NHS hospitals are having to repair the damage done during botched operations on people who have been sent to private centres for hip and knee replacements to cut waiting lists, it is revealed today.
Independent sector treatment centres (ISTCs) have been set up around the country using mainly surgeons from overseas to take the pressure off major NHS hospitals by fast-tracking the easiest cases.
But Angus Wallace, professor of orthopaedic and accident surgery at Nottingham University, writes in the British Medical Journal that "the number of patients we are seeing with problems resulting from poor surgery - incorrectly inserted prostheses, technical errors and infected joint replacements - is too great."
Many overseas surgeons, he says, "have been asked to carry out joint replacement operations that they have never seen or done before". Many of the centres have contracts to buy just one type of artificial joint - but sometimes it is one that the surgeon has no experience in using.
"It is quite clear that this has occurred with inadequate training of both the surgeons and the operating theatre staff and as a consequence there have been several serious errors - joint replacements put in without bone cement when bone cement was essential for that joint replacement, the use of the incorrect size heads (ball) for a hip joint replacement, etc," he writes.
It is hard to know how many operations are going wrong, Prof Wallace told the Guardian, but it is clear there are problems that ought to be investigated.
"We expect failures of hip replacements at approximately 1% a year and knees at about 1.5% a year. But we have got some of the ISTCs that are looking at 20% failure rates," he said.
The British Orthopaedic Association has submitted two dossiers of cases to the Department of Health, its president, Ian Leslie, told the Guardian. The first went to then deputy chief medical officer Aidan Halligan about 16 months ago and the second was submitted nine months ago.
"Although they investigated, it hasn't made much difference to our concerns," he said. "The difficulty is getting hold of the information from the ISTCs. We don't know how many patients are being done in the treatment centres."
But in two centres where the figures have been examined the failure rate was significantly higher than in NHS hospitals - at a diagnostic and treatment centre in Weston-super-Mare it was three times the NHS rate and in Cheltenham it was something like 10 times the rate, he said.
At an inquiry by the Commons health select committee yesterday, Royal College of Surgeons president Bernard Ribeiro said the government policy in establishing the treatment centres was "to win elections and to get waiting lists down".
Extra theatre time for hip and knee replacements had indeed been needed, he said. "The government gave us capacity through ISTC but somewhere down the line it lost the plot. In developing ISTC it is challenging the NHS."
The BOA and the royal college strongly urged the need for an audit of success rates and revision rates (where the operation has to be redone).
"Let's find out whether the quality of work in ISTCs is equivalent to the work in the NHS," said Mr Ribeiro. "Let us actually do a paper study. If it could be funded we would do it tomorrow."
The treatment centres are also having a detrimental effect on the training of UK surgeons, they argue. Junior surgeons used to learn their craft on the simple operations - firstly by watching senior surgeons perform them and then by carrying them out under supervision.
"This time-honoured and soundly proved method of training has now, sadly, been denied," writes Prof Wallace in the BMJ. "Even if training were to be allowed in ISTCs, the supervising surgeons may not be fully competent themselves ... let alone competent as trainers. Consequently the competence of our next generation of surgeons is in jeopardy."
