Pathology Modernisation: The Carter Report and implications

1. Pathology Modernisation: The Carter Report and implications Brian I. Duerden Inspector of Microbiology and Infection Control, Department of Health

2. The opportunity • The past : 1970 – 2000 • “Infection is conquered” • A nuisance – impedes the modern medical success story • Microbiology/IC sort it out! • Now – infection matters again • MRSA/C. difficile/HCAI • Pandemic/avian flu; TB; BBV/STI • The future: an Infection Service for the 21st century

3. Pathology Modernisation • 1999 Modernisation of Pathology Services: Modernisation Funding • HSC 1999/170; £10m • June 2002 Pathology: the essential service (Draft guidance for consultation) • February 2004 Modernising Pathology Services • £9.1m revenue, £54m capital • September 2005 Modernising Pathology: building a service responsive to patients • Carter Review

4. IoM Report July 2006 • August 2005 – May 2006 • 20 meetings with SHA leads for Pathology Modernisation • Jointly with HPA Regional Microbiologist • Report on DH IoM web page

5. Network development • Managed network operational 1 • Managed network planned • 1 well advanced; 3 proposed • Formal network collaboration 6 • Not single management/budget • Planned formal network • board in place 2; planning only 3 (1 SHA) • Professional network 8 • Review of Pathology Services 5 • No plans 6

6. Modernisation funds • IT investment 5 • Service redesign 4 • Equipment 7 • Not allocated 16 • Network IT programmes 7 • In full or part

7. Network activities • Transport – recognised but not actioned • TB services • Fully coordinated 2 • Under review 10 • Individual responsibility 6 • Chlamydia • Fully coordinated 4 • Part coordination 1; funding problem 2 • Under review 2 • Molecular diagnostics 1

8. Problems • Staffing • Medical; biomedical and clinical scientists • On call services • Distant site working • Funding – lack of! • Both existing services and network development • Commitment • Foundation Trusts

9. Carter report – August 2006 • Commissioned end-to-end core clinical service • Stand alone service • National specification/plan • Contestability/competitiveness/plurality • Economies of scale/rationalisation • 10% gain Define what we provide for patient care and health protection

10. Key drivers • Close to patients • Streamlined around user requirements • Competitiveness, plurality of provision • Commissioner-led • Clinical leadership, business infrastructure • Productivity • Information requirement • Core clinical service

11. Barriers to change • IT end-to-end connectivity • Sample collection fragmented service • Lack of commissioner understanding • Logistic/transport support • Variability of test repertoire • Inconsistency of configuration • Complex workforce/skill mix • Lack of investment • Separate point of care testing

12. Priorities for change • National specification/plan • Creation of stand-alone providers • IT connectivity (including health protection) • National reimbursement/tariff • Large-scale workforce change – multi-disciplinary working • Strong clinical leadership and management skills

13. Carter recommendations “Reform of supply of Pathology must precede commissioner-led provision” • Managed pathology networks • Free standing organisations • Economies of scale • NHS Trusts to have SLA for Pathology • Commissioners draw up specification • DH commissioning specification • Tariff, new technology, workforce reform • Standardisation, independent accreditation

14. Carter Pilots – 12 sites; £1m Objectives • New commissioning model • New organisational model • Increased quality and responsiveness to patients • Reduce NHS costs • 1 per SHA (+2) Oxford in SE SHA

15. Progress November 2006 • Pilots Project Board established • Recognised need for inclusion of • Infection Control • Public health/Health Protection functions • Data • PH/HP investigation; CCDC support • Specimens/cultures for typing etc • Will have a national stakeholder group • Inspector of Microbiology member

16. Actions for Microbiology • IoM to provide national input based on • ‘HP functions of NHS Labs’ • HCAI programme • Regional Microbiologist (HPA) to liaise with Pilot Sites • Project leaders • Microbiology laboratories • Microbiologists in Pilot sites • Ensure local input

17. Blue Skies Agenda

18. Vision and Goal*An integrated and cohesive, quality assured infection service for the clinical care of infected patients, infection control and health protection.*Investigation, diagnosis, treatment, control and prevention of infection

19. Workforce – trained professionals • Medical – range of competencies; training • Laboratory, clinical advice/care/infectious disease, infection control, health protection • Biomedical/clinical scientists • Nurses/nurse consultants • Pharmacists • IT specialists multi-professional teams • In laboratories, clinical settings, hospital and community/primary care, health protection units (and even management and government)

20. Laboratory services • Clinical • diagnosis, treatment, infection control • Health protection • surveillance reporting, outbreak investigation, samples for reference testing • Near patient testing • Communication and IT • Standards and SOPs • Safety and biosecurity • Accreditation Compliance: HCC annual healthcheck Code of Practice (HCAI)