What will be the impact of hub and spoke models on pathology?
Phil Bullock
Speciality Director, Pathology
Consultant Healthcare Scientist in Cytology
The impact of hub and spoke will be dependent on the model agreed. NHSI have given three options: their model as proposed (structure unspecified), a proposed alternative model, or outsource. Efficiency for highly granular pathology services would be optimised, if delivered through a discreet single entity pathology service provider outside existing management structures. Creating a network within existing structures across multiple trusts risks significant inefficiencies around management systems, governance, IT (a single LIMS is essential), quality management and transport. This could outweigh short-term efficiency from joint managed service contracts, centralisation of high-cost low-volume specialised testing, reduction in send out cost and pooling of management expertise.
An imposed solution, which fails to take these factors into account, and does not address key issues, such as alignment with patient pathways, engagement with commissioners and STP projects, support for novel testing solutions e.g. emergency care pathways in the community, staff recruitment, retention and training. It risks imposing further stresses on pathology services, which already struggle with these key issues within existing management structures.
A final impact is for services to ensure they are engaged with trust management and commissioners – the current service provision model and efficiency must be understood and that the consequences
of proposed changes are clear.
Angela Jean-François
Divisional Manager Infection and Immunity
North West London Pathology
For some services little impact will be seen, as some pathology services are already in networks/partnerships, while for others the impact will be bigger as services are reconfigured.
For patients, improvements can be seen in the quality and efficiency of services, enabling better demand management, standardisation of services, improving value for money and use of new technologies.
For staff, this can offer great opportunities for training and development and involvement in translational research. Logistics are key to the success of hub and spokes – with IT and transport playing essential roles.
Alan Lauder
Senior Biomedical Scientist, Microbiology
Mid Yorkshire NHS Trust
Pathology networks are a fine idea in principle. Some key benefits are the advantages to be gained in procurement of goods and services, harmonisation of methods and reports for consistency across the network, increased training and promotion opportunities and increased service resilience. These factors, if astutely managed, should drive up quality. This should be accompanied by a long-term review of staff mix and plans on how to achieve this. As always, however, there is a massive BUT.
To ensure this network operates and communicates efficiently, investment will be needed. The most obvious need is for a common IT platform across the network, so that results from Lab A can be viewed, reviewed and, if necessary, have further work ordered from Lab B.
Equipment, reagents and standard operating procedures will need to be agreed upon and harmonised across the network. There will be other significant costs involved (buildings and writing off old equipment, among others) and a significant increase in the numbers of samples being transported, requiring a comprehensive sample tracking system and arguably temperature control monitoring during transport.
Having been through the trauma of a three-way laboratory merger, I can testify that it is vital that staff working are kept informed, listened to and, if possible, actively involved. Massive investment in time, money and staff will make it work…the only problem is changes seem to be driven not by quality, but by cost-cutting.