Modernising Pathology Services
Modernising Pathology Services READER INFORMATION
Policy Estates HR/Workforce Performance Management IM&T Planning Finance Clinical Partnership Working
Document Purpose Best Practice Guidance
ROCR Ref: Gateway Ref: 1516
Title Modernising Pathology Services
Author DH Pathology Modernisation Team
Publication Date Feb 2004
Target Audience PCT CEs, NHS Trusts CEs, StHAs CEs, Pathology managers and staff
Circulation List
Description Best practice guidance describes how pathology service design, particularly through developing managed networks, can help build the capacity required to deliver key targets and commitments. Services should focus on patients’ needs, and be kept up to date for their benefit, through new, appropriate and properly evaluated technologies, techniques and tests.
Cross Ref Pathology – The Essential Service – Draft Guidance on Modernising Pathology Services
Superceded Docs none
Action required none
Timing
Contact Details Pathology Modernisation Team Area 423 Wellington House 133-155 Waterloo Road London SE1 8UG
For recipient use Contents
Foreword from Minister of State for Health, John Hutton MP 1
Executive Summary 3
Chapter 1: Introduction 7
Chapter 2: Next Steps Locally: Building Capacity 13
Chapter 3: Modernisation Strategies 22
Chapter 4: National Support for Local Action 32
Annex 1: Sources of Further Information and Guidance 36
Annex 2: Pathology Modernisation Guidance Implementation Group Membership 49
Modernising Pathology Services
Foreword from Minister of State for Health, John Hutton MP
Pathology services are essential to delivery of the high quality evidence-based treatments and care which patients receive in the NHS, yet much of the work that pathology staff do is often invisible to the patients that they serve.
I am therefore delighted that this document brings pathology services into focus as a key component of the modern NHS heralded by The NHS Plan.
The new guidance reflects our commitment to ensuring that pathology services are able to become a modern service able to respond to the future challenges posed by new scientific and technical developments, changing practice and changing public perceptions and expectations. The new approach to delivering these vital services will help us both to raise the profile of pathology and make more effective a service which provides an essential foundation for good clinical care. The development of new pathology networks and changes in the skill-mix of the workforce are crucial ingredients in this programme of change.
The implementation of Modernising Pathology Services will also be supported by a total of £9.1 million revenue and £54 million capital funding over the period 2003/04 – 2005/06, helping pathology services to expand.
John Hutton Minister of State for Health
1 Modernising Pathology Services
Executive Summary i The Department of Health launched a Pathology Modernisation Programme in 1999, with the key goals of improving the quality and efficiency of NHS pathology services and encouraging the introduction of new technologies and practices to deliver high quality care for patients. Between 1999/00 and 2002/03, capital funding of £28 million was invested in 39 demonstration projects across England. ii A consultation paper Pathology – The Essential Service – Draft Guidance on Modernising Pathology Services1 proposed future principles, goals and objectives for NHS pathology. The key change proposed was the introduction of managed pathology networks across NHS trusts as a model of service delivery to address the workforce and technology challenges facing the NHS. This document builds on the responses received. It sets out steps that can be taken locally to develop pathology modernisation strategies and describes action which will be taken nationally to support developments.
Next Steps Locally iii The steps proposed in this document will help the NHS build capacity to develop better pathology services as well as putting in place basic building blocks to support clinical services to meet key priorities and targets by:
• setting up a managed pathology network, or similarly robust mechanism, identifying local leaders, appointing and resourcing network managers and clinical champions
• reviewing local pathology services and establishing and promulgating implementation arrangements to achieve change and support local clinical and health protection requirements
• participating in audit of delivery and continuous quality improvement
• undertaking a workforce review and skill mix profile of the staff required to deliver improved services, linked to a training needs analysis to facilitate engagement with the workforce development arm of the SHA.
1 Department of Health. Pathology – the Essential Service – Draft Guidance on Modernising Pathology Services. London: Department of Health 2002
3 Modernising Pathology Services iv The key focus is redesigning services to build pathology capacity to support delivery of targets set out in Improvement, Expansion and Reform: the next 3 years 2. Advice on best practice for implementing change is described for both NHS and Foundation Trusts.
Modernising Strategies
vIt is recognised that managed pathology networks can provide a wider strategic context for pathology services planning. Modernisation strategies which will support service development are outlined including:
• integrating pathology into wider service developments
• redesigning systems
• decreasing inappropriate variation
• making effective use of IT and new technologies
• improving information management.
Next Steps Nationally
vi As part of a national focus to increase diagnostic capacity and support the NHS to implement change in pathology services, the Department of Health will set up an implementation oversight group. They will:
• disseminate key messages on modernising pathology
• advise the Department of Health on using funding resources for success
• support sharing of good practice in pathology across the NHS
• network with the Modernisation Agency and other key stakeholders to re-design pathology services
2 Department of Health. Improvement, Expansion and Reform: the next 3 years. Priorities and Planning Framework 2003-2006. Available at www.dh.gov.uk/planning2003-2006/index.htm.
4 Modernising Pathology Services • work with the diagnostics industry to support the uptake of new technology, new ways of working and effective point of care testing services
• review progress after the first year. vii A total of £9.1 million revenue and £54 million capital funding will be available to support this work over the period 2003/04 – 2005/06.3 As part of this funding, in 2005/06 each SHA will receive £100,000 revenue funding for project management to support pathology network development locally. In addition, during 2004/05 and 2005/06 the Department of Health and the Modernisation Agency will fund a programme manager to lead a project on pathology service redesign and modernisation. In 2005/06 the Department of Health will provide £325,000 to roll that work out nationally. viii This document has been developed with the advice of a Working Group, chaired by the Department of Health’s Pathology Modernisation Adviser, Dr Ian Barnes. Its membership is set out at Annex 2. We are very grateful to the group for the time they gave to developing this document. We are also very grateful to all who contributed to developing the consultation paper and to those who responded to it (names at www.dh.gov.uk/pathologymodernisation/commsdoc318june.pdf). ix Any comments or queries on this document should be addressed to:
Pathology Modernisation Team Department of Health Area 423 Wellington House 133- 155 Waterloo Road London SE1 8UG Email: [email protected]
3 Further information on allocations to SHAs and Trusts is at www.dh.gov.uk/nhsfinance.htm
5 Modernising Pathology Services
Chapter 1 Introduction
1.1 The NHS Plan set out a vision of services designed around patients and supported by a major programme of investment and reform. This document sets out how NHS pathology services in NHS and Foundation Trusts can offer an up-to-date modern service responsive to the needs of patients.
Defining pathology
1.2 The term pathology describes clinically-led diagnostic, laboratory and post mortem services based in NHS trusts. This includes direct patient care, interpretation and clinical liaison. The services cover a range of tests on blood and other human materials necessary for diagnosis and monitoring of a wide range of clinical conditions so that the appropriate treatment can be given; and the investigation of the reasons why people may have died and the care of their body if they do so whilst in hospital.
Services which pathology departments provide
1.3 NHS pathology services provide a range of important diagnostic support services to help primary, secondary and tertiary care clinicians, and diagnose and treat diseases and other medical conditions. 60%-70% of NHS patients’ diagnoses depend on laboratory tests. While services are currently mainly based in acute trusts, about 40% of work is carried out for patients whose conditions are managed in primary care settings.
