Hampshire & Isle of Wight Pathology Consortium Dr John Wood - - PowerPoint PPT Presentation

Hampshire & Isle of Wight Pathology Consortium Dr John Wood

Managing Director

Where are we?

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Hampshire and Isle of Wight

Hampshire and Isle of Wight

Population 500,000 Population 400,000

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Population 138,500

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Vision

“To have a high quality, cost effective and efficient pathology service which comprises a consortium of NHS laboratories which will change their services to reduce costs of provision by 20% by 2015-16 to the benefit of all Trusts. The consortium will develop effective service models, logistics, IT and monitoring services, with or without third party involvement, to offer different products and services to our customers, attracting further business opportunities which will be shared for the mutual benefit of our partners in the consortium”.

• Single organisation
• Single management team
• Single income and expenditure account
• Existing income maintained
• Sharing of benefits

Hampshire & Isle of Wight Pathology Consortium Programme

Programme Structure

National QIPP work stream Shaping the future executive Regional Enablement Group REG D Kennedy Project Manager Dr J Wood HR M Elmore Project Planner S Shahid Clinical Lead Dr C James Finance Manager K Perry Quality R Simpson Clinical & Laboratory Leads from each organisation Leads of each Task & Finish Group Project Delivery Group Project Board Task & Finish Groups Blood Sciences Lead Dr D Sinclair Microbiology Lead Dr A Basarab Cellular Pathology Lead Dr B Green SHIP Board of Commissioners SRO M Hackett Pathology Development Group Lead Dr J Wood IOW K Baker PHT R Toole REG B Vearncombe SHIP Commissioning Dr S Ward Enabling Projects IM&T Lead: G Hickton Logistics Lead: L Thorne Quality/Standards Lead: Dr J Wood Workforce and HR Lead: M Elmore/R Simpson Commercial Legal Framework Lead: M Hackett/ Dr J Wood Phlebotomy Lead: R Simpson Finance Directors & Leads

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Main decisions

• Configuration of services?
• Location of laboratories?
• How the Consortium is going to work?

Hampshire & Isle of Wight Pathology Consortium Programme

Organisational structure - Criteria

• Quality

– No drop in quality of current service – Maintain accreditation (CPA, UKAS) – Meet regulatory requirements (MHRA, HTA, HFEA) – To respond to new legislation / directives / requirements – Provide results within a clinically relevant turn around time

• Finance

– Achieve 25% cost reduction between Apr 2011 and March 2014 – Reduction in costs to be delivered over three years (i.e. not all realised in final year) – Minimal capital/infrastructure investment

• Sustainability

– Capacity to deliver the existing workload – Capacity to grow the business – Configure the workforce to meet workload requirements – Meet training requirements – Create opportunities to delivery further efficiencies into the future

• Operational

– Maintain PCT and commissioner support – Deter adverse publicity – Respond to political demands (DOH) – Align service with local structures – Respond to opportunities for research and development – To ensure equitable treatment of service users across Hampshire &Isle of Wight – To ensure the service facilitates the patient pathway – Support clinical services in the most optimal way – Minimise any service disruption – No unnecessary duplication – Ability to maximise utilisation of current staffing, their skills and competencies – Ensuring accessibility and choice for patients

Option Appraisal – Blood Sciences

The preferred options for development as agreed by the senior Pathology teams were:

Option 3a Essential Lab Services on all sites plus 1 x specialist centres and 1 x GP Hub All three options will be taken forward for evaluation. It is expected that specialist services such as paediatric metabolic biochemistry and screening services will remain

• n current sites.

Provider A Provider B Provider C ESL ESL ESL GP Hub No 1 ?Specialist laboratory No 2

Option Appraisal – Microbiology

The preferred option for development as agreed by the senior Pathology team was: Option 3 Minimal Services on all sites plus 1 x Hub laboratory for other work. It is expected that the 24/7 multidisciplinary blood sciences team will handle any microbiology work that requires urgent processing at the local site. Sample numbers will be very small.

Provider A Provider B Provider C Minimum Minimum Minimum Hub laboratory

Option Appraisal – Cellular Pathology

Option 3 All processing of samples to be carried out on a single hub site. Pathologists to remain on their own local site for cut up, reporting and multidisciplinary team (MDT) meetings. Some facilities required on local sites for booked frozen sections. There will be a requirement to create a hub laboratory capable of processing 80,000 histology and 80,000 cervical cytology specimens per year.

