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The cost of soft tissue sarcoma surgery is not being fully met by the NHS to the hospitals who undertake it. Bone sarcoma treatment is funded centrally by the National Specialist Commissioning Advisory Group (NSCAG). The seven centres in Stanmore, London’s University College Hospital, Birmingham, Newcastle, Oswestry, Bristol and Oxford are immune to cost issues with their bone sarcoma work. However these seven and the other hospitals which undertake soft tissue sarcoma surgery are not centrally funded and their charges to the patients’ Primary Care Trust (the fund holder) are paid on a fixed tariff. It is calculated that the average soft tissue sarcoma patient is underfunded by the NHS to about £5000. The patient is not, of course, aware of this, the transaction being one that happens in the background between PCT and hospital, but it is beginning to impact on medium and long term decisions being taken by hospitals in the wake of the Improving Outcomes Guidance from NICE. The largest surgical units treating several hundred patients a year are also the units which tend to take on those patients who need the most challenging surgery, so while the average financial loss per patient is £5000, in the larger centres it tends to be more, bringing the total in some cases to more than a million pounds. Hospitals which also provide an oncology service may be able to recover some of the loss on surgery but where a multidisciplinary treatment team comes from several hospitals, as is often the case, there is no opportunity to offset costs in this way. The directors of one major hospital have already raised the question of why they should continue to provide a surgical oncology service for soft tissue sarcomas when they are also expected to balance their books each year. Delegates at the BSG Conference expressed their concern and their hope that there could be a resolution to the problem. The threat is that the NICE Improving Outcomes Guidance will come into conflict with funding. Hospitals which the Guidance would suggest should become specialist centres expanding their sarcoma treatment will refuse to do so, while hospitals with a smaller practice will happily close their service and turn patients away on the basis of the Guidance. Solutions which might resolve the problem include changing the fixed tariffs and making an exception for sarcoma surgery, on the basis of its complexity, adding a bonus payment for sarcoma surgery, removing sarcoma surgery from the tariff altogether and making it fundable at cost, or making all sarcoma work a responsibility of NSCAG. Finding the right solution will be a matter for the Department of Health and hospital trusts, professional and patient groups will be making representations in the coming weeks. Additional reports: General Report Royal College of Radiologists Discussion Board
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