1.4 Pathology departments also provide support functions, such as phlebotomy (blood collection), autopsy and mortuary services, as well as direct clinical care to adults and children with conditions such as haemophilia or immune system problems.
7 Modernising Pathology Services 1.5 Finally, NHS pathology services support:
• national screening programmes
• public health and health protection:
• communicable disease surveillance
• infection control in hospital and the community
• investigation and management of incidents and outbreaks
• monitoring of programmes
• service planning
• antimicrobial prescribing control
• blood transfusion and blood product usage
• local authority environmental health services
• Port Health Authorities
• education and training
• local, national and international medical research programmes.
Patient and public involvement
1.6 Pathology is a key interface in delivering services to patients yet often patients and laboratory staff do not come face to face. In some areas, there may be direct patient contact, but currently most pathology work is done in laboratories. More often staff see the clinical users of pathology services, such as hospital doctors, general practitioners and nursing staff. Pathology services may already have in place some processes and fora to involve users who are clinicians – surveys, multidisciplinary meetings, medical councils and clinical advisory groups. However, even here there is scope to improve user input in the design and delivery of pathology services. To include users who are patients, existing systems may need further work locally, to ensure that information from all users is used to help improve services.
8 Modernising Pathology Services 1.7 There are very few existing processes and fora to inform pathology directly about patient priorities and views and to stimulate dialogue. However, work has been taking place in this area in North East London. For more information, see http://www.nelwdc.nhs.uk
Pathology and diagnostic services
1.8 This document sets the direction of travel for NHS pathology services as part of the Department of Health’s wider work to modernise diagnostic services, which will co-ordinate and build on existing initiatives in the areas of imaging, endoscopy and other clinical support services, and will provide support to enable diagnostic services to be improved locally.
1.9 The pathology network model proposed in this document sets the pattern for the wider modernisation of other diagnostic services. Through successful examples of managed networks, workforce initiatives and technological support, the pathology modernisation programme will lead the way in diagnostics modernisation. National work to modernise diagnostic services will focus investment and regeneration across the entire service.
Pathology and genetics
1.10 NHS genetics laboratories are also being asked to consider options for reconfiguration. The White Paper on genetics (“Our inheritance, our future: realising the potential of genetics in the NHS” at http://www.doh.gov.uk/genetics/whitepaper) invited providers and commissioners of NHS genetics laboratories to take a strategic look at how their services might be organised to increase capacity and maximise quality. Options may include closer links with other pathology services.
Pathology and industry
1.11 The NHS Plan set the framework for the NHS to engage more constructively with the independent sector. The Plan made clear that such partnerships would not compromise the fundamental principles underpinning the NHS – that healthcare should be available on the basis of need and not the ability to pay. Quality improvements are essential elements of any such contracts.
9 Modernising Pathology Services 1.12 Traditionally NHS pathology services have worked closely with the diagnostics industry, which has a long-standing role in developing new technology, providing equipment and consumables, and developing and supporting IT systems. These arrangements support delivery of high quality services for patients. By working together, the NHS and the diagnostics industry can give patients greater choice in how and where they are tested, through innovative models of service delivery, and by developing new tests which can be carried out in quality-assured non-traditional settings. There will be new opportunities for pathology networks to engage with independent services, including hospitals.
Evidence-based medicine, research and development
1.13 Good quality evidence enshrined within the principles of evidence-based medicine is the foundation of high quality clinical care. Similarly, good pathology practice involves developing an inquiring and investigative approach, which will lead to new discoveries and a better understanding of disease processes.
1.14 To date, the evidence which underpins pathology testing has tended to focus on analytical performance, speed and cost of delivery rather than on the outcomes achieved by pathology investigation. The focus will need to change to address health outcomes derived from the use of the tests, for example, by defining a test’s performance in a variety of clinical conditions, evaluating clinical impact, assessing cost-effectiveness and how clinical decision-making is affected by provision of laboratory data. Key to this is understanding the type and quality of evidence required, and the gathering, evaluating and disseminating of evidence to promote good practice to improve health outcomes and quality of life.
1.15 Much of this work will take place in specialised laboratories before being rolled out across the NHS. Health communities will need to consider the interface with research laboratories in commissioning and developing services.
10 Modernising Pathology Services Autopsy and mortuary services
1.16 While the main focus of NHS pathology services is providing diagnostic services for living patients, they are also responsible for autopsy and mortuary services. There are many changes underway in this area, following publication of the Chief Medical Officer’s advice on the removal, retention and use of human organs and tissue from post mortem examination. This advice included 17 recommendations, which the Government accepted. An extensive programme of implementation is well underway. The Government has published the Human Tissue Bill and it is now progressing through Parliament. This will provide a consistent legal framework for all issues relating to the taking, storage and use of human tissues and organs. In the meantime, it is vital that the needs of patients and families are addressed and that the bereaved are comprehensively informed on post mortem practice, and treated with the utmost sensitivity.
1.17 As part of that work programme, the Department of Health is developing guidance for the NHS on bereavement services. Advice on good practice for staff working in mortuaries will also be developed and published as a web-based resource.
Improving pathology service accommodation
1.18 Health Building Note (HBN) 154, aimed at teams involved in the design and build of new pathology facilities, gives guidance on the planning and design of a hospital pathology service. This is currently being updated and will give guidance on the facilities required to deliver a comprehensive pathology service across primary, secondary and tertiary care. It will cover the issues involved in planning and designing facilities which reflect the latest developments and policy around modernising pathology services. Final guidance is scheduled for publication in early 2004.
11 Modernising Pathology Services Conclusion
1.19 Historically, pathology has been at the forefront of change in many areas of medicine and science; now the challenge is to deliver care to patients in new ways and new settings, building on technological and scientific developments and working with a plurality of providers. Technological developments – new equipment, information technology and communications – have opened up a wide range of possibilities for delivering this.
4 NHS Estates. Health Building Note 15 Accommodation for pathology services. London 1991
12 Modernising Pathology Services Chapter 2 Next Steps Locally: Building Capacity
2.1 Pathology services face a number of challenges in delivering high quality diagnostics for patients including:
• workforce pressures
• the impact of the EU Working Time Directive
• new scientific and technical developments
• growing demand, especially from primary care
• changing clinical practice
• growing development of new and expensive diagnostic technologies
• the need for more sophisticated information technology systems
• changing public perceptions and expectations of pathology services
• the effect of several recent reports on post mortems and organ retention and use
• new guidance on consent to treatment and use of tissue
• planned legislation and regulation on the taking and use of tissue
• data protection issues.
2.2 These challenges can also provide opportunities for change. Health communities have found taking an integrated, whole system approach helps:
• build diagnostic services around the needs of patients and their clinicians, seeing services from their perspective and enabling staff to work across organisational boundaries to deliver the highest quality care to all
13 Modernising Pathology Services • ensure that patients get appropriate treatment at the right time in the right setting
• ensure pathology services do not stand in isolation (particularly in enabling rapid access to diagnostics in A&E, critical care and primary care).
2.3 Effective pathology services are planned and delivered for the whole health community and determined locally. They may be based on an SHA or part of it; or, in some circumstances, a natural health community may cross SHA boundaries.