Provider A Provider B Provider C Cut up Central processing laboratory Cut up Cut up Post Mortems Post Mortems Post Mortems Pathologist reporting Pathologist reporting Pathologist reporting MDT meetings MDT meetings MDT meetings

The preferred option for development as agreed by the senior Pathology team was:

Hampshire & Isle of Wight Pathology Consortium Project 11

Location of services - criteria

• Location

– Location which gives minimal sample travelling time for the area served (for un- spun blood samples: objective of 4 hours maximum from “vein to result”) – Good access to road networks and Motorways – Regular links (road, rail and sea) – Ease of travel/parking for staff

• Finance

– Short implementation time – Minimal capital expenditure

• Commercial

– Ability to retain and grow the business

• Site services

– Flexible work area with ability to absorb workload increases – Able to expand in the future – Sample reception area must be sufficiently large to be able to deal with workload (CPA C1.2 & E5) – Costs of any modifications – Space compliant environmentally (e.g. Air temperature, water, drainage) – Ability to receive goods/equipment – Facilities for staff (CPA C2) – Facilities for storage (CPA C4) – Facilities for containment (CPA C5.4) – Minimise unnecessary inter-site movement

• f samples

– Sufficient capacity to handle extra GP work (one or two GP hubs) – Minimal disruption caused by implementation

Hampshire & Isle of Wight Pathology Consortium Project 12

Some would have liked!

UHS PHT IOW

Microbiology Histology Blood Sciences Specialist labs New born screening Histology Cervical Cytology Blood Sciences Microbiology Cervical Cytology Blood Sciences Microbiology Histology

UHS PHT IOW

Microbiology Histology Blood Sciences Specialist labs New born screening Histology Cervical Cytology Blood Sciences Microbiology Cervical Cytology Blood Sciences Microbiology Histology

Current State Proposed State

UHS PHT IOW

Microbiology Histology Blood Sciences Specialist labs New born screening Histology Cervical Cytology Blood Sciences Microbiology Cervical Cytology Blood Sciences Microbiology Histology

UHS PHT IOW

Microbiology Histology Blood Sciences Specialist labs New born screening Histology Cervical Cytology Blood Sciences Microbiology Cervical Cytology Blood Sciences Microbiology Histology

Blood Sciences

• Hub based at PHT
• ESL at IOW and UHS
• Specialist laboratories at UHS

Cellular Pathology

• Histology processing hub at UHS
• Consultants based on local sites
• Local cut up, frozen sections and diagnostic cytology
• Cervical cytology screening hub at PHT

Microbiology

• Contracted out to Public Health England (PHE)
• Hub based at PHT
• ESL at IOW

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Future state

UHS PHT IOW

Histology Blood Sciences Hub Specialist labs New born screening Microbiology Hub Cervical Cytology ESL Extended ESL

UHS PHT IOW

Histology Blood Sciences Hub Specialist labs New born screening Microbiology Hub Cervical Cytology ESL Extended ESL

Hampshire & Isle of Wight Pathology Consortium Programme

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Issues requiring resolution

• Information Management and Technology
• Logistics (sample transport)
• Legal entity
• Contracts
• Staffing requirements
• Equipment requirements

Hampshire & Isle of Wight Pathology Consortium Programme

IM&T = Major issue

EPR A

HOSPITAL A LAB A GP A

Sample LIMS A PMIP Result EPR Result

Hub laboratory

EPR A

HOSPITAL A LAB A GP A

Sample LIMS A EPR B

HOSPITAL B LAB B GP B

LIMS B PMIP Result EPR Result

Single LIMS solution

EPR A

HOSPITAL A LAB A GP A

Sample EPR B

HOSPITAL B LAB B GP B

Single LIMS PMIP Result EPR Result

Hampshire & Isle of Wight Pathology Consortium Programme 18

Logistics

Route 1 UHS – PHT – UHS Ten runs per day Route 2 PHT – IOW – PHT Three runs per day

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Workload Blood Sciences – Central v local

Hampshire & Isle of Wight Pathology Consortium Programme

Local Central Emergency department 100% 0% Inpatient 100% 0% Outpatient 10% 90% GP 0% 100%

Samples come from numerous sources

• In patients
• Out patients – Some from medical oncology
• General Practitioners (GP)
• Specialist referred work
• Commercial sources – clinical trials

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Blood Sciences Workload – Central v local

