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Hampshire & Isle of Wight Pathology Consortium Dr John Wood Managing Director

Hampshire & Isle of Wight Pathology Consortium Dr John Wood Managing Director. Where are we?. Hampshire and Isle of Wight. 2. Hampshire and Isle of Wight. Population 138,500. Population 500,000. Population 400,000. 3. Vision.

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Hampshire & Isle of Wight Pathology Consortium Dr John Wood Managing Director

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  1. Hampshire & Isle of Wight Pathology ConsortiumDr John WoodManaging Director

  2. Where are we? Hampshire and Isle of Wight 2

  3. Hampshire and Isle of Wight Population 138,500 Population 500,000 Population 400,000 3

  4. Vision “To have a high quality, cost effective and efficient pathology service which comprises a consortium of NHS laboratories which will change their services to reduce costs of provision by 20% by 2015-16 to the benefit of all Trusts. The consortium will develop effective service models, logistics, IT and monitoring services, with or without third party involvement, to offer different products and services to our customers, attracting further business opportunities which will be shared for the mutual benefit of our partners in the consortium”. • Single organisation • Single management team • Single income and expenditure account • Existing income maintained • Sharing of benefits Hampshire & Isle of Wight Pathology Consortium Programme

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

  6. Main decisions • Configuration of services? • Location of laboratories? • How the Consortium is going to work? Hampshire & Isle of Wight Pathology Consortium Programme

  7. Organisational structure - Criteria • Operational • Maintain PCT and commissioner support • Deter adverse publicity • Respond to political demands (DOH) • Align service with local structures • Respond to opportunities for research and development • To ensure equitable treatment of service users across Hampshire &Isle of Wight • To ensure the service facilitates the patient pathway • Support clinical services in the most optimal way • Minimise any service disruption • No unnecessary duplication • Ability to maximise utilisation of current staffing, their skills and competencies • Ensuring accessibility and choice for patients • Quality • No drop in quality of current service • Maintain accreditation (CPA, UKAS) • Meet regulatory requirements (MHRA, HTA, HFEA) • To respond to new legislation / directives / requirements • Provide results within a clinically relevant turn around time • Finance • Achieve 25% cost reduction between Apr 2011 and March 2014 • Reduction in costs to be delivered over three years (i.e. not all realised in final year) • Minimal capital/infrastructure investment • Sustainability • Capacity to deliver the existing workload • Capacity to grow the business • Configure the workforce to meet workload requirements • Meet training requirements • Create opportunities to delivery further efficiencies into the future

  8. Option Appraisal – Blood Sciences The preferred options for development as agreed by the senior Pathology teams were: Option 3a Essential Lab Services on all sites plus 1 x specialist centres and 1 x GP Hub All three options will be taken forward for evaluation. It is expected that specialist services such as paediatric metabolic biochemistry and screening services will remain on current sites. Provider A Provider B Provider C ESL ESL ESL GP Hub No 1 ?Specialist laboratory No 2

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

  10. Option Appraisal – Cellular Pathology The preferred option for development as agreed by the senior Pathology team was: Option 3 All processing of samples to be carried out on a single hub site. Pathologists to remain on their own local site for cut up, reporting and multidisciplinary team (MDT) meetings. Some facilities required on local sites for booked frozen sections. There will be a requirement to create a hub laboratory capable of processing 80,000 histology and 80,000 cervical cytology specimens per year. Provider A Provider B Provider C Cut up Cut up Cut up Post Mortems Post Mortems Post Mortems Central processing laboratory Pathologist reporting Pathologist reporting Pathologist reporting MDT meetings MDT meetings MDT meetings

  11. Location of services - criteria • Site services • Flexible work area with ability to absorb workload increases • Able to expand in the future • Sample reception area must be sufficiently large to be able to deal with workload (CPA C1.2 & E5) • Costs of any modifications • Space compliant environmentally (e.g. Air temperature, water, drainage) • Ability to receive goods/equipment • Facilities for staff (CPA C2) • Facilities for storage (CPA C4) • Facilities for containment (CPA C5.4) • Minimise unnecessary inter-site movement of samples • Sufficient capacity to handle extra GP work (one or two GP hubs) • Minimal disruption caused by implementation • Location • Location which gives minimal sample travelling time for the area served (for un-spun blood samples: objective of 4 hours maximum from “vein to result”) • Good access to road networks and Motorways • Regular links (road, rail and sea) • Ease of travel/parking for staff • Finance • Short implementation time • Minimal capital expenditure • Commercial • Ability to retain and grow the business Hampshire & Isle of Wight Pathology Consortium Project 11