2.4 Building on the experience of cancer, coronary heart disease, diabetes and pathology networks in the UK and internationally, this chapter describes the organisational steps which health communities can take to build a high quality service. Elements include:
• setting up a managed pathology network, or similarly robust mechanism, identifying local leaders, appointing and resourcing network managers and clinical champions (from clinical services as well as within pathology)
• reviewing local pathology services and establishing and promulgating local implementation arrangements to achieve change and support local clinical and health protection requirements
• participating in audit of delivery and continuous quality improvement
• undertaking a workforce review and skill mix profile of the staff required to deliver improved services, linked to a training needs analysis to facilitate engagement with the workforce development arm of the SHA.
2.5 Changes in these areas will be supported centrally by the NHS Modernisation Agency and the Department of Health’s Care Group Workforce Teams.
14 Modernising Pathology Services Pathology networks
2.6 In developing pathology services, health communities can consider putting mechanisms in place to support delivering the standards and targets set out in Improvement, Expansion and Reform: the next 3 years and the National Service Frameworks. Such mechanisms should:
• engage all stakeholders, including clinical and other staff, managers and patients
• work across traditional service boundaries and models of care
• have clear lines of accountability
• demonstrate excellence in leadership and management.
2.7 Clinically-led pathology networks provide a means of translating these aims into practice. A network of this type will provide a structure for service planning and delivery, promote seamless care and support staff by targeting resources where they are most needed. The aims of such networks should be:
• integrated care
• improved clinical outcomes
• cost-effective services
• improved patient experience and greater choice
• equity of service provision
• cohesive contribution to health protection activities.
2.8 Experience has shown that the most effective networks are inclusive, bringing together all stakeholders, including patients and users of the service. While detailed arrangements should be determined locally, an example of who might be included in a pathology network is given in Figure 1 and a model of its possible role is given in Box 1.
15 Modernising Pathology Services Box 1
Planning: providing a strategic framework for developing services and ensuring investment is put to best use by the health community
Delivery: ensuring the financial, organisational and workforce resources are available and agreeing how best to use and share resources, ensuring that each organisation makes its agreed contribution to implementation
Leadership: providing strong leadership for delivery, focusing on the needs of patients and their clinicians for access to high quality diagnostic services at the right time and in the right setting
Information: ensuring that the implementation of Information for Health and Delivering 21st Century IT support for the NHS support change in pathology services to deliver clinical priorities, health protection information, and collating, analysing and feeding back clinical audit and benchmarking information about the services provided
Monitoring: tracking the delivery of services and achievement of key clinical priorities and targets, and reporting annually to PCTs and local people.
2.9 Experience also suggests that an effective network should cover a “natural” population. For pathology, this will need to take into account existing and planned clinical services in acute and non-acute settings, other clinical networks (such as cancer networks), and patient flows. Access to pathology services supporting specialised clinical services will also need to be taken into account, in line with the Specialised Services National Definitions Set5. The Department of Health has also published specific guidance on commissioning arrangements for specialised pathology services6.
2.10 Where a network covers the population served by several NHS trusts, it is good practice to build in accountability arrangements to ensure that decisions are implemented.
5 Available at www.dh.gov.uk/specialisedservicesdefinitions. 6 Department of Health. Guidance on Commissioning Arrangements for Specialised Services. London 2003.
16 Modernising Pathology Services Figure 1: Example of a pathology network
Informed by: • national standards • clinical audit and Health benchmarking data Protection Coroners Local • CHI/CHAI reviews Authority/ies Voluntary Agency sector and inspections (HPA) Patients • evidence
Other networks, eg. Cancer, Renal
Accountable to (host) NHS Trust (s) Managed Pathology trust, thence to Strategic Health Authority and PCT(s): Network Core Group Department of Health • health improvement • clinical care • commissioning specialist services • partnership working • primary care provision
Supported by Workforce • network manager Development • clinical champion(s) Confederation(s): • information • workforce planning management support • workforce development Clinicians Diagnostics Higher industry education
Input from client organisation is via CEO or nominated representatives.
Local leadership
2.11 Where pathology networks are set up, success is more achievable where a dedicated network manager and (a) clinical champion(s) are identified to lead change.
2.12 Clinical leadership will be crucial in building and sustaining professional ownership for modernising pathology services. Clinician advocates are important voices in a network to ensure that priorities and obstacles identified within pathology are aligned to diagnostic needs.
17 Modernising Pathology Services Reviewing local pathology services
2.13 When undertaking a review of local pathology services, networks will need to plan across the whole health economy, using standard methods. Money will be available to SHAs to carry out this work.
Audit of delivery and continuous quality improvement
2.14 Clinical governance (underpinned by a statutory duty of quality as set out in the Health Act 1999) is the local delivery mechanism for ensuring safe and high-quality care. Patient-centred care, effective risk management, learning from complaints, national and local surveillance, and clinical audit will be key elements. While this can be achieved in a number of ways, managed networks are a viable means of delivering continuous quality improvement.
2.15 To do so, pathology networks will need to develop robust local processes to monitor delivery and continuous quality improvement. They will also need to define key deliverables for their health communities in terms of:
• access
• responsiveness
• patient choice
• equity
• quality
• cost-effectiveness
• evidence base
• sustainability
• national service standards and targets, as detailed in Local Delivery Plans.
2.16 Pathology networks and commissioners of services will need to ensure quality oversight of pathology services outside the laboratory setting.
18 Modernising Pathology Services 2.17 To help pathology services and their health communities develop services and monitor the progress of modernisation locally, the Audit Commission will make available data as part of its Acute Hospitals Portfolio project, which carried out a national survey of pathology services in England and Wales over the summer of 2003. These data will be fed back to trusts between now and March 2004, with each trust receiving the results of a performance assessment by their local external auditor, drawing on this data, but also taking into account the local circumstances of the trust. The data, together with computer software to facilitate their use, will also be released to trusts (and other stakeholders within the NHS) once the data have been finalised. These data, alongside the local audit reports, should provide a useful tool in modernising services.
2.18 Laboratory accreditation is also a key part of improving quality. Until recently, enrolment for accreditation was voluntary for NHS laboratories, with the exception of cervical cytology laboratories. Laboratory accreditation systems are a key part of clinical governance and quality improvement in the NHS. Therefore, all NHS trusts should now ensure that pathology services locally are accredited or seeking accreditation with Clinical Pathology Accreditation (UK) Ltd (CPA) (or another relevant body accrediting to equivalent standards). Any laboratories which are not already accredited, or in the process of becoming accredited, should complete applications for accreditation as soon as practicable.
Re-profiling the workforce
2.19 Effective pathology services need enough staff with the appropriate mix of skills and competences, with strong leadership, who are well supported to deliver high quality diagnostic services for clinicians and patients, and to contribute to health protection. National initiatives for both the medical workforce (such as the SHO histopathology training schools) and the non-medical workforce are underway to develop the additional capacity needed in pathology. These will need to be complemented by local action across all the pathology disciplines.
2.20 A workforce plan developed to increase capacity to meet local service requirements agreed with those who are responsible for workforce planning and development locally can be worked up. It will need to reflect the national initiatives in:
19 Modernising Pathology Services • Agenda for Change
• Making the Change
• Improving Working Lives
• the Changing Workforce programme
• the EU Working Time Directive
• the National Occupational Standards Healthcare Scientist Project.
