Region rejects regulator’s efficiency proposal

The West of England Pathology Network – which comprises acute NHS trusts in Bristol, North Somerset and Gloucestershire – is set to explore three other pathology reconfiguration options instead of a proposal put forward by NHS Improvement.

In autumn 2017, the regulator told the NHS to create 29 networks of trusts in which high-volume pathology services are centralised at one site – often the biggest provider in the area – leaving only essential services in operation at neighbouring trusts.

However, the WEPT network scored NHSI’s proposed model lower than the “do nothing” option when assessing its options in the autumn. The highest scoring option was a “virtual hub”, in which the network centralises some specialist testing, and possibly IT and/or training, but with all laboratories remaining in use.

NHSI has previously said it is open to networks delivering their own model if they can put an equal or stronger case forward, and a spokesman reiterated this to HSJ when asked about the WEPT network’s decision.

The regulator is targeting £200m worth of savings from the networks scheme by 2021, and it suggested the WEPT network could save £8.2m by centralising pathology services at North Bristol Trust.

But the network’s board said that number has not been validated. Its members agreed that “wholesale adoption of the NHSI-recommended model was unlikely to meet the needs and aspirations of local providers” – according to a business case drawn up by project leaders.

Deborah Lee, chief executive of Gloucestershire Hospitals Foundation Trust and the network’s senior responsible officer, told HSJ several organisations in the network have “invested in buildings, equipment and other technologies in recent times, and the network is mindful that any future model must be cognisant of these investments if it is to demonstrate overall value for money”.

She added the network’s geography, which spans three sustainability and transformation partnerships (Bristol, North Somerset and South Gloucestershire; Gloucestershire; and Bath and North East Somerset, Swindon and Wiltshire), is also an “influencing factor” as the network is “characterised by considerable distances between some organisations and North Bristol Trust”.

Ms Lee added: “Organisations [must be] confident that there are considerable additional benefits associated with a single hub that cannot be achieved equally well through other models which offer additional benefits associated with the proximity of pathology staff to patients and other clinical colleagues.

“Given the significant change implications of the NHSI model for pathology staff and the clinicians that rely on timely diagnostic tests and results, the scores were derived from the assessment of a range of criteria by individual member organisations.

“Helpfully, NHSI acknowledges that local circumstances should be a key consideration in determining any future model alongside the NHSI benefit case for full consolidation.”

After each member organisation assessed seven reconfiguration options, including the status quo and NHS Improvement’s proposal, the network put forward three models which will now be explored further – subject to each trust’s board’s approval. 

Along with the “virtual hub”, the other two options are a “distributed hub”, in which tests are consolidated at different sites with “sub specialisms delivered locally” and a “dual/twin hub”, in which two large laboratories do most of the pathology services, with only essential services run at the three remaining sites.

A decision on the network’s preferred option is expected in June. The network has allocated £100,000 to this work, but it has yet to appoint leads for procurement, IT and workforce – despite this being requested by NHS Improvement.

Ms Lee said the network “intends to recruit a small number of dedicated staff to key roles” in future. The network is also seeking a managed equipment service provider in a 15-year contract worth nearly £300m. 

Thirteen of 29 networks across England have yet to formally commit to new pathology models, according to a report published by the regulator in November 2019.

The proposals have prompted controversy in several areas, such as Lancashire, while no trust in Cheshire and Merseyside and South Yorkshire and Bassetlaw had formally agreed to a model as of late last year. 

NHS Improvement was invited to comment further.