• NHS Improvement sets out pathology reconfiguration plans 
  • Scheme aims to save £200m from NHS’s £2.2bn spend on pathology tests
  • All 105 hospitals providing pathology services to retain labs

NHS Improvement has outlined plans to create 29 pathology networks across England in a bid to save £200m – or nine per cent of the total spend – as part of work to implement recommendations set out by Lord Carter.

The regulator is asking trusts to develop a business case for how they will achieve their share of the efficiencies via networking and, if necessary, outsourcing.

NHSI wants to link the 105 individual hospital pathology services together through the centres, to create networks which will each serve populations of between 1.5 million and 2 million.

The centres will run as a “hub and spoke” model, where the “hub” will be the lead provider, where complex and high volume tests are processed, while the “spokes” will provide more routine hospital laboratory services.

Click here to see which trusts will become pathology “hubs” for their network.

It follows the gathering of two years’ worth of pathology data, which revealed “continued unwarranted variations” in how rapidly and efficiently services are delivered to patients, NHSI said.

The Carter review said consolidated pathology organisations were the most efficient, and recommended that trusts who were unlikely to hit pathology performance benchmarks should outsource their service.

Dr Suzy Lishman, chair of the Pathology Alliance, said the networks would reduce the impact of current staffing shortages and welcomed the data collection.

However, while the proposals focus on acute trusts, Dr Lishman said the needs of the “whole health system” should be considered - including primary care and specialised services, which are outside the scope of these proposed networks.

The plans were unveiled in a letter on 8 September to trusts’ chief executives and pathology leads from Jeremy Marlow, NHSI’s executive director of operational productivity.

NHSI said analysis shows that the 105 hospitals with pathology services complete 1.12bn tests per year, at a cost of £2.2bn.

The regulator wants to shave £200m off that cost by 2020-21.

Within each network, the “hub” will provide “state-of-the-art technology and innovative services”, NHSI said.

The networks have been divided across the country as follows:

  • London (five networks).
  • Midlands and East (eight).
  • North Midlands (three).
  • North (five).
  • South (eight).

In his letter, Mr Marlow said “cross network arrangements” will be necessary as the plans include restricting the number of sites used for the most advanced investigations such as genetic and molecular techniques.

Professor Tim Evans, national director for clinical productivity at NHSI, said every hospital would retain its own lab.

Trusts have been told to respond by 30 September with confirmation that they agree with the composition of the proposed pathology network. Trusts disagreeing will have to set out their evidence to NHSI.

All network partners must agree on a timetable for rationalising its pathology services, and form a project team to deliver a strategic outline business case, a governance structure, and an engagement plan setting out how patients and the public will be kept informed.

NHSI has set a target of 31 January 2018 for networks to confirm that the trusts’ board has agreed on a partnership or outsourcing model.

Dr Lishman said: “Networks will reduce the impact of the staffing shortages currently seen in many areas, although investment in staff and their training remains a key component of any successful service. Sufficient numbers of appropriately skilled professionals are vital to achieving the aims of the programme.

She added: “It is important that data is as accurate as possible so that comparison between networks is meaningful and any savings recognised. Investment in pathology services must not be cut before the benefits of a networked approach can be realised.”

NHSI reveals nationwide pathology network plan