2.21 The workforce plan needs to reflect the particular requirements of the pathology service or network, encompassing all groups (both medical and non-medical) within the workforce which may be influenced by the labour market within the local community. An ideal plan would include the following components:
Service design/re-design – should take into account a review of workforce requirements in relation to the services to be delivered, and identify where skill mix and new ways of working can be introduced to support efficiency and effectiveness. These may include greater cross- disciplinary and multi-professional working.
Flexible staffing – this needs to take account of:
• the introduction of flexible working and shift patterns for 24/7 working or extended working days
• the application of the EU Working Time Directive for the whole pathology workforce (including doctors in training from 2004)
• the implementation of Improving Working Lives
• the introduction of changed or new roles to provide enhanced capability and capacity
• opportunities for greater cross-discipline working.
Flexible entry routes – to provide access to professional education and training and to support the introduction of skill mix and new ways of working, which would provide:
• opportunities to recruit from local populations and to reflect local diversity
20 Modernising Pathology Services • a skills escalator for the non-medical workforce linked to appropriate education and training programmes to allow the introduction of career pathways
• embracing and actively promoting return to practice initiatives
• providing access to specialist and higher specialist training and education, and providing continuing professional development.
New ways of working – opportunities for new ways of working in pathology include:
• providing improved and innovative support for medical consultants, allowing them to spend more time on diagnosing patients
• providing innovative re-training options for medical consultants through Conversion Fellowship schemes
• evolution of new roles for scientists
• re-examination of pathology functions and re-assessment of roles to staff lower down the skills escalator
• more integration into direct patient care/management.
21 Modernising Pathology Services Chapter 3 Modernisation Strategies
3.1 There are five key steps to modernising services:
• integrating pathology into wider service developments
• redesigning systems
• decreasing inappropriate variation
• making effective use of IT and new technologies
• improving information management.
Integrating pathology into wider service developments
3.2 Pathology modernisation best takes place in support of wider service developments and improvements. To achieve this, pathology services will need to:
• be part of local work to modernise diagnostic services
• integrate pathology into the wider health community, networking across health communities in a multi-disciplinary way
• adopt new relationships with commissioners, clinicians and patients, working within the framework of integrated care pathways
• use the knowledge base as effectively as possible
• embrace appropriate leading-edge technologies
• work effectively with primary care commissioners
• contribute to health protection activities such as surveillance and outbreak investigation
• re-profile the pathology workforce.
22 Modernising Pathology Services 3.3 Change needs to be linked both with national strategies and local plans for service improvement. Service reconfiguration in pathology will need to support other clinical networks and patient flows and to take account of commitments in the The NHS Plan and The NHS Cancer Plan and standards in the National Service Frameworks (NSFs).
Re-designing systems
3.4 There is already a diverse range of settings where pathology testing can take place (see below), and this range is expanding as patients demand improved access to services. Some aspects of pathology may benefit from being developed at a more local level, with others lending themselves to consolidation. For example, in A&E access to pathology testing is crucial to the rapid assessment and diagnosis of patients with urgent conditions. However, the absence of pathology tests out of hours can mean unwelcome patient waits. Similarly, lack of communication between primary and secondary care can further impair the patient experience.
Pathology Settings
• Hospital laboratories
• “Satellite” laboratories
• Wards and clinics
• GP Surgeries
• Treatment Centres
• Pharmacies
• Self-Testing
• Home Testing
23 Modernising Pathology Services 3.5 Providing testing services outside the acute hospital setting will depend on good networking with the hospital laboratory to be successful. Such networking fits well with Keeping the NHS Local – A New Direction of Travel. Ensuring that high quality services are available for clinicians and patients, staff skills maintained and technology and IT used effectively will depend on good quality management and quality assurance systems. Laboratory services already have long-established quality assurance systems and these will need to be extended to support diagnostic services offered outside the traditional acute hospital setting.
3.6 System redesign may actually be small-scale but can still have an important effect on clinical service delivery and the patient experience.
3.7 Maintaining and improving quality is a complex, continuous process. Networks will help to raise standards, support development of best practice and agree appropriate standardisation. A modern, developmental and consistent service will need clear planning and standards against which delivery can be monitored.
Appropriate testing
3.8 With the increasing need for rapid access to diagnostics in a variety of settings, there is an increased need for effective and appropriate testing. Demand management strategies will benefit from a variety of clinical decision-support mechanisms and research resources, including adopting new information management systems.
Decreasing inappropriate variation
3.9 While pathology in the UK is generally of high quality, there is variation in practice across the country. Some of this variation in practice is the result of genuine variations in case mix or justified variations in clinical practice. However, where it is not, the aim is to achieve a service with comparable standards of practice whatever the point of access for patients.
3.10 This can be achieved by standardising methodology and reporting across a pathology service. This has advantages for all involved, including:
• patients who will receive better care
• clinicians and public health/health protection practitioners supported by the service
24 Modernising Pathology Services • staff operating within the service
• pathology service commissioners.
3.11 Specifically, standardisation of Standard Operating Procedures (SOPs) across a network (or more widely) has significant advantages in terms of producing common standards of patient care and laboratory service, and saves considerable staff time by avoiding duplication of effort in drafting similar SOPs in many locations. The use of evidence-based guidelines is a way of decreasing inappropriate variation.
3.12 The following schema provides a detailed best practice approach for large or complex projects, but a simplified version may suffice for small or localised standardisation projects:
• Identify and define the problem Define the scope of the problem to be studied. Define the success criteria for the project, as well as the audit criteria for the procedure itself. Clearly defining the task and the objective at the outset reduces later misunderstandings, unnecessary effort, and rework.
• Identify the people who need to be involved Include staff involved in the service from all relevant locations where differences currently exist and who represent different views and approaches. Fair representation of the current diversity on the working group is essential, including representation of the various professions within laboratory medicine. Consider user representation and clinical representation from other departments within the trusts involved, depending on the specific problem under investigation.
• Review the evidence This may include an examination of the effectiveness of current procedures (outcome measures, cost-effectiveness etc), using existing data or data generated for the purposes of evaluation; published guidelines or standards from national or international bodies (e.g. National Institute for Clinical Excellence (NICE)); local policies and procedures and information published in the scientific literature or device evaluations produced by agencies such as the Medicines and Healthcare Products Regulatory Agency (MHRA). Visits to other laboratories or pathology networks may also provide useful information.
25 Modernising Pathology Services • Decide on the standard to be adopted When the evidence has been collected, define the ‘best practice’ or ‘best value’ option so that it reflects a consensus view and has the support of all involved. This process will require skilful facilitation and openness to new ideas, and even formal survey techniques.
• Decide if further consultation is necessary Generally, you should circulate the draft standards for wider consultation to ensure ownership of the procedures. The drafting group will need to meet again to review the results of consultation and revise the standards as appropriate. More than one round of consultation may be necessary. In a few cases, especially for limited projects where the standardisation group comprises all those affected, no further consultation will be necessary.
• Implement the standards Depending on the project, you may wish to pilot implementation of the standards before implementing them across the network. With other projects, particularly those involving processes which are closely linked across the network or which involve major procurement, piecemeal implementation will not be practicable. In that case, complete implementation will be the only option.
