NHSI Operational Productivity - Pathology Consolidation the state of the nation Presenters
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NHSI Operational Productivity Pathology Consolidation the state of the nation Presenters: David Wells, Head of Pathology Consolidation Date: Spring 2019
Improving the quality and value of NHS pathology
services
122 Pathology Workforce of 25 Processing 1.1 billion £2.1 billion delivery Data shows +£200m
providers thousand tests per year cost efficiency saving
NHS Improvement is working with trusts to • Pathology is essential in over 70% of patient pathways.
move towards 29 pathology networks across
England • High quality services, delivering timely results for
patients, will also support national priorities in genomics,
cancer care and integrated healthcare
• Currently there is national excess capacity in
equipment, yet we are seeing local workforce shortages
• Variation of non-pay costs in routine testing from 2p to
£1.26 per test
• Networking at scale allows for better value, better
utilisation of capital equipment, faster turn around times
where required and more opportunities for the
workforce to undertake extended roles.
• NHS Improvement is engaging with the sector, with
strong support for the hub and spoke model
2
By next year, the networks need to be operational and starting to deliver these quality and efficiency improvements.
Pathology
Covers all healthcare across prevention, screening, monitoring and diagnosis from before conception until post
mortem. All with appropriate clinical and scientific support for local clinical teams.
• Clinically lead service. Every result issued has
been monitored, reviewed or commented
upon by a medical clinician or state registered
(via HCPC) Biomedical or Clinical Scientist.
• Integrated access to sub-specialty expertise
available for community, primary, secondary
and tertiary at a single touch point. Scientists
all have a sub-speciality training, and have an
active role in many specialist MDT meetings.
• Accreditation and quality assurance integral
to service delivery. Pathology in the UK has
lead the way in clinical accreditation for more
than 20 years. UK system is the basis of the
current international accreditation standard.
• Keen technology adopters. Moving academic
and novel technologies into routine, safe,
clinical practice.
Networks & Consolidation with engagement
The programme is working in true partnership with the clinical and scientific community to deliver the right test, with the r ight advice at the
right time – utilising the right approach and technology via the National Pathology Delivery group (NPODG)
We are working with other colleagues in legal, procurement, finance. In addition with are also aligned and contributing to n ational
programmes for example Genomics, AMR, sepsis and digital / AI with NHS England, Public Health, and Office of Life Science
The benefits are:
Regulators • Driving up clinical quality, better for patient outcomes
- UKAS
- CMA • Faster turnaround times
- BIVDA • Right testing available at the right time.
Workforce
Clinical community
• Better access to sub-specialty expertise
- Unions such as
UNITE - RCPATH • Access to new technology
- Health Education - IBMS
England
• Improving service resilience
NPODG
• Efficient use of highly skilled staff. Right role, right person.
Providers
Commissioners
- Trusts
• Economies of scale and purchasing – linking into the current NHS Improvement
- NHSE
- CCGs
- Private sector Procurement teams and Category Tower provider using the NPODG to set the
providers
clinical standard and requirements for national purchasing
Suppliers
- Equipment
- Private sector • National excess equipment capacity, yet workforce shortages
operators
• Networking across wider geographies provides a solution to localised
recruitment challenges and development of advance scientific roles.
4
Outputs Described and enabling 29 Pathology networks: To set out the direction and ambition. Publication of clinical and operational advice in the form of toolkits: To share learning and provide consistent advice with agreement of the professional bodies and other ALBs Development of specialist testing networks: To ensure highly complex clinical services are sustainable and efficient, supporting faster access to sub-specialist clinical expertise Facilitating network workshops involving clinical and operational teams: To drive the pace of change to ensure local empowerment and ownership of networks. Development and launch of the National Pathology Quality Assurance Dashboard: To monitor and measure quality of pathology services clinically and operationally. To ensure good practice in adoption of national guidance, accreditation, training and education and also to ensure corporate good practice in monitoring supplier performance, quality of industry service delivery and provider interactions for new models of care (e.g Point of care testing in primary care). Identifying national funding and innovations: A Working with Office of Life Science to ensure innovation pipelines to digitise and adopt AI where clinical appropriate at pace and scale. Working with industry to identify disruptive technologies – for example drone delivery for blood samples, or point of care diagnostics to improve bed utilisation Collecting system wide data….
Data insights – Total costs
Model Hospital – Cost per test
Spring 2018: NHS Improvement pathology networks
Data insights - Accreditation
• 94% of Laboratories cite they are accredited
• Of those 35% state it is with CPA. 2% with ‘Other’
• The PQAD will look at number so tests being
provided unaccredited.
Data insights – Managing Demand • 20% of Trusts have no demand management in place • 28% of Trusts that do have passive demand management. • Work with one CCG demonstrated 10% saving could be achieved through targeting variation in testing targeting just the 10% highest requestors. • If that was applied nationally that would equate to a further £100m savings
Data insights
• 28% of Trusts have a digital pathology strategy
• Often linked with a partner trust or network.
