Modernisation of Pathology Across the North East Dr Chris Shaw Laboratory Manager 21st October 2016

Brief History of Pathology Modernisation in the North East of England 1999 UK Government Launch Pathology Modernisation Programme – key aims of which were to improve quality and efficiency while addressing the following issues: decades of underinvestment increasing demand shortage of staff in all disciplines, coupled to an aging workforce new technological and scientific developments require new skills and new ways of working Key Feature – Creation of a formally managed Pathology Network Department of Health (2002) Pathology the essential service draft guidance on modernising pathology services. London: Department of Health.

2006 Carter Report - Reiterated the requirement for the formally Managed Network 2008 Second phase suggested that consolidation of services could achieve potential annual savings of between £250-500 million 2009 UK Pathology identified as a work stream within the Quality Innovation Productivity and Prevention (QIPP) programme Department of Health (2006) Report of the review of NHS pathology services in England (Chaired by Lord Carter of Coles).London: Department of Health. Department of Health (2008) Report of the second phase of the Review of NHS Pathology Services in England (Chaired by Lord Carter of Coles). London: Department of Health.

North East of England TeesPath (2000) – ‘collaborative clinical partnership’ within the Tees valley (South Tees, North Tees, Darlington and Durham. N.E. Pathology Network (2009) 8 Trusts consolidation of 15 laboratories Consolidation of services has had a major impact across the region in conjunction with improved IT infrastructure such as ICE order communications. Significant investment in capital equipment via numerous Managed Equipment Service (MES) contracts Significant investment in new facilities Pathology Centre QE Gateshead, Specialist Emergency Care Hospital in Cramlington

Pathology Modernisation in the N.E. England Trust Laboratory Services Northumbria Healthcare NHS Foundation Trust Wansbeck, Hexham, North Tyneside & Northumbria Specialist Emergency Care Hospital Newcastle upon Tyne Hospitals NHS Foundation Trust RVI, Freeman Queen Elizabeth Hospital Gateshead Queen Elizabeth, Sunderland & South Tyneside County Durham & Darlington NHS Foundation Trust University Hospital North Durham, Bishop Auckland & Darlington North Tees and Hartlepool North Tees & Hartlepool South Tees NHS Foundation Trust James Cook University Hospital & Friarage Hospital Northallerton

Internal and External Barriers Relationships with clinicians damaged Lack of convenor to manage change Increasing operational complexity Previous “heavy handed” approaches left apprehension in system Delayed result turnaround times Lack of capital for investment in reorganisation costs Resistance from staff, loss of income increased travel etc. Excessive savings as the driver for change Loss of income to Trust Lack of Trust and poor relationships between neighbouring Trusts Higher priorities for Trust boards Lack of managerial capacity Lack of understanding of Pathology Karakusevic, S. et al (2016) The Future of pathology services, London Nuffield Trust

Carter report 2016 Reduction in ‘unwarranted variation’ Save at least £5bn from the annual spend by acute hospitals of £55.6bn in 3-4 years. Pathology providers are considered productive if the cost of pathology to the trust is less than 1.6% of operating expenditure. Data gathered suggests a two fold variation in current costs from 1.1% to 2.4% Skill mix variation - within the N.E. compounded by variation in staff banding particularly with regard to ‘run through’ banding or auto-progression of BMS staff between grades 5 and 6

We recommend all trusts should achieve the acute pathology model hospital benchmarks (1.6% target) by April 2017, or have agreed plans for consolidation with, or outsourcing to, other pathology providers by January 2017. They should be required to introduce the pathology quality assurance dashboard recommended by the Review of Pathology Quality Assurance. NHS Improvement should also publish guidance notes for forming collaborative joint ventures and specifying Managed Equipment Service contracts for local adaptation by October 2016. Taking all this into account there is an opportunity for the NHS to save around £200m in the provision of pathology. Carter, (2016) Operational Productivity and Performance in English NHS Acute Hospitals: Unwarranted Variation DoH London

Sustainability and Transformation Plans (STP) Move away from ‘fortress mentality’ to establish a place based system of care in which they collaborate with other NHS organisations and services to address the challenges and improve the health of the populations they serve. https://www.kingsfund.org.uk/publications/place-based-systems-care

Collaborative approach ‘With a shift to place based planning it is possible that systemic collaboration between sites will deliver greater benefits than consolidation into larger-scale centres’ Karakusevic, S. et al (2016) The Future of pathology services, London Nuffield Trust

Current Pathology Service Model N.E. England North East England Regional/Specialist Centres Referring Laboratory Specialist Centre Outsourced tests

Collaborative working model HENE Regional support for training STP, HSST Inter organisational training? On-call cover? Win-Win relationship!! Regional/Specialist Centre Referring Laboratory Outsourced test Manage and co-ordinate a portfolio of outsourced tests? Reciprocal transfer of tests?? Specialist Centre laboratory North East England

Regional Collaboration Regional collaboration needs to ensure a high quality, low cost, competitive service. Requires appropriate infrastructure, logistics, IT and supply chain management to ensure best value and economies of scale – Some form of lab to lab link is essential to this development. Requirement to be innovative to keep ahead of the market ‘invest to save’ in staff, training and technology. Requirement to positively engage with partners and develop mutually beneficial relationships both regionally and nationally Regional collaboration is potentially a Win-Win relationship - Strengthens regional laboratories to develop specialist services, whilst at the same time provides a quality, cost effective pathology service which will ultimately benefit patients across the N.E. England and beyond.

Questions? christopher.shaw@nuth.nhs.uk