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 Cross Ref Pathology – The Essential Service – Draft Guidance on Modernising Pathology Services Superceded Docs none Action required none Timing Contact Details Pathology Modernisation Team Area 423 Wellington House 133-155 Waterloo Road London SE1 8UG [email protected] 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