• Around half of proposed pathology networks between acute trusts may change
  • Trusts across England discussing proposals
  • Regulator wants to save £200m in pathology reconfiguration
  • In full: How trusts in your area have responded

Less than half of areas have so far fully agreed to NHS Improvement’s plans to set up a regional pathology network, HSJ analysis has revealed.

Trusts in 12 of 29 areas have agreed to the regulator’s plans to establish pathology networks in a bid to save £200m by 2020-21, analysis by HSJ reveals.

Twelve networks have different memberships than proposed by NHSI or are still waiting for individual trusts to confirm membership – meaning they have not yet agreed to form as planned by the regulator.

Trusts in five areas still have no firm proposals and are in discussions about forming a network, despite a January deadline for plans to be submitted to NHSI.

A spokeswoman for NHSI said they are reviewing responses from trusts. She added “updated networks” will be published in “due course”.

In September 2017 the regulator published proposals for pathology consolidation, which has been a suggestion in two efficiency reviews by Lord Carter during the last decade.

NHSI’s plan is for the networks to run as a “hub and spoke” model, with complex and high volume tests processed at hubs, while more routine hospital laboratory services provided at the spokes.

Trusts were given until 31 January to provide written confirmation to NHSI that each trust’s board had agreed on a partnership or outsourcing model for their network.

A small number of networks build on existing arrangements between trusts, such as the Eastern Pathology Alliance in Norfolk and the North West London Pathology network, and require little or no change.

Several networks comprise trusts which were already involved in establishing networks, with business cases drawn up that predate NHSI’s proposals.

One example is in the Black Country where Dudley Group, Walsall Healthcare, Royal Wolverhampton, and Sandwell and West Birmingham trusts were already planning a pathology merger, but NHSI’s proposals for the network include Shrewsbury and Telford Hospital Trust – whose participation in the network is uncertain.

It is not clear what will happen to trusts left without a network.

In addition to driving the consolidation agenda, HSJ understands NHSI has set up a board with members of specialist trusts to explore if they can be integrated into the networks.

Jo Martin, president of the Royal College of Pathologists, said she was “not surprised” a number of the networks look set to change from NHSI’s proposals.

“Where patients’ clinical pathways are different to those in the original proposals the expectation would be that it must be more sensible to adjust the form of the network to reflect those clinical pathways,” she said.

“I think in general the profession realises there are financial pressures and changes are needed, but we want to make sure pathways and services are preserved.”

She added the process is being driven by financial savings, and stressed the importance of learning from previous attempts to consolidate pathology.

“To make a network effective you have to have decent IT and connectivity,” Professor Martin said.

“Around 30-40 per cent of laboratory information management systems across England are 30 years old.

“We have also been reminding NHSI about the importance of stability in the workforce. We know where there are big changes you don’t want staff to feel unsettled.”

  • List updated at 4.38pm on 28 February after North Midlands 2 network clarified its response. The network has not yet formally agreed to be established as planned by NHSI, and nothing has been finalised. 

NHSI pathology proposals agreed by less than half of trusts