  12. Some would have liked! Current State Proposed State Hampshire & Isle of Wight Pathology Consortium Project 12

  13. Future state • Blood Sciences • Hub based at PHT • ESL at IOW and UHS • Specialist laboratories at UHS • Cellular Pathology • Histology processing hub at UHS • Consultants based on local sites • Local cut up, frozen sections and diagnostic cytology • Cervical cytology screening hub at PHT • Microbiology • Contracted out to Public Health England (PHE) • Hub based at PHT • ESL at IOW Hampshire & Isle of Wight Pathology Consortium Programme 13

  14. Issues requiring resolution • Information Management and Technology • Logistics (sample transport) • Legal entity • Contracts • Staffing requirements • Equipment requirements Hampshire & Isle of Wight Pathology Consortium Programme

  15. IM&T = Major issue HOSPITAL A EPR A EPR Result LIMS A PMIP Result LAB A Sample GP A

  16. Hub laboratory HOSPITAL A HOSPITAL B EPR B EPR A EPR Result LIMS A LIMS B PMIP Result LAB A LAB B Sample GP A GP B

  17. Single LIMS solution HOSPITAL A HOSPITAL B Single LIMS EPR B EPR A EPR Result LAB A LAB B PMIP Result Sample GP A GP B

  18. Logistics Route 1 UHS – PHT – UHS Ten runs per day Route 2 PHT – IOW – PHT Three runs per day Hampshire & Isle of Wight Pathology Consortium Programme 18

  19. Workload Blood Sciences – Central v local • Samples come from numerous sources • In patients • Out patients – Some from medical oncology • General Practitioners (GP) • Specialist referred work • Commercial sources – clinical trials Hampshire & Isle of Wight Pathology Consortium Programme 19

  20. Blood Sciences Workload – Central v local Before After Hampshire & Isle of Wight Pathology Consortium Programme 20

  21. Takt time calculations – Sample reception Calculate workload Calculate staff Total staff = 24.5 whole time equivalents Hampshire & Isle of Wight Pathology Consortium Programme 21

  22. Analyser configuration Before After Hampshire & Isle of Wight Pathology Consortium Programme 22

  23. Commercial & contractual position • Shared Services Organisation • Hosted by UHS • Legally binding contracts • Consortium partners • Hosting services • Commissioners • PHE for microbiology H&IOW Pathology Consortium Commissioners CCG UHS PHE SHIP CCG PHT IOW CCG Hampshire & Isle of Wight Pathology Consortium Programme 23

  24. Board structure & relationships to Trusts Partner Trusts UHS Host Services Pay & Rations IOW Trust Board PHT Trust Board UHS Trust Board Consortium Board Chair Tony Barron IOW Karen Baker PHT Ursula Ward UHS Mark Hackett IOW Sue Wadsworth PHT Steve Erskine UHS Dr Nick Marsden Senior Management Team Managing Director Dr John Wood Clinical Director Finance Director Quality Director Hampshire & Isle of Wight Pathology Consortium Programme 24

  25. Financial headlines • Baseline income • £22m • Baseline spend • £44m • Net spend • £22m • Staffing 586 w.t.e. Recurrent savings • Reconfiguration savings £4.8m p.a. by 2015-16 • Recurrent savings of £10.1m p.a. by year nine • Major element of both providers and commissioners QIPP plans. Recurrent investment • Recurrent investments £1.9m p.a. • IM&T £0.8m • SMT £0.4m • logistics £0.4m • hosting £0.3m Commissioners • A reduction of 25% in the direct access tariff to primary care • £2.8m p.a. already delivered • £1.3m p.a. by 2015-16 • £1.2m p.a. by year nine (tariff deflator of 1.5% p.a.) Transitional costs • Significant one-off transitional costs of £5.4m • Staff reconfiguration • Re-training • IM&T procurement and implementation • SHA non repayable funding of £4.4m Hampshire & Isle of Wight Pathology Consortium Programme 25

  26. Benefits realisation • Patient • Opportunity for more responsive phlebotomy service • Improved access and choice to pathology • Avoidance of unnecessary repeat tests • Reduction of tests with limited clinical value • Opportunities to support testing closer to • Patient • Clinician • Supporting clinical pathways • Right test right time • Standardised reporting of results • Harmonised units and reference ranges • Improved access to clinical advice • Access all results through a single LIMS • Stabilised pathology service • Commissioner • Reduction in direct access tariff (25%) • No profit motive • Collaboration to reduce activity levels • Implementation of best practice • Equity of provision (service level and tariff) • Demand management • Pathology • Improved value for money 20% reduction • Collaboration instead of competition • Improved IT functionality • sample track/trace • electronic coms • Critical mass allowing new technologies • More resilient workforce • Shared consultant appointments Hampshire & Isle of Wight Pathology Consortium Programme 26

  27. Breaking news Where are we now? Hampshire & Isle of Wight Pathology Consortium Programme

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