FINANCE: Documents seen by HSJ reveal NHS London is proposing to make financial bail-outs conditional on trusts signing up to its plans to shake-up pathology.

Following a review of pathology lab costs across the acute sector by Deloitte, a report to the SHA proposed making trusts “demonstrate that they are taking all reasonable steps to deliver their efficiency programme before financial support is considered”.

The document, presented to NHS London’s delivery group meeting on 27 June and released under the Freedom of Information Act, also said: “NHS trusts will be instructed not to undertake new procurement exercises until the local networked pathology model has been explored. Foundation trusts will be encouraged to be fully involved in the local network, as the benefits of the remodelled service will increase with the size of the network.”

The project proposes that each of London’s six primary care trust clusters has one core laboratory, with local laboratories in each acute hospital.

A planning document said: “To ensure that collaboration is achieved, savings at a system level will need to be shared through an agreed mechanism, ensuring that local hospitals do not bear the brunt of rising unit costs from the loss of non-urgent secondary care and direct access testing.”

Trust data submitted to Deloitte indicated a potential saving across the capital of £135m in the £423m sector if outlying clusters can be brought down to the average unit cost of £2.94 in the capital.

The data for 2010-11 shows wide disparities in unit cost, with Ealing Hospital, which saw 3.8 milllion procedures, having a unit cost of 71p. Lewisham Healthcare Trust, which performed a similar number of tests, had a unit cost of £2.68.

The report said another £41m could be saved with “consistent end-to-end sample tracking, a London formulary and demand management”.

A project initiation document said cluster area pathology plans should be ready no later than October.