• Audit the effectiveness of the standards Review the effectiveness of the standards, protocols etc. after implementation against the objectives defined at the outset. This may involve study of specific outcome measures, audits or surveys of users or staff to ensure that the standard procedures are working effectively. The working group should review the audit data, make any necessary adjustments to the standards and re-audit. This is an ongoing process, which should take into account new evidence as it becomes available. Appropriately document the review process, including reasons why suggestions have not been adopted. Circulate the review documentation to the consultation group.
• Disseminate the results While it is necessary to review standards continually, when they have stabilised and been assessed as effective, disseminate the results in an appropriate format so that other networks can benefit from the exercise. This may involve publication of the results in scientific or management journals, poster or oral communications at meetings, or making data available on laboratory websites.
26 Modernising Pathology Services • Evaluation The process of developing standardised methods will identify areas where available evidence is inadequate to select an optimum method and where further evaluation is necessary. These areas will need prioritising and should lead to evaluation programmes, which may be co-ordinated and funded at the national level.
• Periodic review & quality management Regular formal reviews of standard procedures by senior staff are essential, in addition to informal assessments of their effectiveness. Laboratory quality management systems need to include appropriate document control systems, including draft and issue numbers of documents, dates of issue, amendment and authorisation, and lists of recipients.
Making use of new technology and IT
3.13 Pathology services are already well used to developing and adopting new technologies. They have long experience of pioneering and validating specialised tests which are eventually adopted as the standard diagnostic technique. Changes in technology will drive new ways of working and cross-disciplinary developments, such as the increasing use of molecular diagnostic techniques. There is also scope to maximise efficiency by sharing kit and equipment and supporting staff to work in a multi- disciplinary way.
3.14 Appropriate application of technology is an important consideration in developing new ways of working, including:
• delivery of services: centrally (e.g. specialist analyses in the lab) and locally (e.g. Treatment Centres, GP surgeries and other settings)
• transfer of information: between requester, analyst and interpreter
• automation of processes: improved turnaround and throughput.
27 Modernising Pathology Services 3.15 Rapid advances in technology across the health system are driving pathology modernisation but also have the potential to be a key means to accomplish the changes required. A modern pathology service will need to rely on a wide range of technologies to expand and improve its service. All managed pathology networks need to have a formal technology strategy in place. The strategy should focus on getting maximum benefit from emerging technologies, while also managing risks.
3.16 A technology strategy should monitor new opportunities as they emerge, assessing their relevance, costs and benefits, and harnessing and implementing them to benefit the service. Key areas to consider are:
• Developing pathology diagnostics Have in place systematic mechanisms to scan for promising technologies, assess their cost-benefit and integrate them as appropriate into the overall network plan. Strengthening relationships between the different parts of the network, and between networks both locally and nationally and commissioners, will allow development and technology transfer to proceed efficiently. Plan and implement in the context of the larger health economy, given the important links with advances in diagnostics and in information management.
• Improving access Link disseminated laboratory services as part of area network services, e.g. by remotely linking point of care testing with laboratories.
• Maintaining quality Carefully maintain the quality of a disseminated service and the introduction of new techniques. Staff should ensure that dissemination, including point of care testing, in no way diminishes the quality of analysis or record keeping the patient receives. High quality should be achieved across the network.
Any test performed anywhere in the network should provide comparable quality of information for clinical care and quality of data collection for epidemiological and health protection purposes. Where quality cannot be maintained or costs are inappropriate, dissemination may not be feasible. Send supra-network analyses to a laboratory with recognised expertise to achieve this.
28 Modernising Pathology Services • Cost-effectiveness Identify the clinical and economic benefits of disseminated services and balance these against the benefits of central laboratories within the network. A key issue will be convenience and accessibility for patients. Introduce and update new technology within the context of any wider local work to modernise diagnostic services.
• Demand management Consider the financial consequences of increased demand in introducing technology. Consider the resultant impact on staffing, training and the effect on quality standards as these factors affect the ability of technology to be harnessed appropriately. Regularly review and challenge demand and the technology used.
• Clinical governance/risk management Operate all pathology technology within the network through the pathology network management structures to ensure appropriate clinical governance and risk management.
• Standards Adhere to appropriate ISO, CPA, Medical Devices Regulations7, and other published standards which apply to pathology technology.
• Managing technology Consider the establishment of a local standing committee to consider how technology is used as part of any wider work to modernise diagnostic services. Ensure fair representation of service users (both clinical and patients), service providers and other stakeholders.
Improving information management
3.17 Improving the quality of information management and technology is crucial for successful patient-focused care. The National Programme for IT in the NHS focuses on the key developments that will make a significant difference in improving the patient experience and delivery of care and services. Of the four key deliverables, two will have particular impact on pathology: an Integrated Care Records Service (ICRS) and an underpinning IT infrastructure (NHSNet) with sufficient connectivity and broadband capacity to support the critical national applications and local systems.
7 SI 20002 No. 618. See also relevant MHRA guidance, e.g. DB2002(02) “The management of in vitro diagnostic medical devices” and DB2002(03) “The management and use of IVD point of care devices”.
29 Modernising Pathology Services 3.18 While laboratory computing has been at the leading edge of health information systems development for the past three decades, a patchwork of pathology systems has developed across the NHS. IT no longer has to contend solely with isolated laboratory matters, (e.g. instrument interfacing and data reduction technologies) but now needs to address externally driven needs, such as:
• Integrating across systems Integration across health communities - linking trusts, laboratories, non- traditional diagnostic sites, and disciplines within and across sites - will become increasingly important. The ability to exchange data rapidly on referred tests will enable the sharing of scarce resources and expertise.
• Integrating point of care testing There is increasing use of point of care testing. Systems will need to be put in place to ensure that results from point of care testing are collected into the electronic patient record and also captured for health protection surveillance purposes. Integrating such devices into pathology networks is now feasible and should be pursued to ensure effective quality assurance of the data generated by these systems.
• Clinical governance The importance of accountability is placing a new emphasis on value-added clinical outputs to support clinical governance, evidence-based care, decision support and performance-reporting, as opposed to traditional measures of purely workload and cost. Pathology information systems should be able to capture and report on relevant clinical outcomes to support surveillance, benchmarking and performance management.
• Managing services As services become bigger and more complex, information systems and information skills will need to develop to support management functions. Functions such as payroll and HR will be supported by the new corporate NHS systems. There will still be a need for local systems, for example, covering staff development, CPD and study leave across the wide range of disciplines and to support project management, costing and workload audit. Pathology services will need to consider plans to develop, purchase and maintain a full portfolio of such systems.
30 Modernising Pathology Services 3.19 Pathology services will need to work closely with key stakeholders locally on the implementation of the National Programme for IT, and ensure that new and more integrated ways of managing diagnostic information are developed to meet the increasing needs of pathologists, clinicians and patients. The following areas deserve particular attention:
• Managing IT Pathology services should ensure that they have a standing committee constituted which holds responsibility for IT Policy and system implementation. This committee should report directly to the more senior management board and should have executive responsibility of IT spending across the service.
• IT staffing & skills All pathology services should ensure that they have a sufficiently well-trained cohort of staff to support their information systems. All pathology staff should be in possession of the European Computer Driving Licence (ECDL) and IT staff should have additional IT qualifications commensurate with their level of responsibility.
