Hampshire & Isle of Wight Pathology Consortium Dr John Wood - PowerPoint PPT Presentation

Hampshire & Isle of Wight Pathology Consortium Dr John Wood Managing Director

Where are we? Hampshire and Isle of Wight 2

Hampshire and Isle of Wight Population 138,500 Population 500,000 Population 400,000 3

Vision “To have a high quality, cost effective and efficient pathology service which comprises a consortium of NHS laboratories which will change their services to reduce costs of provision by 20% by 2015-16 to the benefit of all Trusts. The consortium will develop effective service models, logistics, IT and monitoring services, with or without third party involvement, to offer different products and services to our customers, attracting further business opportunities which will be shared for the mutual benefit of our partners in the consortium”. • Single organisation • Single management team • Single income and expenditure account • Existing income maintained • Sharing of benefits Hampshire & Isle of Wight Pathology Consortium Programme 4

Programme Structure National QIPP work stream Shaping the future executive Regional Enablement Group SHIP Board of Commissioners REG IOW SRO PHT SHIP Commissioning B Vearncombe K Baker M Hackett R Toole Dr S Ward Project Board Quality Clinical Lead Project Manager Finance Manager R Simpson Dr C James Dr J Wood K Perry Finance Directors & Leads REG HR Clinical & Laboratory Leads from Project D Kennedy M Elmore each organisation Delivery Group Project Planner Leads of each Task & Finish Group S Shahid IM&T Blood Sciences Lead: G Hickton Lead Dr D Sinclair Logistics Microbiology Lead: L Thorne Lead Dr A Basarab Task & Finish Workforce and HR Groups Cellular Pathology Lead: M Elmore/R Simpson Enabling Lead Dr B Green Projects Quality/Standards Lead: Dr J Wood Pathology Development Group Commercial Legal Framework Lead Dr J Wood Lead: M Hackett/ Dr J Wood Phlebotomy Lead: R Simpson

Main decisions • Configuration of services? • Location of laboratories? • How the Consortium is going to work? Hampshire & Isle of Wight Pathology Consortium Programme 6

Organisational structure - Criteria • Quality • Operational – No drop in quality of current service – Maintain PCT and commissioner support – Maintain accreditation (CPA, UKAS) – Deter adverse publicity – Meet regulatory requirements (MHRA, HTA, HFEA) – Respond to political demands (DOH) – To respond to new legislation / directives / – Align service with local structures requirements – Respond to opportunities for research and – Provide results within a clinically relevant turn development around time – To ensure equitable treatment of service users across Hampshire &Isle of Wight • Finance – To ensure the service facilitates the patient – Achieve 25% cost reduction between Apr 2011 and pathway March 2014 – Support clinical services in the most optimal way – Reduction in costs to be delivered over three years – Minimise any service disruption (i.e. not all realised in final year) – No unnecessary duplication – Minimal capital/infrastructure investment – Ability to maximise utilisation of current staffing, • Sustainability their skills and competencies – Ensuring accessibility and choice for patients – Capacity to deliver the existing workload – Capacity to grow the business – Configure the workforce to meet workload requirements – Meet training requirements – Create opportunities to delivery further efficiencies into the future

Option Appraisal – Blood Sciences The preferred options for development as agreed by the senior Pathology teams were: Option 3a Essential Lab Services on all sites plus 1 x specialist centres and 1 x GP Hub All three options will be taken forward for evaluation. It is expected that specialist services such as paediatric metabolic biochemistry and screening services will remain on current sites. Provider A Provider B Provider C ESL ESL ESL ?Specialist laboratory GP Hub No 2 No 1

Option Appraisal – Microbiology The preferred option for development as agreed by the senior Pathology team was: Option 3 Minimal Services on all sites plus 1 x Hub laboratory for other work. It is expected that the 24/7 multidisciplinary blood sciences team will handle any microbiology work that requires urgent processing at the local site. Sample numbers will be very small. Provider A Provider B Provider C Minimum Minimum Minimum Hub laboratory

