 This was based on a Scottish example and does not in fact reflect the experience of the English ISTC program, where referrals have been more in line with the expectations of the original contracts and continue to grow.The Department of Health claims stated that by concentrating on a set type of procedures they are able to streamline the patient care pathway, resulting in an improved patient experience and help the NHS to quickly meet waiting time targets; however, the majority of independent research conducted to date has contradicted these claims.A critique of this development is that more difficult and expensive work is left for NHS hospitals to do, increasing their marginal costs and making them appear less 'efficient'.