• IT standards Integration of data across pathology will be achieved only if national standards are incorporated into laboratory systems and are adhered to by individual laboratories. Pathology services should therefore ensure that all systems, new and existing, are brought into line with current NHS standards. In particular, all systems should hold the NHS number as a key patient reference. For other data standards reference should be made to the NHSIA for each particular data-exchange.
• Renewing technology New information and communications technologies such as digital imaging, wireless networking and integrated telephony services should be actively evaluated and installed wherever they can be justified. Some disciplines may be poorly served at present and investment in new systems with appropriate functionality, safety, quality and performance, should be considered as appropriate.
• Building on the National Programme’s design arrangements and interfaces for the ICRS There should be appropriate recognition and assessment of risk factors and dependencies, so that these can be managed and monitored. This should be considered and planned for in early project stages. There should also be linkage with likely future ICRS arrangements for origin authentication (either domain or individual level, dependent upon business requirement), integrity checking and digital signing that will combine to underpin legitimacy and evidential value in electronic data / messages.
31 Modernising Pathology Services Chapter 4 National Support for Local Action
4.1 There are national programmes underway which will influence and support local modernisation of pathology services, including:
• national leadership for diagnostics/pathology
• investment
• support from the NHS Modernisation Agency for improving services
• workforce planning and development
• information strategy
• patient and public involvement
• support from the NHS Purchasing and Supply Agency (NHSPASA) in promoting best practice in procurement.
The NHS Modernisation Agency
4.2 The NHS Modernisation Agency (www.modernhs.nhs.uk) supports local NHS staff and their partner organisations in improving services for patients by focusing on four key areas:
• improving access – helping to provide fast and convenient services
• raising standards of care – improving the quality and safety of the patient’s experience
• supporting local improvement – building local capacity
• spreading good practice – helping everyone share their knowledge and learning.
32 Modernising Pathology Services 4.3 Building on publication of this document, the Modernisation Agency will develop a national framework for service improvement in pathology. As part of this initiative, the Agency has appointed a national clinical lead for pathology. The Department of Health and the Agency are also working together on a national project on service redesign in pathology. A national programme manager for this project will be appointed in April 2004 and the project will be rolled out nationally in 2005/06.
Paediatric pathology
4.4 The Department of Health will work with NHS commissioners and key stakeholders to help them define what is involved in delivering a quality paediatric pathology service.
Mortuary services
4.5 Advice on good practice for staff working in mortuaries will also be developed and published as a web-based resource.
Information strategy
4.6 The National Programme for IT in the NHS focuses on the key developments that will make a significant difference to improving the patient experience and the delivery of care and services. There are four key deliverables: electronic appointment booking, an integrated care records service, electronic prescribing and an underpinning IT infrastructure with sufficient connectivity and broadband capacity to support the critical national applications and local systems.
4.7 The Programme has been created specifically to manage the introduction of new NHS-wide applications and services. This represents investment of £2.3 billion in information technology for the NHS over the next three years and supports the vision of The NHS Plan. The Programme will have a significant impact upon how pathology services are delivered over the coming years. Further information can be found at Annex 1.
33 Modernising Pathology Services The NHS Purchasing and Supply Agency
4.8 The NHS Purchasing and Supply Agency (http://nww.pasa.nhs.uk) is able to support local NHS staff in making the most effective use of their resources by getting the best value for money when purchasing goods and services.
4.9 The Agency is pursuing a number of national initiatives which will underpin and support change locally. Key developments which will impact upon pathology managers in their current purchasing capacity and which the Agency can offer support or guidance are:
• standardising common processes – for example terms and conditions
• developing e-commerce and IT solutions for procurement
• developing appropriate intervention levels for pathology markets
• introducing a performance measurement framework
• linking to evolving managed pathology networks through the development of Supply Management Confederations.
4.10 A key aspect of supply modernisation is the establishment of Supply Management Confederations. These confederations will be able to offer support to emerging managed pathology networks in such areas as strategic sourcing, product and supplier rationalisation, stock management, supply chain management, information management, staff development, best practice and contracting.
4.11 Confederations will be trust-led and will encompass all NHS organisations (including PCTs) within the local health economy. NHS PASA working with SHAs will actively support these confederations and the links they develop with managed pathology networks.
34 Modernising Pathology Services National support for pathology
4.12 As part of our national focus to increase diagnostic capacity and support the NHS to implement change in pathology services, the Department of Health will set up an implementation oversight group. They will:
• disseminate key messages on modernising pathology
• advise the Department of Health on using funding resources for success
• support sharing of good practice in pathology across the NHS
• network with the Modernisation Agency and other key stakeholders to support redesign in pathology services
• work with the diagnostics industry to support the uptake of new technology, new ways of working and effective point of care testing services
• review progress in the first year.
Investment
4.13 A total of £9.1 million revenue and £54 million capital funding will be available to support this work over the period 2003-04 – 2005/06.8
8 Further information on allocations to SHAs and Trusts is at www.dh.gov.uk/nhsfinance.htm
35 Modernising Pathology Services Annex 1 Sources of Further Information and Guidance
Reference Summary Website
Policy Documents
Department of Health
Department of Health Here you will find the latest http://www.dh.gov.uk/ on the Department’s work, as well as health and social care guidance, publications and policy.
Pathology Modernisation Here you will find the latest http://www.dh.gov.uk/ on the Department’s Pathology pathologymodernisation Modernisation Programme and current initiatives.
National Service The National Service http://www.dh.gov.uk/nsf/ Frameworks Frameworks (NSFs) set national standards and define service models for defined service or care groups. NSFs are introduced in The New NHS and A First Class Service. The NHS Plan re- emphasised the role of NSFs as drivers in delivering the modernisation agenda. This website links to all the NSFs, but a selection are included below:
• The NHS Cancer Plan is a http://www.dh.gov.uk/ comprehensive strategy, cancer covering prevention through to palliative care, and including research,
36 Modernising Pathology Services genetics etc. The reorganisation of cancer surgical workload is being driven by Improving Outcomes Guidance (IOG) for individual cancer sites. The website gives access to the original IOGs, with more recent and future service guidance available via the NICE website.
• CHD NSF: was launched http://www.dh.gov.uk/nsf/ by the Secretary of State for coronary.htm Health on 6 March 2000. It covers all aspects of heart disease from prevention through surgery to rehabilitation.
• Diabetes NSF: aims to http://www.dh.gov.uk/nsf/ improve health outcomes diabetes/index.htm for people with diabetes by raising the quality of services and reducing variations between them.
• Renal Services NSF: sets 5 standards and identifies markers of good practice to help the NHS and its partners to manage demand, increase fairness of access, and improve choice and quality in dialysis and kidney transplant services.
Configuring hospitals in This website explains the http://www.dh.gov.uk/ health and social care background to the project on configuringhospitals/ systems configuring hospitals in health and social care systems. It provides access to material and work-in-progress for comment and feedback and is a route in
37 Modernising Pathology Services for organisations seeking further information or support relating to reconfigurations. Includes: Keeping the NHS Local – A http://www.dh.gov.uk/ New Direction of Travel configuringhospitals/ confighos.pdf
Specialised Services The Specialised Services http://www.dh.gov.uk/ National Definition Set National Definitions identify specialisedservicesdefinitions/ No. 25 – Pathology the activity that should be 25specpath.htm regarded as specialised and therefore subject to collaborative commissioning arrangements. The definitions provide a helpful basis for service reviews and strategic planning and enable commissioners to establish a broad base-line position and make initial comparisons on activity and spend.