Hampshire & Isle of Wight Pathology Consortium Programme

Workload requests IOW PHT UHS Totals Emergency department 12,030 42,304 39,460 93,794 Inpatient 44,057 205,026 250,804 499,887 OPD + Other 35,450 203,921 104,962 344,333 GP 104,466 489,979 424,243 1,018,688 Total 196,003 941,230 819,469 1,956,702 Workload requests IOW PHT UHS Totals Emergency department 12,030 42,304 39,460 93,794 Inpatient 44,057 205,026 250,804 499,887 OPD + Other 35,450 298,387 10,496 344,333 GP 104,466 914,222 1,018,688 Total 196,003 1,459,939 300,760 1,956,702

Before After

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Takt time calculations – Sample reception

Hampshire & Isle of Wight Pathology Consortium Programme

Calculate workload

Discipline samples per year Biochemistry 1,459,939 Haematology 1,107,809 Total 1,681,501 Samples processed per hour 52 Hours required to process 32,337 Weeks require to process (/37.5) 862 Staff required to process (/52) 16.58 Allow for annual leave (x52 /44) 19.60 Assume 80% efficiency (/0.8) 24.50

Calculate staff

Total staff = 24.5 whole time equivalents

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Analyser configuration

Hampshire & Isle of Wight Pathology Consortium Programme

System IOW PHT UHS Processing Power processor Power processor Power processor Biochemistry DxC 800 (2) DxC 800 (5) DxC 800 (5) Immunoassay DxI 800 (2) DxI 800 (2) DxI 800 (2) System IOW PHT UHS Processing Automate 1250 Power processor Power processor Biochemistry AU 600 (2) AU 5811 (1) AU 5822 (1) AU 600 (1) AU 5811 (1) AU 600 (1) Immunoassay DxI 600 (2) DxI 800 (2) DxI 800 (2)

Before After

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Commercial & contractual position

• Shared Services Organisation
• Hosted by UHS
• Legally binding contracts

– Consortium partners – Hosting services – Commissioners – PHE for microbiology

SHIP CCG CCG CCG UHS IOW PHT

H&IOW Pathology Consortium

PHE

Commissioners

Hampshire & Isle of Wight Pathology Consortium Programme

Hampshire & Isle of Wight Pathology Consortium Programme 24

Board structure & relationships to Trusts

Consortium Board Senior Management Team Managing Director Dr John Wood Quality Director Finance Director Clinical Director IOW Karen Baker PHT Ursula Ward UHS Mark Hackett UHS Dr Nick Marsden PHT Steve Erskine IOW Sue Wadsworth IOW Trust Board PHT Trust Board UHS Trust Board Partner Trusts UHS Host Services Pay & Rations Chair Tony Barron

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Financial headlines

Baseline income £22m Baseline spend £44m Net spend £22m Staffing 586 w.t.e. Recurrent investment

• Recurrent investments £1.9m p.a.

− IM&T £0.8m − SMT £0.4m − logistics £0.4m − hosting £0.3m

Recurrent savings Transitional costs

• Reconfiguration savings £4.8m p.a. by 2015-16
• Recurrent savings of £10.1m p.a. by year nine
• Major element of both providers and commissioners QIPP

plans.

• Significant one-off transitional costs of £5.4m

− Staff reconfiguration − Re-training − IM&T procurement and implementation

• SHA non repayable funding of £4.4m

Commissioners

• A reduction of 25% in the direct access tariff to primary care

− £2.8m p.a. already delivered − £1.3m p.a. by 2015-16 − £1.2m p.a. by year nine (tariff deflator of 1.5% p.a.)

Hampshire & Isle of Wight Pathology Consortium Programme

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Benefits realisation

Patient

• Opportunity for more responsive phlebotomy

service

• Improved access and choice to pathology
• Avoidance of unnecessary repeat tests
• Reduction of tests with limited clinical value
• Opportunities to support testing closer to

Patient Commissioner

• Reduction in direct access tariff (25%)
• No profit motive
• Collaboration to reduce activity levels
• Implementation of best practice
• Equity of provision (service level and tariff)
• Demand management

Clinician

• Supporting clinical pathways
• Right test right time
• Standardised reporting of results
• Harmonised units and reference ranges
• Improved access to clinical advice
• Access all results through a single LIMS
• Stabilised pathology service

Pathology

• Improved value for money 20% reduction
• Collaboration instead of competition
• Improved IT functionality

– sample track/trace – electronic coms

• Critical mass allowing new technologies
• More resilient workforce
• Shared consultant appointments

Hampshire & Isle of Wight Pathology Consortium Programme

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Breaking news

Where are we now?

Hampshire & Isle of Wight Pathology Consortium Programme