, it was agreed that there was little point in asking these questions in the meeting as it was unlikely that there would be answers to hand, and that instead, a list of written questions should be submitted to Care UK and NHS Brighton & Hove at a later date.

9.7       RESOLVED –  (1) That the report be noted; (2) That a further monitoring report be requested at a later date; (3) That a list of written questions be submitted to Care UK and NHS Brighton & Hove.