“Pathology Modernisation”

Ken BarrQIPP Network Director – North Mersey

Merseyside & Cheshire Pathology QIPP Network

www.networks.nhs.uk/nhs-networks/merseyside-cheshire-pathology-network

Why ‘modernise’ Carter and QIPP – 20% saving required in 4 years Good for patients, profession and... Good for finance – reducing PbR and direct access New technology – better, more accurate, quicker Opportunities for cross NHS working Share rare skills and technology/capacity Commissioners/GPs want a top notch accessible service – fit for

purpose and VFM Limit risk – growing private sector interest ‘Any willing provider’ - competition

Pathology Network: Merseyside and CheshirePopulation Served ~ 2.4m by 12 Trusts

Pathology Network

9 Trusts on 14 sites (incl. Warrington and STHK) 3 x Acute FT, 4 x Specialist FT, 2 x Acute Population served ~1.7m 5.7m requests pa = 26m tests 1,030 staff Direct budget £64m (09/10) QIPP savings target £14m

Latest Network Configuration

South SectorObservers

Wirral,Countess of

Chester

East SectorObservers

St. Helens & Knowsley

Warrington & Halton

North Mersey Sector

Aintree, RLBUHT,LWH, Alder Hey,

TWC, LHC, COCH,SONHST

Network Vision & Progress

“To provide an efficient and effective Pathology service for

our population that is patient focused and clinically led,

delivering measurable quality and performance that is

continually improving”

Singly managed

Hub & spoke model

Clinical leadership

IT connectivity

Pathology Board

Time to be bold and brave?

“Don’t be afraid to take a big step if one is indicated. You can’t cross a chasm in two

small jumps”

David Lloyd George

Multiple Hub – local needs

Many organisations

Single organisation

Business Case

Single managed network with single identity/employer

Remove historic organisational barriers and deliver services to population/GPs

‘Carter consolidated model’ – hub and spoke concept

Flexibility to reuse/rent space as available and affordable

Explore options for single business structure

NHS host, social enterprise, JV

Centralise multi-discipline, automated, non-urgent testing

Improve standardisation, quality, efficiency based on agreed TAT

Centralise specialist and sub-specialist services

Cost benefit analysis to include access to peer support, R&D, training, MDTs etc.

Clinically led integrated services

Respond to population/patient needs - improve access & patient experience

Increased efficiency

Reduce direct spend from £64m to £50m over four years (>20%)

Enablers: IT, Estate and Transport

• IT is vital to making the network viable – investment required

• Two way IT communication needed – order comms/L2L

• Sample tracking, specimen control, collection times, stats etc.

• Transport may require temperature regulated vehicles

• Needs to be flexible based on zones and ad-hoc capability

• Specialist companies available – need scaling

• Estate clearance house – inform hub opportunities

Biochemistry – Spoke Tests

Alanine transaminase (ALT)AlbuminAlkaline phosphataseAmmoniaAmylaseAspartate transaminaseBilirubin (total and conjugated)Blood gases and lactate (use ward-based instruments)BicarbonateCalcium[Cortisol]Carboxyhaemoglobin (ward)ChlorideC-reactive proteinCreatine kinaseCreatinineDigoxinEthanol (alcohol)GlucoseHuman chorionic gonadotrophin[Iron]

LithiumMagnesiumOsmolalityParacetamolPhosphateSalicylate[TFTs]Total protein[Transferrin]TroponinUrateUreaCSFGlucoseTotal proteinXanthochromia screenUrineCreatinineOsmolalityPotassiumPBGSodium

Copyright of Kent & Medway Pathology Network

Haematology ~ 3m tests

Urgent FBC and coagulationRoutine FBC and

coagulationFull Blood Transfusion

serviceESR GFST

Sickle screensMalaria investigations

B12 & Folate Hb Profile

G6PD Immunophenotyping

Bone Marrow Asp CSF Cytospin CytochemistryThrombophilia

LUPUS Factor assays (exc FVIII)

Plasma Heparin (Xa) HIT screen

Platelet AggregrationsMTHFR, Leiden, PTGM

HUB (60%)

SPOKE (40%)

Urgent FBC and ESR Urgent coagulation

Full Blood Transfusion serviceSickle screens

Malaria investigations

Copyright Kent & Medway Pathology Network

Next Steps

New return of cash releasing plans to DH on 7th January 2011

Develop Service Spec with external management support

by March 2011

CEO decision on business model/delivery method

by April 2011

Estate hub/spoke options by Trust/discipline

Commence consolidation during 2011/12

Meaningful consultation/communication with staff and stakeholders

To commence once CEOs have approved implementation

Project team to develop and deliver implementation plan 2011-2015

April 2011