Guidance on commissioning This guidance gives advice http://www.dh.gov.uk/ arrangements for specialised regarding the continuing role commissioning/ services of Regional Specialised specservices03.htm Commissioning Groups (RSCGs) or equivalent, and provides examples of good practice in collaborative commissioning of specialised services.
Getting Ahead of the Curve The Chief Medical Officer’s http://www.dh.gov.uk/cmo/ strategy for combating idstrategy/index.htm infectious diseases (including other aspects of health protection).
Genetics White Paper Outlines a comprehensive http://www.dh.gov.uk/ (“Our inheritance, our strategy to help the NHS genetics/whitepaper.htm future: realising the prepare for future genetic potential of genetics in the knowledge and technologies. NHS”) Includes details of upgrade plans for NHS genetics laboratories.
38 Modernising Pathology Services Unfinished Business – Unfinished Business – Proposals http://www.dh.gov.uk/ proposals for reform of the for Reform of the Senior House shoconsult/index.htm Senior House Officer Grade Officer Grade was published for consultation in August 2002. The report proposes that the SHO grade should be reformed so that all SHOs pass through time-limited, managed basic specialist training programmes with clearly defined end-points.
Strengthening Information on the range of http://www.dh.gov.uk/ Accountability – Involving new patient and public involvingpatients Patients and the Public. involvement arrangements, Policy and Practice Guidance. including overview and scrutiny Section 11 of the Health committees and the new duties and Social Care Act 2001. to involve and consult patients and the public, is available at this website.
Overview and Scrutiny Local authority Overview and Committees Scrutiny Committees (OSCs) now have powers to scrutinise local health services (as of 1 January 2003). The NHS will have a legal duty to consult the OSC at an early stage on any substantial change to health services. All meetings of the OSC will be open to the public.
Delivering 21st Century IT Delivering 21st Century IT is http://www.dh.gov.uk/ipu/ Support for the NHS the implementation plan for the whatnew/deliveringit/ 1998 document ‘Information index.htm for Health’. The primary focus is the delivery of Integrated http://www.dh.gov.uk/ Care Record Services, which ipu/whatnew/ incorporates both Electronic specs_12d.htm Health Record and Electronic Patient Record concepts.
Building the Information Building the Information Core: http://www.dh.gov.uk/ipu/ Core: Implementing the Implementing the NHS Plan strategy/overview/index.htm NHS Plan provides an update of
39 Modernising Pathology Services Information for Health. It outlines the necessary information and IT infrastructure investment required to deliver the NHS Plan and support patient centred care and services.
Other Organisations
Royal College of The professional body http://www.rcpath.org Pathologists responsible for maintaining standards in pathology through training, examinations and professional development
Institute of Biomedical The professional body for http://www.ibms.org Science biomedical scientists in all fields of work, including medical laboratory scientific officers in the National Health Service and related services in the United Kingdom and Ireland. Its aims are to promote and develop biomedical science and its practitioners and to establish, improve and maintain professional standards.
Association of Clinical A professional body dedicated http://www.acb.org.uk/ Biochemists to the practice and promotion of clinical science.
Association of Clinical A multidisciplinary organisation http://www.pathologists. Pathologists dedicated to improving org.uk/ pathology practice and improving the status of clinical pathologists.
Association of Clinical The professional body for http://www.aclinmicrobiol. Microbiologists clinical scientists in medical org.uk/ microbiology (bacteriology, mycology, parasitology, public health and virology).
40 Modernising Pathology Services Clinical Molecular Aims to advance the science of http://www.cmgs.org/ Genetics Society clinical molecular genetics and to further public education.
Association of Clinical Professional association of http://www.cytogenetics. Cytogeneticists clinical cytogeneticists working org.uk/ in the UK. It organises training, initiates and co-ordinates research, and establishes professional standards.
Health Protection Agency The Health Protection Agency http://www.hpa.org.uk/ is a new national organisation for England and Wales, with many of the functions of the former PHLS. It is dedicated to protecting people’s health and reducing the impact of infectious diseases, chemical hazards, poisons and radiation hazards.
Clinical Pathology The principal accrediting body http://www.cpa-uk.co.uk/ Accreditation (UK) Ltd of clinical pathology services (CPA) and External Quality Assessment Schemes (EQA) in the UK.
General Medical Council Keeps current registers of http://www.gmc-uk.org/ qualified doctors, fosters good medical practice, promotes high standards of medical education and deals with those doctors whose fitness to practice is in doubt.
Health Professions Council Set up to safeguard the health http://www.hpc-uk.org/ and well-being of patients using the services of the professions its regulates and to ensure that the public has access to and is treated by health professionals who are qualified and competent.
41 Modernising Pathology Services Toolkits, practical guidance and support
Working with people
Involving patients and the Sections 7–11 of the Health http://www.dh.gov.uk/ public in health and Social Care Act 2001 and involvingpatients associated regulations, SI 2002/3048, with new duties on the NHS to involve and consult patients, came into force on 1 January 2003. This website gives further details, including guidance. It covers both duties to involve patients (section 11), and the new arrangements for overview and scrutiny of health (sections 7–10 and associated regulations).
‘Removal, retention and use Provides information on the http://www.dh.gov.uk/tissue of human organs and tissue’ Chief Medical Officer’s advice on the removal, retention and use of human organs and tissue from post mortem examination. Includes: “Families and Post Mortems – http://www.dh.gov.uk/ a code of practice” tissue/families& postmortemscode.pdf
The Retained Organs The Commission was set up http://www.nhs.uk/ Commission following the Alder Hey retainedorgans/index.htm Report in April 2001. One of its aims is to restore public confidence in the post mortem system and improve understanding of the need for retention of organs and tissue.
Guidance for Local Strategic The Local Strategic Partnerships http://www.local-regions. Partnerships are the key element in odpm.gov.uk/lsp/guidance developing integrated approaches to local service delivery, and to tackling policy priorities in a joined-up way.
42 Modernising Pathology Services Modernisation Agency: The service improvement and http://www.modern.nhs.uk/ Improvement Leaders’ collaborative programmes of improvementguides/human/ Guide to Involving Patients the Modernisation Agency and Carers have gained considerable practical experience in ways of directly involving patients and carers in service redesign. The Improvement Leaders’ Guide to Involving Patients and Carers is one of the series.
Improving Working Lives The Improving Working Lives http://www.dh.gov.uk/ Standard Standard sets a model of good iwl/background.htm HR practice against which NHS Employers and their staff can measure the organisation’s HR management and against which NHS employers will be kite-marked. NHS organisations will be required to achieve accreditation against the Standard by April 2003, demonstrating they are improving the working lives of staff.
Working Together: Staff This tool aims to help you http://www.dh.gov.uk/pdfs/ Involvement assess how much progress your staffinvself.pdf organisation has made in involving staff in planning as well as delivering services.
