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Last Updated: Friday, 8 August, 2003, 09:14 GMT 10:14 UK
Q&A: Treatment centre row

There is a storm over the introduction of new diagnostic and treatment centres - which the government hopes will cut waiting times for surgery.

Doctors in Oxford say that the impact of the centre will be disastrous.

BBC News Online looks at what the centres are meant to do - and the problems they face.

What are diagnostic and treatment centres?

Diagnostic and treatment centres will be surgery centres which will specialise in common operations for which there are currently long waiting lists.

The idea is that the extra capacity in the centres will mean that patients with, for example, cataracts, can have them removed with far less delay.

Currently, more than 50,000 older people are waiting over three months for cataract treatment - and one quarter of all people over 75 develop a cataract.

The government is paying out an extra 52m to fund extra operations in existing NHS eye units and diagnosis and treatment centres (DTCs).

The government expects the number of DTCs will rise to 100 by 2006, carrying out not just cataract operations, but also more complex surgery such as hip and knee replacement.

Sounds like a good idea. What's the problem?

Some of the diagnostic and treatment centres are run by the NHS, some by the private sectors.

As part of their contract with the NHS, these private firms need to guarantee that enough work - in this case, operations - will come their way to make it worth their while.

However, the way the NHS works means that existing hospitals also need to attract a certain amount of work to justify their existence.

In this particular case, surgeons at the Oxford Eye Hospital say there is simply not enough cataract work to go around.

Since the contract with the local DTC will fix the number of operations carried out there, it will mean a drastic cut in the number of operations carried out at the Oxford Eye Hospital.

This, in turn, will mean less money coming into the hospital's coffers.

What impact do they say this will have?

Put quite frankly, surgeons say the impact will be "disastrous" for the hospital - which is a nationally-known centre of excellence.

Cataract surgery may be the most common eye operation, but it is by no means the only one - and money from cataracts underpins the other far more complex work that surgeons do.

They say that the loss of income from cataracts - which could be more than 2 million a year - could make it more difficult for them to carry out these more complex operations.

It could also mean an end to out-reach clinics in local communities, and damage the training of new ophthalmolgists - which can only be carried out in big hospitals such as this.

Redundancies are also a likelihood, claim the doctors.

What have they tried to do about it?

In theory, it isn't up to the government where these operations are carried out.

Local primary care trusts, collectives of GPs and other local health professionals, hold the pursestrings for 75% of money spent on health in an area, and can decide which treatments to pay for, and who to "buy" them from.

Three PCTs - concerned about the impact on the Oxford Eye Hospital - wrote to the Department of Health asking to "opt out" of the diagnostic and treatment centre for their area.

In short, they said they'd rather spend their money at the Oxford Eye Hospital.

Their request was refused - the Department of Health said it could undermine the whole private deal setting up the centre.

What does the government say about all this?

Ministers say that none of these arrangement has yet been finalised.

They have assured the surgeons that there are no plans to close the hospital or cut back its services.

In general, the diagnostic and treatment centres, they say, are vital to drive down waiting times to meet a three month maximum target by 2005.

Is this just a local problem, or could other areas be affected?

The Oxford row is the most powerful attack yet on the creation of treatment centres.

However, there have been suggestions that it is likely that the extra capacity is unnecessary in some other areas of the UK.

While this is not necessarily a problem if the NHS is in charge of the treatment centres, as staffing levels can be adjusted to suit, where the centres are run privately, a fixed number of patients will be treated in them, and lost to local services.

The Independent Healthcare Association says that diagnostic and treatment centres may create similar problems in many other parts of the UK.

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