CCSC statement on CATS and ICATS

Primary Care Trusts in Cumbria and Lancashire have issued a consultation seeking the public’s views on the establishment of a Clinical Assessment, Treatment and Support (CATS) service in Cumbria and Lancashire.

Plans to roll out a similar scheme in Greater Manchester are also underway. This is called Integrated Care Assessment and Treatment services (ICATS) and it will also be provided by the independent sector.

These services are a radical development whereby the independent sector will provide triage, assessment, diagnostic and some treatment services in a number of specialties, outside local acute trusts, on referral from GPs. The specialties are: –

  • ENT
  • General surgery
  • Gynaecology
  • Orthopaedics
  • Rheumatology
  • Urology

The preferred bidder in Cumbria is Netcare UK, an independent sector provider which already operates a number of treatment centres and primary care walk-in centres in England.

This scheme’s stated aim is to help reduce waiting times, so that the area can achieve the 18 week waiting time target by 2008. It is also intended to push forward the “care closer to home agenda” – the Government’s intention to move more care traditionally provided by hospitals into community and primary care settings – and to simplify the patient journey.

These types of referral management scheme present considerable challenges to the secondary sector. They introduce a new tier between primary and secondary care and ultimately threaten to remove large parts of local acute Trusts’ work, particularly pre-assessment and diagnostics, and shift it to different settings altogether. Ultimately this may have serious implications for medical services in those trusts.

Naturally, the BMA’s Central Consultants and Specialists Committee has serious concerns about CATS and ICATS. It is encouraging medical staff and patients in these areas to participate in the CATS consultation which can be found at, to be participate in planned public meetings and to raise the issues in their Trusts

The BMA believes this consultation to be totally inadequate, as it is largely about the logistics and location of the scheme, rather than about whether it needs to be provided by the independent sector, or indeed whether an additional tier in the local NHS is a good use of public money at all. Those decisions are not presented as up for public debate, either locally or nationally.

Some of the questions which need to be asked of CATS and ICATS are: –

  • Is the work being moved all additional to core NHS activity?
  • Why can’t the work be done by existing staff?
  • Where will staff working in CATS/ICATS be recruited from? How many will be required and at what grades?
  • Who will train, monitor and assess the staff in the CATS/ICATS?
  • Who will draft and agree the protocols under which they will work?
  • Will GPs/Patients have a choice not to go via CATS/ICATS?
  • What assessment has been made of the impact of the diversion of such a large number of cases on the training of NHS staff?
  • What evidence is there that CATS/ICATS will improve accessibility? In relation to ICATS, for example, how many people in Greater Manchester are more than 30 minutes away from one of the 10 acute hospitals?
  • How will local patients know that the service has improved? Will the quality of the treatment received in CATS/ICATS be recorded and assessed and be compared with that previously received in the local NHS hospitals?
  • Has an assessment been made of the impact of CATS/ICATS on the local health economy and, in particular, local NHS hospitals?
  • How can they be sure this will be value for money when that of Independent Sector Treatment Centres (ISTCs) has been questioned by the House of Commons Health Select Committee.
  • How will they ensure that the quality of work is maintained when existing audit has been severely criticised by the Healthcare Commission?

We are raising all these questions and concerns at national level. For that we need reliable information from the local level. It would therefore be very helpful for any consultants affected by these plans to e-mail us information at [email protected] or to contact their local BMA Industrial Relations Officer (via ask BMA) if concerned about the implications for them.

19 January 2007

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