Modernisation Agency: NatPaCT is helping PCTs build http://www.natpact.nhs.uk The National Primary and their capacity and capability Care Trust Organisational and lead change in the NHS. Development Programme It creates opportunities for (NatPaCT): Engaging people working in PCTs to Communities Learning learn from each other. It has a Network number of strands of work, one of which is the Engaging Communities Learning Network.
43 Modernising Pathology Services Service and workforce redesign
European Working Time Guidance on implementation http://www.dh.gov.uk/ Directive implementation, of the EWTD. A number of workingtime/ including Working Time pilots have been established, Directive pilots and further information about them is available on the working time website.
Modernisation Agency The Modernisation Agency has http://www.modern.nhs.uk a wide range of programmes and initiatives supporting service and workforce redesign. Some are described in more detail below, but there are many others which will be of interest, and a range of other service improvement programmes. Details are available on the Modernisation Agency web pages.
Modernisation Agency: The Cancer Services http://www.modernnhs. Cancer Services Collaborative ‘Improvement nhs.uk/scripts/default. Collaborative: Pathology Partnership’ (CSC’IP’) is a asp?site_id=26&id=2795 Service Improvement Guide national NHS programme designed to improve the way in which cancer services are provided. It offers practical approaches to delivering the improvement commitments laid out in The Cancer Plan
Radiology Service The Cancer Services http://www.modernnhs. Improvement Guide Collaborative’s National nhs.uk/scripts/default. Service Framework for Service asp?site_id=26&id=2797 Improvement in Radiology is based on best practice, focuses on whole systems and uses a modality approach. This format could easily be adapted for pathology.
44 Modernising Pathology Services Modernisation Agency and This site provides an http://www.modern.nhs.uk/ the National Clinical information pack giving advice protocolbasedcare Institute for Clinical on the development and use of Excellence: Protocol-Based protocol-based care in the Care: Underpinning NHS associated organisations. Improvement
Modernisation Agency: The National Primary and http://www.natpact.nhs.uk NatPaCT Care Trust Organisational Development Programme (NatPaCT) helps PCTs build their organisational capacity and capability in the NHS. Specific strands of work include programmes on reconfiguration and community engagement (see also above).
Modernisation Agency: Summaries of current thinking Improvement Leaders’ and practical advice and tips Guides for improvement for those involved in improving patient care and experience, including:
Matching capacity and demand http://www.modern.nhs.uk/ improvementguides/capacity/
Process mapping, analysis and http://www.modern.nhs.uk/ redesign improvementguides/process/
Modernisation Agency: The Changing Workforce http://www.dh.gov.uk/ The Changing Workforce programme has been set up to hrinthenhs/ Programme help the NHS and associated changingworkforce.htm organisations redesign their workforce. There is a great deal of good practice that can be shared, and areas where potential changes need more intensive support to achieve change.
45 Modernising Pathology Services Modernisation Agency: Clinical governance is the http://www.modern.nhs.uk/ The Clinical Governance framework which helps NHS cgs Support Team organisations provide safe and high quality patient care. The programme enables a wide variety of NHS organisations to involve staff and patients in improving services and continuing to do so. Clinical governance is about changing the way people work, demonstrating that effective teamwork is as important to high quality care as risk management and clinical effectiveness.
Modernisation Agency: Improvement, Expansion and http://www.dh.gov.uk/ Practitioners with Special Reform sets out clear targets pricare/gp-specialinterests Interests for improving access to and convenience of primary care services, by reducing waiting times in primary care and extending the range of services available in primary and secondary care settings. Recruiting a GPwSI is one of a range of options available to PCTs to help achieve these aims and this website has further information about this.
Developing key roles for Across the country nurses and www.dh.gov.uk/ nurse and midwives – a midwives are working in newrolesfornurses guide for managers different ways, developing their roles to improve the patient’s experience of care. Drawing together a range of case studies of good practice, useful contacts and resources, this guide aims to help managers by providing ideas and practical ways of meeting service objectives.
46 Modernising Pathology Services Information and communications technology, confidentiality and consent
Information Guidance by This guidance is based on http://www.dh.gov.uk/ipu/ the Department of Health patients’ expectation that confiden/protect/pguid1.htm information about them will be treated as confidential; and the importance of making patients fully aware that NHS staff and sometimes staff of other agencies need to have strictly controlled access to such information, anonymised.
NHSIA In May – June 2002 the http://www.nhsia.nhs.uk/ NHSIA undertook research confidentiality/pages/ jointly with the Consumers’ Association and its magazine Health Which? to find out how people wanted their health information to be managed in the NHS. This site brings together information about confidentiality and it will keep you up-to date with progress from the national confidentiality programme.
The Medicines and Information on guidance, http://www.mhra.gov.uk Healthcare Products alerts and evaluations Regulatory Agency (MHRA) published by MHRA.
The Controls Assurance Information on Controls http://www.casu.org.uk Support Unit (CASU) Assurance standards.
Investment and purchasing
NHS Estates This website is aimed at all http://www.nhsestates.gov. those who are involved in uk/capital_procurement/ proposing, developing and index.asp assessing schemes in NHS trusts, Strategic Health Authorities and Primary Care Tr usts and succeeding organisations.
47 Modernising Pathology Services The Agency supports many national initiatives that will underpin and support purchasing and supply changes at a local level. A dedicated pathology procurement team at NHS PASA as well as local supplies teams will endeavour to support any requests for assistance from pathology departments on purchasing and supply matters.
48 Modernising Pathology Services Annex 2 Membership of Working Group to Develop Good Practice Guidance on Modernising Pathology Services
Chair
Dr Ian Barnes Pathology Modernisation Adviser, Department of Health/Director of Pathology, Leeds Teaching Hospitals NHS Trust
Members
Dr David Clark Director, Path Links
Mr Richard Clayton Programme Director, Teespath
Dr Peter Cowling Consultant Microbiologist and Director of Microbiology, Path Links
Professor Chris Foster Professor of Pathology, University of Liverpool
Dr Rick Jones Director of Chemical Pathology and Immunology, Leeds Teaching Hospitals NHS Tr ust
Mr Michael Hallworth Consultant Biochemist, Royal Shrewsbury Hospitals NHS Trust
Mr Michael Howard Department of Medical Microbiology, Central Manchester Healthcare Trust
Professor Sir John Lilleyman Former President, Royal College of Pathologists/Department of Paediatric Haematology and Oncology, The Royal London Hospital
Mr Barry Muir Project Lead, Pathology, Cancer Services and EUWTD, North East London Workforce Development Confederation
49 Modernising Pathology Services Mr Jeff Seneviratne Consultant Clinical Scientist, Central Manchester Healthcare NHS Trust
Dr Colin Taylor Consultant Haematologist, Maidstone & Tunbridge Wells NHS Trust
Professor James Underwood President, Royal College of Pathologists
Dr Ian Watson Consultant Biochemist, Aintree Hospitals NHS Tr ust / Southport & Ormskirk Hospital NHS Tr ust
Mr Peter Wisher General Manager, Path Links
Dr Dennis Wright Consultant Biochemist & Clinical Director of Pathology and the NW Thames Genetics Service, The North West London Hospitals NHS Trust
Dr Tim Wyatt Consultant Microbiologist, Mater Infirmorum Hospital HSS Trust
50 Modernising Pathology Services
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