• 9 different LIMS systems
• Multiple versions of each system
• 48% of Trusts have more than 20% of activity
requested by paper reports.
• 32% of Trust report more than 10% of their
activity on paper. (60% report some activity on
paper)State of the Nation
National Programme Updates
Progress so far:
State of the Nation follow up:
- All networks (barring two) have been written to
with follow up timelines and actions.
- 5 Networks working at the size and scale described
by NHSI.
- 21 Networks have an approved Strategic Outline
Cases (SOC).
- 18 Networks working up Outline Business Cases
(OBC)
- Q3 and Q4 Data collections available. Preparations
for the next annual collection is underway
Sub- committees: Microbiology and Histopathology ESL
- Pan UK Specialist Bone cancer group met.
- Awaiting feedback
- Blood Transfusion group met.
- Specialist testing and Digital and LIMS groups PQAD
convened. - Drafted – Comments sought on launch document
- Initial meetings will be to agree membership and
Terms of reference. NHS Digital – Unified Test List
- Broad agreement that these committees, via - First 350 lines of code delivered
NPODG, should be agreeing standards and
- NHS D working with NHE/I, PHE, RCPath
specifications which NHS Improvement will
- Seeking prioritisation list for next cohort of tests
mandate to providers and suppliers.
- Formal launch in April 2019 with next publication of
SNOMED CTNext steps for the sector
• It is important that networks are progressed at pace.
• Actions to support realisation of efficiencies, available immediately, should be taken now.
• Centres that have been identified as Essential Services Laboratories should begin to model
the transition to delivering this service model.
• Centres identified as hubs should be supporting the preparatory work to consolidate any
testing activity that can be moved in advance of further networking.
• It is vital that staff and subject matter experts are engaged at all stages of the process,
executive commitment is also essential in the next phase of developing networks.Next steps for NHS Improvement
• NHS Improvement will continue to support and guide the development of these networks,
ensuring that services are safe, effective, caring, and responsive.
• We will work with trusts in networks yet to become operational to jointly agree milestones,
establish what extra support they need and ensure local leadership (across trusts and
commissioners) is in place to complete or network becoming operational.
• Support progress at pace.
• Continue data collection and providing insight support to providers and commissioners.
• Release Pathology Quality Assurance DashboardPathology Quality Assurance Dashboard
The first iteration of the PQAD was launched in response to the Dr Barnes’
Pathology Quality Assurance review.
• This is a tool for individual Trusts to assess and manage
Health check the benefit Pathology services can deliver.
- SIs
- Staff turnover /
Sickness • It is not a contractual tool to manage the service
- Activity
Operational • Timely collection of appropriate data.
performance
Aspirational metrics
- TATs • Board visibility of system wide metrics that Pathology
- Logistics
has an impact.
• Support national initiatives
• Collecting data in one place, once.
Commercial /
procurement /
PQAD Quality and clinical
Innovation Governance • Benchmarking for some metrics to continuously drive
- Capital planning / - Accreditation improvement.
Contractual meetings - Adherence to
- Innovation and national standards
adoption planning • Innovation and Training, a method to and report and
support long term sustainability of workforce and
adopting advance and innovative roles and technologies.
People
Stakeholder
engagement - Training and
Education
- Clinicians and users
- Agency and locum
- Commissioners
use
15IT as the enabler
• Networks require a high degree of interoperability
• Digital Pathology (not just Cancer and Genetics….) will need the ability to work from
anywhere for anyone, especially the patient.
• Support progress at pace, as IT can be deployed in advance of physical re-location
• UK Plc is working towards a digital future that needs interoperable IT
• Better use of England’s (and the UK’s) expertise, supporting better training, access to sub-
specialists, and national expertise without creating new capacity – Network to Network
communicationThe Long Term Plan
Long Term Plan
Pathology:
Commitment for the Pathology networks, commitment for advanced roles:
3.60. The NHS will use its capital settlement to be negotiated in the 2019 Spending Review in part to invest in new equipment,
including CT and MRI scanners, which can deliver faster and safer tests. Broader reforms of the way that diagnostic services are
organised – including pathology and imaging networks – will also mean test results can be turned around quickly and staff time and
skills will be used most effectively, so that patients can have multiple successive tests in one visit.
