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Myths and Mysteries of Creating Pathology Networks

Pathology services across the country continue to be under pressure to deliver more for less by forming networks, consolidating services and incorporating new tests, modern workflows and technologies. 

All these changes are happening while still delivering the best service possible for the patient, GP and Clinical Commissioning Group (CCG). The two-day programme at this year’s CliniSys National Summer Conference, brought together NHS, primary care, pathology leaders and IT in an absorbing agenda, providing delegates with insight and advice on how to support and deliver upon the very latest requirements.

Robin Morris Weston, CliniSys CEO, opened the conference by summarising the differing nationwide approaches to pathology delivery across England, Scotland, Wales and Northern Ireland. He also highlighted that similar challenges were also being seen across Europe and referenced the Paris network, which is the largest European public hospital group with 38 hospitals supporting 7 million patients. Robin also discussed the important role that Digital Pathology has to play in providing a solution to the reducing numbers of Histopathologists. Information Technology, and indeed CliniSys, is being seen as an enabler to many of the current challenges with CliniSys becoming the gold standard for Enterprise solutions for healthcare networks in the UK.
 

Robin then introduced David Wells, Head of Pathology Services Consolidation, NHS Improvement (NHSI) who gave and update to the Pathology Consolidation Programme.

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David Wells began by summarising the Pathology Consolidation Programme and stating that this is but the next step in a decade long journey. Pathology Service figures across England as they currently stand were detailed as:

  • 136 non-specialist acute trusts
  • 105 pathology providers
  • 1.12 billion tests
  • 7,000 full time equivalent staff
  • £2.2billion delivery cost

David continued by stating that the case for change has been identified through successive Carter reports and plans for Pathology consolidation across STPs/geographical clusters will unlock opportunities in the workforce to achieve greater efficiencies. Consolidation will also enable significant productivity improvements through economies of scale as well as driving up clinical quality through faster turnaround times, better access to sub-specialty expertise and access to new technology.

Figures show that a saving of c.£50 million can be achieved in the short term by targeting trusts with below average work rate efficiencies and achieving a staff saving of up to 10%. A further saving of c.£29 million can be realised if all trusts in a specific Category achieve staff efficiency in line with the top 25%.

David informed the audience that 119 trusts have now accepted the NHSI proposal with a further 14 trusts having accepted the network principle but suggesting an alternative configuration. Only two trusts are reported to be seeking to remain with their existing set up.

David concluded by highlighting the next steps, which include the Publication of pathology toolkit and National engagement with key stakeholders through the National Pathology Optimisation Delivery Group.

Dr Bill Bartlett, representing NHS Scotland Shared Services, was then handed the microphone to give the audience an introduction to the Scottish approach to Pathology Service Networking. Bill began by giving an outline of NHS Scotland, i.e.14 territorial boards, 2 special boards, 32 local authorities and 31 integration joint boards all servicing 5.3 million people. Bill described the current service model across Scotland as complex, having unnecessary levels of variability and not fit for purpose to facilitate cross board working and lab to lab communications.

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The current pathology configuration in Scotland of 27 laboratory locations supported by approximately 3,759  FTE staff with annual costs estimated at £251.6m was then detailed. Bill explained that NHS Scotland is moving towards a distributed service model for laboratory services which is expected to deliver significant benefits. The aim is not for centralisation but rather a functional distribution of laboratory resources that enables equitable delivery of high quality healthcare independent of location. Service distribution will be governed to support delivery of equitable access to healthcare  with the repertoire of local services, optimised to enable patient pathways, flow and capacity within the localities constituent boards and across Scotland.  

Benefits of this approach will see a reduction of variation and cost avoidance via a “do once and share” process and optimal use of capacity within existing infrastructures. Improved opportunities for workforce planning and training will also be seen with staff having the ability to work across boards and potentially across disciplines. The proposes architecture will also deliver a Scotland wide focus enabling more rapid deployment of new technologies that can adapt to changing local and national agendas.

Bill concluded by stating that without this service transformation, developments within the current model of laboratory service delivery will prove slow and difficult, compromising the existing service and undermining wider healthcare reform.

Amazon Web Services (AWS) is in a unique position to give insights into the future of cloud computing for health and social care and John Davies of AWS gave an interesting presentation on how cloud computing is enabling innovation in care delivery. Security is always the highest priority and moving data to the cloud offers an opportunity to review and implement new global scale security mechanisms. Leveraging the highly durable and cost-effective options for short and long-term storage inherent in cloud computing provides obvious benefits. Cloud computing also supports the latest trends whereby access to data sets across differing healthcare sectors is now achievable as well as the ability to analyse data with the capability to identify factors at national scales. 

