 An article by Angus Wallace in the British Medical Journal (BMJ vol 332 11 March 2006) suggested that treatments may be proportionally less successful in ISTCs due to the employment of inexperienced or less fully trained staff with less backup than the NHS facilities.This could result in the NHS having to fund difficult revision operations (insofar as they can be so revised) and would defeat the object of the exercise.However, a subsequent study conducted by the researchers from London School of Hygiene & Tropical Medicine and the Royal College of Surgeons of England confirmed the high quality of care, concluding that "patients undergoing cataract surgery or hip replacements in ISTCs achieved a slightly greater improvement … than those treated in NHS facilities" and "Patients treated in ISTCs were less likely to report post-operative problems than those treated in NHS facilities…"(BMC Health Services Research 2008.