5.28. Digital technology can support the NHS to deliver high quality specialist care more efficiently. Early examples of what will be a
much more profound shift include:
• By 2021, pathology networks will mean quicker test turnaround times, improved access to more complex tests and better
career opportunities for healthcare scientists at less overall cost. Mandated open standards in procurement will ensure that
these networks are ready to exploit the opportunities afforded by AI, such as image triage, which will help clinical staff to
prioritise their work more effectively, or identify opportunities for process improvement;
6.17 (iii) Delivering pathology and imaging networks to improve the accuracy and turnaround times on tests and scans will make best
use of the expanding workforce, and reduce unit costs. In 2018, seven Genomic Laboratory Hubs were established with mobilisation
towards consolidated provision. By 2021, all pathology services across England will be part of a pathology network and, by 2023, we will
have introduced new diagnostic imaging networks. The pathology networks will mean quicker test turnaround times, improved access
to more complex tests at a lower overall cost and better career opportunities for healthcare scientists and clinicians. The investment in a
new digital diagnostic imaging service will enable clinical images from care settings close to the patient to be rapidly transferred to the
relevant specialist clinician to interpret regardless of geography. This infrastructure will enable the rapid adoption of new assistive
technologies to improve and speed up image reporting, as well as the development of large clinical data banks to fuel research and
innovation.Long Term Plan Digital and interoperability • Create straightforward digital access to NHS services, and help patients and their carers manage their health. • Ensure that clinicians can access and interact with patient records and care plans wherever they are. • Use decision support and artificial intelligence (AI) to help clinicians in applying best practice, eliminate unwarranted variation across the whole pathway of care, and support patients in managing their health and condition. • Use predictive techniques to support local health systems to plan care for populations. • Use intuitive tools to capture data as a by-product of care in ways that empower clinicians and reduce the administrative burden. • Protect patients’ privacy and give them control over their medical record. • Link clinical, genomic and other data to support the development of new treatments to improve the NHS, making data captured for care available for clinical research, and publish, as open data, aggregate metrics about NHS performance and services. • Ensure NHS systems and NHS data are secure through implementation of security, monitoring systems and staff education. • Mandate and rigorously enforce technology standards (as described in The Future of Healthcare) to ensure data is interoperable and accessible. • Encourage a world leading health IT industry in England with a supportive environment for software developers and innovators.
Long Term Plan Cancer and Rapid Diagnostics centre Milestones for cancer • From 2019 we will start to roll out new Rapid Diagnostic Centres across the country. • In 2020 a new faster diagnosis standard for cancer will begin to be introduced so that patients receive a definitive diagnosis or ruling out of cancer within 28 days. • By 2020 HPV primary screening for cervical cancer will be in place across England. • By 2021, where appropriate every person diagnosed with cancer will have access to personalised care, including needs assessment, a care plan and health and wellbeing information and support. • By 2022 the lung health check model will be extended. • By 2023, stratified, follow-up pathways for people who are worried their cancer may have recurred. These will be in place for all clinically appropriate cancers. • By 2028, the NHS will diagnose 75% of cancers at stage 1 or 2.
Diagnostics – Current reactive
Current Infrastructure and service
Opportunity for faster better diagnostics
Opportunity for Remote co-ordination and delivery
Patient diagnostic pathway
Asymptomatic Symptom Observation Interpretation Diagnosis Treatment
Physiological measurement
Endoscopy
Imaging Network
Pathology Network
Genomics Laboratory Hub
Patient access point Care Centre
Use of ‘big-
data’ and
algorithms
Hub /
NPT / POCT Network Essential
services servicesDiagnostics – Future Pro-active
Future Infrastructure and service
Remote co-ordination and delivery
Patient diagnostic pathway
Pro-active Interpretation Diagnosis Treatment
Asymptomatic Symptom
Observation
Physiological measurement
Endoscopy
Imaging Network
Pathology Network
Genomics Laboratory Hub
Patient access point Care Centre
Use of ‘big-
Wearable
data’ and
tech / AI algorithms
Hub /
and
NPT / POCT Network Essential
Machine
services services
LearningDiagnostics to realise the LTP
Now Future Need
Lack of time Time prior to pathways Pro-active testing using big data risk analysis based
testing strategies
Lack of capacity Appropriate capacity Capacity that has flex and deployed at point of need
(not want). Clear equipment specifications and
framework/network purchasing agreements.
Lack of workforce Range of workforce skilled to deliver service need Development of new roles
working to top of licence Adoption of extended roles
Adoption of novel approaches to ensure availability
of skilled advisory services
Over provision of service (where it exists) Service provided on need (not want) Regional, networking approached to service
provision. Professional leadership to champion and
support change. Clear business continuity plans with
live capacity mapping.
Inequality of access to service Equality of access to service Defined what services require delivery (not how)
across the diagnostic pathway.
Lack of interoperability Complete interoperability at user interface Defined standards, defined codes, agreed diagnostic
protocols.
Variable service delivery Service delivery around standard specifications. Defined service specifications
Adoption and innovation lacks consistent evidence Innovation by exemplars leading and supporting Innovation exemplars, funding once for each
base and shows variable pace of adoption adoption. innovation, with requirement to lead adoption across
healthcare economy.
National Innovation pipeline.Questions?
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