New cost-cutting primary and community “care models” to replace hospital services, and the centralisation of hospitals’ pathology labs are putting patient safety at risk. This is giving some West Yorkshire GPs pause for thought about the direction of travel in the NHS, which is being driven by the West Yorkshire and Harrogate Sustainability and Transformation Partnership.
At a recent West Yorkshire GP practice peer discussion meeting, it emerged that GPs are realising their work is increasing because of the fall out from the West Yorkshire and Harrogate Sustainability and Transformation Partnership’s cost cutting changes to radiology, cataract surgery and bloods; and patient safety is threatened by putting specialist hospital services into GP practices.
A member of staff who took part in the peer discussion meeting told us
“I thought the discussion spoke volumes and to me demonstrated some reflection on the direction of change the Clinical Commissioning Groups and Sustainability and Transformation Partnership are driving.
“The whole thing is a pickle.”
Merging pathology services has increased inefficiency and risks patient safety
Pathology is one of the services that the 2015 Carter Review identified as a major source of “efficiency savings” – ie cost cutting.
The West Yorkshire Sustainability and Transformation Plan sees “Carter provider efficiencies” as generating £93m “savings” by 2020/1. The Sustainability and Transformation Plan’s West Yorkshire Pathology Strategy includes an operational clinical network or alliance for “sustainable pathology services” and delivery of “economies of scale” in pathology services.
But now a West Yorkshire GP practice peer discussion meeting has revealed real confusion following the creation of a new Airedale and Bradford pathology partnership, particularly about where bloods are sent for testing and where results will be found when urgent. Staff have been ringing three hospitals and chasing their tails.
In April 2016, NHS Improvement, the hospitals regulator, approved Bradford Teaching Hospitals NHS Foundation Trust spending £246,950 on a consultancy about an Airedale and Bradford pathology partnership.
Following the consultancy, Integrated Pathology Solutions LLP (IPS) was set up as a joint venture between the Pathology Departments of Airedale NHS Foundation Trust and Bradford Teaching Hospitals NHS Foundation Trust.
IPS delivers Airedale pathology, and describes itself as:
“a high quality diagnostic and consultative service to clinical users of both [Airedale and Bradford] Hospital Trusts, and to Primary and Secondary Care providers in the locality.
Airedale pathology is a pioneer within the region in the use of order communications to allow for electronic requesting of pathology tests. It also provides paperless reports via its use of the ICE results server and seamless integration into SystmOne for GP surgery access.”
However, this doesn’t seem to be working too well.
A West Yorkshire clinician said,
“I cannot work out what is going to Airedale, what to Leeds and what to Bradford. It is a mess.
It’s no good when bloods are urgent and the bloods go missing in the system.”
The clinician continued,
“They have spent a fortune but a Pathology Assistant told me she left because of the poor equipment in the Airedale labs, lack of training on the equipment in use, and all the cross-site disjointed working.”
A recent study showed that consultancies are associated with increased inefficiency, so are worse than a waste of money.
And in 2016, the Royal College of Pathologists said there was no support for Carter’s cost cutting recommendation on centralising pathology and imaging departments:
“The experience of service transformation in pathology is that…the cheapest service is not necessarily the best, and consolidation not always the answer.”
For example, the 2009 takeover of the NHS’s biggest pathology labs by a public-private consortium led by the multinational Serco was followed by a series of clinical and financial failures.
The GP practice peer discussion meeting also discussed problems around commissioning of other services, following changes introduced by the Sustainability and Transformation Partnership. You can read about them here.
Update 20 July 2018
Evidence-free policy making geared to cutting costs and privatisations
Unite reports on the damaging effects of Carter’s plan to centralise pathology services. Lord Carter of Coles holds a number of directorships in healthcare companies and currently chairs the review body on the future of NHS pathology. There seems to be a conflict of interest here.
Currently there are 105 laboratories in England which the government intends to cut to 29 with the rest acting as satellites. It is a reintroduction of the ‘hub and spoke’ model, which has already been tried in some areas and which has failed to produce results or save money.
Ian Evans, chair of Unite’s healthcare scientists’ committee and a member of the union’s health sector committee, says the centralisation strategy would lead to delays in analysing samples and in some cases incorrect analysis leading to misdiagnosis – including for killer diseases like cancer.
Ian argues centralisation is not about increasing efficiency, but to make it cheaper and primed for privatisation.
West Yorkshire and Harrogate STP has announced the Dept of Health has given it £2m National pathology exchange funding
This is to deliver a lab-to-lab messaging solution that connects Laboratory Information Management Systems (LIMS) together across the area to facilitate the electronic transfer of pathology test requests and results. This will be led by the Health Informatics Service which is a shared service hosted by Calderdale and Huddersfield NHS Foundation Trust. More info here.