Analysis: Questions over new cherry picking safeguards for NHS

‘We will create additional safeguards against ‘cherry picking,’ said the Government today, announcing a set of welcome changes to the Health and Social Care Bill.

NHS doctors have long complained about privately-run treatment centres’ practice of cherry-picking, which amounts to selecting the most uncomplicated, low-risk cases while leaving the risky patients to be dealt with in NHS hospitals. For example, surgical treatment centres may not treat patients with diabetes, or those who are obese.

The Government announced plans to tackle this using a new pricing system; ‘Services will be covered by a system of prices that accurately reflect clinical complexity, except where this is not practical’, it declared.

However there is a greater risk to patients than being turned down by private treatment centres – and that is not being turned down.

The Healthcare Commission noted, in 2007, difficulties around transfer of care from independent sector treatment centres to NHS facilities when patients experienced complications.

In 2008, at the inquest into Ann Ellis, who bled to death following surgery at the Greater Manchester Surgical Centre, run by Netcare, the coroner criticised delays in getting blood to the centre.

That same year the death of lecturer John Hubley in a treatment centre run by Nations Healthcare prompted warnings from National Patient Safety Agency that surgery should not be commissioned or delivered in facilities which lack the systems and equipment to manage emergencies safely.

Dr Hubley bled to death during a routine gall bladder operation at Eccleshill Treatment Centre in Bradford. At the inquest it emerged that vital surgical equipment and supplies needed to resuscitate him were not available and there were long delays in obtaining blood for a transfusion.

A year later Mrs Doris Allen died after surgery at the Sussex Orthopaedic Treatment Centre. The coroner found that a failure to diagnose a serious complication for five hours was ‘aggravated by poor communication, both verbal and written, by clinical staff.’

However cases remain where timely treatment of patients appears to have been an issue.

It’s likely that private providers have now revised their policies with regards to blood supplies. But in some regions, relationships between NHS hospitals and treatment centres have soured under the competitive pressure, leading to a lack of co-operation between hospital and TC staff.

Add risky patients with co-morbidities into the mix, and serious incidents may become more likely.