Option Appraisal – Cellular Pathology The preferred option for development as agreed by the senior Pathology team was: Option 3 All processing of samples to be carried out on a single hub site. Pathologists to remain on their own local site for cut up, reporting and multidisciplinary team (MDT) meetings. Some facilities required on local sites for booked frozen sections. There will be a requirement to create a hub laboratory capable of processing 80,000 histology and 80,000 cervical cytology specimens per year. Provider A Provider B Provider C Cut up Cut up Cut up Post Mortems Post Mortems Post Mortems Central processing laboratory Pathologist Pathologist Pathologist reporting reporting reporting MDT meetings MDT meetings MDT meetings

Location of services - criteria • Site services • Location – Flexible work area with ability to absorb – Location which gives minimal sample workload increases travelling time for the area served (for un- spun blood samples: objective of 4 hours – Able to expand in the future maximum from “vein to result”) – Sample reception area must be sufficiently – Good access to road networks and large to be able to deal with workload (CPA Motorways C1.2 & E5) – Regular links (road, rail and sea) – Costs of any modifications – Ease of travel/parking for staff – Space compliant environmentally (e.g. Air temperature, water, drainage) – Ability to receive goods/equipment • Finance – Facilities for staff (CPA C2) – Short implementation time – Facilities for storage (CPA C4) – Facilities for containment (CPA C5.4) – Minimal capital expenditure – Minimise unnecessary inter-site movement of samples • Commercial – Sufficient capacity to handle extra GP work (one or two GP hubs) – Ability to retain and grow the business – Minimal disruption caused by implementation Hampshire & Isle of Wight Pathology Consortium Project 11

Some would have liked! Current State Proposed State UHS UHS UHS UHS Blood Sciences Blood Sciences Blood Sciences Blood Sciences Histology Histology PHT PHT Histology Histology PHT PHT Specialist labs Specialist labs Specialist labs Specialist labs Blood Sciences Blood Sciences Blood Sciences Blood Sciences Microbiology Microbiology Microbiology Microbiology New born screening New born screening New born screening New born screening Cervical Cytology Cervical Cytology Cervical Cytology Cervical Cytology Histology Histology Histology Histology Microbiology Microbiology Microbiology Microbiology IOW IOW Cervical Cytology Cervical Cytology IOW IOW Cervical Cytology Cervical Cytology Blood Sciences Blood Sciences Blood Sciences Blood Sciences Microbiology Microbiology Microbiology Microbiology Histology Histology Histology Histology Hampshire & Isle of Wight Pathology Consortium Project 12

Future state UHS UHS Blood Sciences ESL ESL Specialist labs Specialist labs PHT PHT • Hub based at PHT Histology Histology Blood Sciences Hub Blood Sciences Hub • ESL at IOW and UHS Microbiology Hub Microbiology Hub • Specialist laboratories at UHS New born screening New born screening Cervical Cytology Cervical Cytology Cellular Pathology IOW IOW • Histology processing hub at UHS Extended ESL Extended ESL • Consultants based on local sites • Local cut up, frozen sections and diagnostic cytology • Cervical cytology screening hub at PHT Microbiology • Contracted out to Public Health England (PHE) • Hub based at PHT • ESL at IOW Hampshire & Isle of Wight Pathology Consortium Programme 13

Issues requiring resolution • Information Management and Technology • Logistics (sample transport) • Legal entity • Contracts • Staffing requirements • Equipment requirements Hampshire & Isle of Wight Pathology Consortium Programme 14

IM&T = Major issue HOSPITAL A EPR A EPR Result LIMS A PMIP LAB A Result Sample GP A

Hub laboratory HOSPITAL A HOSPITAL B EPR B EPR A EPR Result LIMS A LIMS B PMIP Result LAB A LAB B Sample GP A GP B

Single LIMS solution HOSPITAL A HOSPITAL B Single LIMS EPR B EPR A EPR Result LAB A LAB B PMIP Result Sample GP A GP B

Logistics Route 1 UHS – PHT – UHS Route 2 PHT – IOW – PHT Ten runs per day Three runs per day Hampshire & Isle of Wight Pathology Consortium Programme 18

Workload Blood Sciences – Central v local Samples come from numerous sources • In patients • Out patients – Some from medical oncology • General Practitioners (GP) • Specialist referred work • Commercial sources – clinical trials Local Central Emergency department 100% 0% Inpatient 100% 0% Outpatient 10% 90% GP 0% 100% Hampshire & Isle of Wight Pathology Consortium Programme 19