Pathology Modernisation: The Carter Report and implications Brian I. Duerden Inspector of Microbiology and Infection Control, Department of Health

The opportunity The past : 1970 – 2000 Now – infection matters again “Infection is conquered” A nuisance – impedes the modern medical success story Microbiology/IC sort it out! Now – infection matters again MRSA/C. difficile/HCAI Pandemic/avian flu; TB; BBV/STI The future: an Infection Service for the 21st century

Pathology Modernisation 1999 Modernisation of Pathology Services: Modernisation Funding HSC 1999/170; £10m June 2002 Pathology: the essential service (Draft guidance for consultation) February 2004 Modernising Pathology Services £9.1m revenue, £54m capital September 2005 Modernising Pathology: building a service responsive to patients Carter Review

IoM Report July 2006 August 2005 – May 2006 Report on DH IoM web page 20 meetings with SHA leads for Pathology Modernisation Jointly with HPA Regional Microbiologist Report on DH IoM web page

Network development Managed network operational 1 Managed network planned 1 well advanced; 3 proposed Formal network collaboration 6 Not single management/budget Planned formal network board in place 2; planning only 3 (1 SHA) Professional network 8 Review of Pathology Services 5 No plans 6

Modernisation funds IT investment 5 Service redesign 4 Equipment 7 Not allocated 16 Network IT programmes 7 In full or part

Network activities Transport – recognised but not actioned TB services Fully coordinated 2 Under review 10 Individual responsibility 6 Chlamydia Fully coordinated 4 Part coordination 1; funding problem 2 Under review 2 Molecular diagnostics 1

Problems Staffing On call services Distant site working Medical; biomedical and clinical scientists On call services Distant site working Funding – lack of! Both existing services and network development Commitment Foundation Trusts

Define what we provide for patient care and health protection Carter report – August 2006 Commissioned end-to-end core clinical service Stand alone service National specification/plan Contestability/competitiveness/plurality Economies of scale/rationalisation 10% gain Define what we provide for patient care and health protection

Key drivers Close to patients Streamlined around user requirements Competitiveness, plurality of provision Commissioner-led Clinical leadership, business infrastructure Productivity Information requirement Core clinical service

Barriers to change IT end-to-end connectivity Sample collection fragmented service Lack of commissioner understanding Logistic/transport support Variability of test repertoire Inconsistency of configuration Complex workforce/skill mix Lack of investment Separate point of care testing

Priorities for change National specification/plan Creation of stand-alone providers IT connectivity (including health protection) National reimbursement/tariff Large-scale workforce change – multi-disciplinary working Strong clinical leadership and management skills

Carter recommendations “Reform of supply of Pathology must precede commissioner-led provision” Managed pathology networks Free standing organisations Economies of scale NHS Trusts to have SLA for Pathology Commissioners draw up specification DH commissioning specification Tariff, new technology, workforce reform Standardisation, independent accreditation

Carter Pilots – 12 sites; £1m Objectives New commissioning model New organisational model Increased quality and responsiveness to patients Reduce NHS costs 1 per SHA (+2) Oxford in SE SHA

Progress November 2006 Pilots Project Board established Recognised need for inclusion of Infection Control Public health/Health Protection functions Data PH/HP investigation; CCDC support Specimens/cultures for typing etc Will have a national stakeholder group Inspector of Microbiology member

Actions for Microbiology IoM to provide national input based on ‘HP functions of NHS Labs’ HCAI programme Regional Microbiologist (HPA) to liaise with Pilot Sites Project leaders Microbiology laboratories Microbiologists in Pilot sites Ensure local input

Blue Skies Agenda

Vision and Goal *An integrated and cohesive, quality assured infection service for the clinical care of infected patients, infection control and health protection. *Investigation, diagnosis, treatment, control and prevention of infection

Workforce – trained professionals Medical – range of competencies; training Laboratory, clinical advice/care/infectious disease, infection control, health protection Biomedical/clinical scientists Nurses/nurse consultants Pharmacists IT specialists multi-professional teams In laboratories, clinical settings, hospital and community/primary care, health protection units (and even management and government)

Laboratory services Clinical Health protection Near patient testing diagnosis, treatment, infection control Health protection surveillance reporting, outbreak investigation, samples for reference testing Near patient testing Communication and IT Standards and SOPs Safety and biosecurity Accreditation Compliance: HCC annual healthcheck Code of Practice (HCAI)