• Trusts in process of forming pathology networks amid efficiency drive
  • Number of fully operational networks lower than expected so far
  • But NHSI praises trusts’ pace and change 

NHS Improvement believes acute trusts’ efforts to create regional pathology networks have been “impressive”, despite the number of fully operational collaboratives being half of what was expected so far.

Five of 29 proposed networks are operating at the required scale. Last September, NHSI said it expected a third of all networks to be “fully operational” by April 2019.

Twenty networks are at the strategic outline case stage. This includes 13 networks which are also “well into” the creation of outline business cases.

Speaking at an HSJ webinar earlier this month, NHSI’s pathology lead David Wells said he “welcomed the pace and change” from trusts, and added he was seeing a “level of engagement from the sector that [he had] not seen before in [his] entire career”.

NHSI has not specified which five networks are fully operational. 

‘A really complex change’

The scheme started in September 2017 when NHSI ordered every acute trust in England to network their pathology services with neighbours. Trusts were placed in networks proposed by NHSI, and told to pursue a “hub and spoke” model where high volume and complex tests are processed at one trust while the other organisations only run pathology services that are essential to their hospital’s work.

However, several trusts, including Lewisham and Greenwich, East Sussex Healthcare Trust, and acutes in Hertfordshire, have proposed different networks. Other regions, including Lancashire, have struggled to agree on a model.

“We’re confident that, in the next few months, we’ll start seeing more of these networks come into being,” Mr Wells said.

“This is a really complex change and we’re asking people to work in a way they have not worked before.”

An NHSI spokeswoman added yesterday: “We continue to be impressed with the commitment and pace of change demonstrated by trusts and networks.”  

The regulator hopes to save £200m through the project by 2021. Asked about progress against that target, Mr Wells said: “We’re on track in terms of where we see savings to be realised.

“We must acknowledge the fact that to form networks you still have to invest some cost in some parts of the system and as the networks form we have to balance up the cost improvement programmes and realising the efficiencies.”

He said NHSI’s savings forecast from the scheme had been “validated completely” by the business cases networks have drawn up. He hinted £200m may be a “conservative” figure.

The NHSI spokeswoman added one network is predicting savings of £26m during the next five years, while others are seeing their average cost per test drop by a fifth.

Agreeing the right model

Addressing the issue of networks and trusts wanting different models, Mr Wells said: “We have defined a model that is hub and spoke, but that’s not the only model and we know that.

“We’re happy to receive alternatives that meet the ambition.

“There are some large sovereign organisations which will say ‘I need to maintain control of what services I can provide’.

“We’ve been through a process of iteration so we’ve given trusts the ability to see who they should best partner with, but partnering is what they must be doing.

“No trust can remain an island. The way diagnostics will be delivered in the future means that is not a sustainable model.”

Mr Wells said some networks are looking at a “distributed hub”, which would involve “certain disciplines at certain sites” rather than full centralisation.

However, he cautioned against running “complete distributed models” where centres buy together but do not change their delivery model, because “that will just store up problems for the future” if there are changes to the work coming in from primary care.

“We’re after a design of the future service and it’s got to be able to absorb that future change,” Mr Wells said.

The capital question

Asked about capital funding for the scheme, Mr Wells said no extra cash would be available through the project, but he added: “We have been trying to signpost people to where capital does exist.

“Some of these costs are costs that can be returned on a business basis. We know where networks have sourced the funding themselves they tend to be more successful in terms of delivery.”

Mr Wells said a “pathology quality assurance dashboard” would be issued to trusts in “a couple of months”, which would help them better understand how their pathology service is performing.

He stressed that, while his team has predominantly focused on getting trusts’ chief executives on board with the changes, it remains key for networks to engage with their clinical staff to ensure the “subject matter experts have a voice”.

Click here to view the full HSJ webinar (requires registration), which was run in association with Clinisys.

Article updated at 11.38am on 26 April after incorrect reporting of NHSI statement.