The must read stories and debate from Monday

Company wants NHS England to come clean

Without wishing to pre-judge the result of a court case, the background to the clinical waste market in the NHS is interesting.

SRCL, which is pursuing NHS England over what it says are £2.5m in unpaid bills, is one of several players in that sector.

Providers in that market say their margins have been pared right back by e-procurements, reverse auctions and a commissioner approach that puts cost saving over everything else.

SRCL, owned by US giant Stericycle, complain that this risks a return to the days of potentially dangerous clinical waste being dumped inappropriately, if the NHS commissions bargain basement suppliers.

Surprisingly, commissioners have some sympathy with this. HSJ was told the decline in Chinese demand for cardboard had meant lower rebates for suppliers (the waste firms), which then charged a higher price to the NHS.

Outside of the legal challenge, SRCL potentially has another card to play. It owns a significant proportion of the plants that burn this waste and turn it into energy. If it cannot sustain its clinical waste removal business, the implication is this will have an effect on the plants.

The company has also confirmed it will be exiting the patient transport business, which it also has a large stake in. ERS Medical in the east of England, which it owns, is a high profile casualty.

The science of reconfiguration

Times are changing fast in the world of NHS pathology.

The sector, which plays a part in 70 per cent of all diagnoses to NHS patients, faces a centralisation programme from NHS Improvement as part of the regulator’s drive to make Carter-recommended efficiencies.

In essence, the plan is to create 29 pathology networks across England, in which one or two trusts will provide the most high volume and complex cases while the others carry on with routine work.

NHSI have stressed that no trust will lose its lab, and the scheme comes with a £200m savings target by 2020-21.

But (and it is a big but) what will trusts, consultants and the lab workers make of this?

Some trusts will be forced to scale back their pathology services while their neighbour expands, which is likely to be a bitter pill for some to swallow.

This could easily be the case in the largest network in Greater Manchester, according to HSJ’s North West expert Lawrence Dunhill. He predicts unhappiness from East Lancashire Hospitals Trust at the prospect of services being moved to Lancashire Teaching Hospitals Foundation Trust.

It also remains to be seen if the Competition and Markets Authority – which has previously examined NHS pathology joint ventures – takes an interest, a scenario raised by competition expert Andrew Taylor.

Meanwhile, the response from the Royal College of Pathologists was mixed – with praise for NHSI’s data collection but doubts over the project’s timescale and savings target.

The college also pointed out that it and other relevant organisations had no input into the proposals, and engagement with pathology staff would be “vital” if the proposed networks are to succeed.