The Future for Pathology Services in England

1. The Future for Pathology Services in England Dr Ian Barnes Head of Pathology, Leeds Teaching Hospitals National Pathology Adviser, Department of Health Edinburgh - November 2004

2. 2 Government Objectives High quality care Patient focus Building capacity Changing practices Delivering key national priorities and targets

3. 3 Drivers for Change Healthcare reform Healthcare demands Technology innovation Workforce issues Efficiency and effectiveness agenda Capacity Sustainability

4. 4 NHS Framework NHS Plan Shifting the balance of Power Keeping the NHS local  � a new direction of travel Reforming Emergency Care National Service Frameworks Choice agenda Plurality of providers

5. 5 Pathology in UK Independent working of laboratories in same area Lack of integrated planning Duplication of services Variable quality, practices and performance Variable cost / efficiency

6. 6 What is Modernisation? Services based on needs and effectiveness Optimal use of equipment, buildings, finance and personnel Accountability to users Patient-centred Integrated Efficient / effective Appropriate

7. 7 The Change Agenda for Pathology Multidisciplinary approach Partnership Dismantling professional barriers Changing working practices Focusing on outputs Whole service redesign Effective performance monitoring Appropriate use of services

8. 8 Pathology Modernisation Guidance How service redesign can help build the pathology capacity required to deliver key national priorities and targets Pathology managed networks, but not prescriptive Focus on outputs and quality Integrated planning SHA / PCTs

9. 9 Update National lead appointed Oversight Board appointed Work Programme being developed Networks being formed Diagnostics Agenda Capacity planning Plurality of Providers

10. 10 Oversight Group Disseminate key messages on modernising pathology Advise the DH Support sharing of good practice in pathology across the NHS Network with the MA and other key stakeholders Work with the diagnostics industry to support the uptake of new technology and effective POCT services Review progress

11. 11 Developing Work Programme Programme of SHA visits Co-ordinating pathology initiatives Working with professional bodies Working with the diagnostic industry Capturing / disseminating best practice Improving communications Website Newsletter Workshops / meetings

12. 12 MA website http://www.modern.nhs.uk/pathology http://www.dh.gov.uk Click on A-Z site index Click on �m� and go to Modernising NHS Pathology

13. 13 Pathology Redesign Project Joint MA / Pathology Modernisation Programme Manager: Ann Eason Local support for service improvement: Pre and post analysis Analytical phase Appropriateness of testing Supporting MDT meetings Clinical Lead: Professor John McClure

14. 14 Key Redesign Areas Forming networks Laboratory organisation / location Technology Information management Workforce Appropriate testing Performance indicators / outcomes Care / patient pathways

15. 15 Networks Pathlinks Leeds / Bradford Teespath Cumbria / Lancs East Kent North Trent Nottinghamshire

16. 16 Diagnostic Services Branch Concerns about poor access to diagnostic services resulting in long waits for patients No single central focus for diagnostic services Small team of 5, part of Access Directorate Remit to work across policy areas, with MA, NHS, Royal Colleges and others Focus is imaging, pathology, endoscopy and other diagnostic services

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18. 18 Independent Sector (IS) in the NHS NHS Plan IS Treatment Centres IS �service� contracts IS Diagnostics Centres Imaging Endoscopy Pathology

19. 19 Why IS Procurement? Slow rate of change in traditional NHS organisations Removing waits by increasing capacity Stimulus for change New approaches Changing practices

20. 20 IS Pathology Provision What can it offer? Services or tests? Buildings and equipment? Change management skills? Primary / secondary / esoteric pathology? What are the models? Joint venture / contracted out / other?

21. 21 What Choice Does for Diagnostics Patient choice will boost supply Encourage new provision of diagnostics service Patient-driven incentives to provide improvements in: Waiting times Convenience Patient experience Clinical quality

22. 22 Technology Development Technology Convergence Specialised Miniaturisation robotics - POCT automation - nanotechnology Consolidation IT Distribution Centralisation Information Knowledge Clinical need Patient need

23. 23 Pathology Locations Laboratories �Satellite� laboratories GP surgeries TC�s Pharmacies Retail outlets Self-testing Home testing Foundation Hospitals

24. 24 What Choice is There? TCs High Street Patient GP Test Other Public Laboratory What role for pathology?

25. 25 Pathology and PCTs Capacity planning Demand control Clinical indicators / NSFs Care pathways Performance targets Resource allocation Health Economics Efficiency and effectiveness

26. 26 The Future Lab Workforce Working in new ways, in extended roles and using skills flexibly Working with others, developing service delivery models and influencing care Challenging established practice Supporting learning opportunities, CPD and commitment to education and training Developing leadership capacity Recognised and represented in local NHS structures Actively participating in healthcare planning for local communities

27. 27 Changing Workforce x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x

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29. 29 The Way Forward Providing services when and where needed Networks Service redesign Challenging traditional practices Reprofiling the workforce Effective performance monitoring Driving national policies locally

30. 30 What�s Needed To Support Change Management support Resources Team Building Organisational development Vision / Plan Leadership Resolve Time Communication