Imperial College Pathology Services and North West London Pathology Modernisation Programme
PCPH November 2015 Stephen Snewin Interim Managing Director Pathology 2015
NWL Pathology 2 ICHT Pathology Service > 800 staff across combined 746 staff across combined Pathology Pathology
Over 16,000 samples processed daily
Total budget > £55£70 million
Distributed labs with ‘Hub and Spoke’
Consistent with Lord Carter’s report (main Autolab opened by Lord Carter)
Services spread across 4 sites and locations within those sites
Contract with Chelsea & Westminster Hospitaland West NHS Middlesex Foundation Hospitals Trust Pathology Service GPs represent approximately 28% of activity
Common IT system deployed
Established transport infrastructure
Accredited labs in all specialties
MHRA compliant for Blood Transfusion
Trust NHSLA level 3 attainment included pathology risk management Hub and Spoke Configuration
CXH Hub, building on Autolab CWH All GP and non-urgent work
Centralised Microbiology, virology Immunology, Special Chemistry SMH CXH HH Histopathology retained on Trust sites for now All sites have acute services with GPs Blood Sciences (Haematology, Transfusion and Clinical Chemistry)
Some specialist services on sites to support clinical services Pathology Modernisation
• £250million to £500 million savings per annum on a total pathology spend of £2.5 billion • NHS London report estimated that the reconfiguration of pathology • services in London would to be able to deliver an NPV of approximately £100m over 7 years • This highlighted the need to change from 27 laboratories to approximately 5 Hub laboratories that would carry out more than 20 million tests each. This would create between 4 and 5 pathology clusters in which Trusts were encouraged to collaborate.
NWL Pathology 6 CCG - Pathology Transformation
• Move diagnosis closer to the patient -Hospital service to primary care -Primary care to high street • Explore new ways of working • Improve access, convenience and choice • Deliver key national priorities • Improve efficiency, productivity ,quality • Empowered patient Geography
THH WMUH CXH HH CWH SMH
NWL Pathology 8 Vision Working together we can identify and deliver pathology services that are
Sustainable Cost effective And provide opportunity to
Pathology delivery
Single management team
9 NWL Pathology Commercial model • Ownership shares calculated on the basis of activity and revenues:
Organisation Business Share CWH 11% ICH 67% THH 15% WMUH 7%
• The business share represents the share of benefits and liabilities.
NWL Pathology 10 Commercial & contractual • Arms length organisation (ALO) • Hosted by Imperial College Healthcare • Contracts −Host to NWL Pathology partners −Partners to Primary Care (CCGs) −Host to 3rd parties
West London CCG CWH Central London CCG Suppliers H’smith & Fulham ICH ICH CCG THH
NWL Pathology NWL Ealing CCG Customers Hounslow CCG WMUH Hillingdon CCG
NWL Pathology 11 ICHT Three main sites:
Charing Cross Hospital, Hammersmith • Evolving to become a new type of local hospital, offering a wide range of specialist, same-day, planned care, as well as integrated care and rehabilitation services for older people and those with long-term conditions. Charing Cross Hospital will retain a 24/7 A&E appropriate to a local hospital. • Major redevelopment costs (of £150 million before inflation uplift as part of IMBC refresh) are included in the IMBC.
Hammersmith Hospital/Queen Charlotte’s & Chelsea Hospital, Acton • Building on their reputations as specialist hospitals, with strong research and education links. For Hammersmith Hospital, particularly with regard to renal, haematology, cancer and cardiology care, and maintaining the regional specialist heart attack centre; and for Queen Charlotte’s & Chelsea Hospital, with regard to a wide range of maternity, women’s and neonatal care. • Costs for small expansion and improvement (of £10 million before inflation uplift as part of IMBC refresh) are included in the IMBC. Additional work to be undertaken to explore options for additional redevelopment to improve facilities, enable possible expansion and tackle backlog maintenance.
St Mary’s Hospital/Western Eye Hospital, Paddington • Developing as the major acute hospital for the region, covering a wide range of specialties. Co-location of hyperacute stroke unit with 24/7 A&E and major trauma centre. Relocation of Western Eye Hospital to the Paddington site. Continuing to provide maternity, neonatology and paediatric services. • Costs for partial redevelopment to be included in the IMBC, with costs for a full redevelopment of the site to be included in the Plus integrated services and IMBCspecialist addendum, outpatients with that investment operating case to beout led of by eachthe Trust. site and additional local centres Other two main sites:
The Hillingdon Hospital a major hospital with all the services of a local hospital plus a 24/7 A&E and associated emergency surgery. It will also deliver complex medicine and surgery and have Intensive Care beds. It will have inpatient paediatric services and consultant-led and midwife-led maternity units, as well as a 24/7 Urgent Care Centre and outpatient and diagnostic services. • .
The West Middlesex Hospital remain a major hospital with all the services of a local hospital plus a 24/7 A&E and associated emergency surgery. It will also deliver complex medicine and surgery and have Intensive Care beds. It will have inpatient paediatric services and consultant-led and midwife-led maternity units, as well as a 24/7 Urgent Care Centre and outpatient and diagnostic services. Plus integrated services and specialist outpatients operating out of each site and additional local centres Institute of Precision Medicine
To develop investigation based disease stratifies to enable construction of decision trees for precise and personalised clinical management. • Cancer • Non neoplastic haematological disease • Infection and molecular pathology • Immunology • Renal disease • Metabolic Medicine • Rare diseases
NWL Pathology 14 Imperial West
• Imperial College is currently developing the Imperial West Site in White City. Discussions are currently underway with Imperial College to understand the opportunities and synergies that both NWL Pathology and Imperial College could benefit from if the pathology hub were located in the Imperial West science park.
NWL Pathology 15 Proposed configuration
Speciality Category Local Hub
Inpatient 100%
Out patient 10% 90% Blood Sciences GP 100%
Specialist tests 100%
Transfusion All work 100% Immunology All work 100% Serology virology Microbiology All work 100%
Frozen sections 100% Histopathology Routine 100%
Cytology All work 100%
NWL Pathology 16 Hot work
HOSPITAL A Diagnostic Cloud
Single LIMS EPR A Results Results
ESL
Sample WARD A
NWL Pathology 17 Cold work
HOSPITAL A Diagnostic Cloud
EPR A Single LIMS EPR Result
PMIP HUB Result GP A Sample
NWL Pathology 18 Charing Cross Hub Multi disciplinary automated MVH laboratory Services Chemistry, Haematology (incl specialist services) Chemistry (+andrology) Cellular pathology / Electron Haematology microscopy Blood transfusion Microbiology THH Immunology/Virology/Serology Chemistry Haematology Blood transfusion WMH HH CX
Hub Chemistry (+andrology) Haematology Blood transfusion Chemistry Haematology Blood transfusion CWH SMH Chemistry Haematology Blood transfusion Cytopathology
NWL Pathology 19 Benefits
Improved access to specialist tests Patients Improved experience for patients across the sector Cloud technology - sharing results sector-wide including community & GPs
Improved experience for learning – training and development Operations Improved resilience - Rationalisation of equipment, LIMS, structures
Savings and re-investment in services Financial Sharing clinical models of service delivery
NWL Pathology 20 Pathology future state
NWL Pathology 21 Tranformative infrastructure
22 Digital pathology
NWL Pathology 23 Business Intelligence
NWL Pathology 24 Patient Centred Pathways
NWL Pathology 25 POCT
NWL Pathology 26 Personalised medicine
NWL Pathology 27 Questions
NWL Pathology 28