John concluded his talk with an introduction to some of the latest Amazon developments and the uses for artificial intelligence. Amazon Rekognition is an exciting innovation for image recognition and analysis, which enables the search, verification and organisation of millions of images. The potential uses are vast such as the detection of inappropriate content and faced-based user identification. John gave a short demonstration of how it can be used for facial recognition and sentiment analysis. John then covered Amazon Polly, which turns text into lifelike speech using deep learning technologies to synthesize speech. The ability to deliver incredibly lifelike voices heralds a fundamental change and certainly a key reason why the Royal National Institute of Blind People use this system to support their membership.

Following a break for lunch, Dr Imran Sajid, GP and Healthcare Commissioner, (North West London Collaboration of Commissioning Group) with supporting contribution from Kathleen Frost (Commissioning Diagnostics Programme Lead) gave a fascinating presentation on what commissioners really want from laboratory medicine. He began with the challenging thought that current healthcare services do not necessarily equate to delivering improvements in health, and illustrated this point with the fact that circa 30-50% of medical practice is ineffective and around a third of requested pathology tests are unnecessary and/or inappropriate. He continued by exploring the false assumption that a diagnosis is beneficial to patient and population health, and that diagnostics will enable better containment of patient treatment and management in primary care, and consequentially alleviate the burden in secondary care.  

Commissioners are exploring new collaborative approaches to taking unwarranted cost/activity out of the system and the developing Accountable Care Organisations (ACO’s) may present opportunities for greater commissioner and provider collaboration. Decisions around pathology service optimisation must include clinical effectiveness, cost effectiveness and affordability and Imran reinforced the message that all stakeholders must take collective responsibility for controlling unsustainable growth and be proactive contributors in service redesign. Now is the time for active engagement and providers of laboratory services have the opportunity to contribute and participate in healthcare service transformation.

Richard Croker (Head of Medicines Optimisation and Lead for Pathology Optimisation, NHS Northern, Eastern and Western Devon Clinical Commissioning Group) then took up the baton and gave a personal view on how adding purpose to testing can improve patient engagement and reduce unnecessary anxiety and potential harm. He began with a brief case study illustrating how a patient recalled by their GP due to an “abnormal calcium”, resulted in unnecessary anxiety for a test that was undertaken with seemingly no purpose. He continued by exploring the year on year growth in pathology testing, highlighting that the volume of testing done on patients last year equated to a test  being done on every resident in North Devon, every 24 days and asked if all these test had “purpose”. Undertaking testing without due consideration as to purpose and validity may not only cause anxiety and patient harm, it can also consume NHS resources and incur unnecessary downstream costs. Richard concluded that Laboratory Medicine was at a crossroad, with pressure to reduce cost and increase efficiency but also recognising the opportunity to strengthen the “value” proposition with purposeful testing to improve patient care and outcomes and consequentially support more efficient and cost effective pathways of care.

The last guest speaker of the day was Simon Brewer form South West London Pathology. Simon gave a thought provoking and enlightening view on the myths and mysteries of creating Pathology Networks. His interactive session had the audience casting votes and polling opinion, illustrating some areas of strong agreement and others of divided views. Simon began by posing a number of the views and statements attributed to developing and established networks, and questioned whether they are fact or myth. He considered statements such as “We have already reduced our costs, we can’t do more” and “We offer a higher quality service” and challenged the validity of these. He also explored some of the common mysteries associated with creating networks such as:

  • are “state of the art” laboratories needed to enable consolidation?
  • is “clinical risk” considered a barrier to change?
  • is “counting” so difficult?
  • are the same things done so differently?
  • is sharing only on “our” terms?

Simon’s challenging themes and real time voting ended the day in a truly interactive session, creating discussion and debate which continued throughout the panel discussion and into the evening.

Robin invited the afternoon speakers to join the panel for a brief and active Q&A session before extending his thanks and ending the conference. 

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The second day of the conference provided delegates with a choice of topics and work-streams allowing them to select those of interest and directly relevant to their individual role or discipline. Some of the highlights included:

  • Dr Rizwan Malik, Greater Manchester collaborative imaging procurement technical lead gave an introduction to the Radiology consolidation programme in Manchester and gave a fascinating insight into the natural diagnostic marriage between Pathology and Radiology
  • Clinical decision support is being seen as an essential tool in supporting clinicians in requesting appropriate tests. Dr Steve Herman of Medcurrent demonstrated a new solution suitable for radiology and pathology that is available within the CliniSys ICE electronic requesting solution
  • Back by popular demand, John Ringrow from UKAS, gave an extremely useful presentation on ISO15189:2012, transition update and managing your schedule when accredited.
  • Nicola Newman of Berkshire & Surrey Pathology Service underlined the commercialisation of pathology in her presentation by detailing a recent project to install CliniSys’ Pathology Relationship Manager to improve relationships with their CCGs and user of their service.
  • The Carter recommendations do not just affect Pathology and Fiona Thow, Head of Imaging Services Transformation at NHSI presented how implementing Carter recommendations affect imaging services, which was of interest to pathology and radiology delegates alike.

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