Thirteen regions yet to agree pathology model

In a second annual update on a scheme to network trusts’ pathology services, NHS England/Improvement revealed 16 regions have formally agreed new models, which is three more than the 13 which had reached such agreements in September 2018.

However of the 147 trusts included in the scheme, 100 have formally agreed to the model proposed in their network, which is three less than last year.

This means some trusts which had formally agreed on a model last year, no longer do so. 

But Adrian Newland, chair of the National Pathology Implementation and Optimisation Delivery Board, said the programme is “on track to deliver 29 networks by the target date of 2021”.

NHSE/I wants all proposed networks to agree new pathology models, which will deliver at least £200m in savings by 2020-21.

Since September 2018, six networks of trusts have signed up to new models, but three other networks (North East and North Cumbria, Lancashire and South Cumbria, and South Yorkshire and Bassetlaw) which, having previously reached agreement, are now described as not yet having formally agreed to a model).

When the scheme was launched back in September 2017, NHSE/I hoped all the networks would achieve formal agreement by January 2018.

The 29 proposed pathology networks range from two to 12 trusts — including specialist trusts — and were each given a savings target, which NHSE/I now describes as “conservative”. Some networks were already fully operational, such as Eastern Pathology Alliance in Norfolk, and Berkshire and Surrey Pathology. 

The regulators envisage a “hub and spoke” model in most of the networks, where high-volume and complex pathology tests are centralised in one or two trusts — leaving the other trusts providing only those pathology services that are essential to the trust’s day-to-day running.

The plans have proven controversial in some areas, with the Royal College of Pathologists previously reporting concerns about the impact on staff and lack of investment in new equipment and IT.

NHSE/I’s report reveals there are currently two networks (Cheshire and Merseyside, and South Yorkshire and Bassetlaw) in which no trust has formally agreed to a model.

Cheshire and Merseyside is the largest proposed network with 12 trusts, but NHSE/I insist the network is on target to deliver at least £10.1m of savings by 2020-21.

Crucially, none of the trusts in the two networks are contesting their place in the network. The number of trusts which disagree with being put in their network has fallen from 14 in September 2018 to one (Shrewsbury and Telford Hospitals Trust) in November 2019.

Two trusts have switched from one network to another in the last year, the report reveals.

These are London North West Healthcare Trust (which switched from North West London to North London) and Lewisham and Greenwich Trust (South East London to East London).

Six networks only require the agreement of one trust to secure network-wide agreement.

NHSE/I are now asking networks to confirm their leadership teams for the programmes, which should comprise a senior responsible officer or chair, a clinical/medical director, network operations/integration director, procurement lead, IT and workforce leads, and programme manager.

Writing in the report, NHSE/I’s improvement director Hugh McCaughey said networks that have completed the transition from single-site operation to a networked model had seen their average costs per test drop by 20 per cent.

“Others have found ways to alleviate shortages of key staff, with access to a pool of 40 consultants to avoid delays to diagnostic results for cancer,” he wrote.

Last month, the Department of Health and Social Care announced a £50m capital funding pot from which trusts can bid for cash to scale up digital pathology, radiology and artificial intelligence capabilities.

HSJ asked NHSE/I what action it could take against Shrewsbury and Telford Hospitals Trust for contesting its network, and why some trusts had agreed on a model but were rated very badly on the prospect of achieving a network within the target — but the regulator did not respond.