Is a single shared Pathology Laboratory Information Management System for the area a good use of £12m NHS capital funding?

A West Yorkshire clinician has told us that the centralisation of pathology services over the last few years has risked patient safety. Regardless, this centralisation is now being taken further, enabled by £12m capital funding from the Department of Health.

CALL TO ACTION Please contact your ward Councillors and ask them to make sure that the West Yorkshire and Harrogate Joint Health Scrutiny Committee holds the West Yorkshire and Harrogate Integrated Care System to account for this pathology services centralisation scheme. You can find your Councillors’ contact details here.

  • The Scrutiny Committee needs to ask the West Yorkshire and Harrogate Integrated Care System (aka Health and Care Partnership) the questions this blog post raises.
  • Please also ask your Councillors to tell their local hospitals trust that the West Yorkshire Association of Acute Trusts should hold its meetings in public and publish its papers and minutes.
  • If your local hospital is a Foundation Trust, you can ask your Elected Governor to ask this too.
  • Hospitals contact details are here. You can find information here about hospitals’ Elected Governors.

Leeds Teaching Hospitals NHS Trust is to get £12 million to provide a single pathology Laboratory Information Management System across West Yorkshire and Harrogate, as part of Johnson’s £1.8bn capital funding for NHS. (This is really only £950m, as half of it comes from removing the requirement for Trusts to cut their capital plans by 20%.)

The £12m will be spent on a digital technology company such as CliniSys Group, which claims its pathology Laboratory Information Management System WinPath Enterprise has been “Developed specifically to meet the needs of the UK’s NHS.”

According to West Yorkshire and Harrogate Integrated Care System, NHS England have a limited “framework” of suppliers for Laboratory Information Management System, although so far ck999 doesn’t know which companies are on it.

Why is this a good use of public money?

There’s evidence that centralisation of pathology services is not working for GP staff or patients.

As ck999 reported last year, Ian Evans, chair of Unite’s healthcare scientists’ committee and a member of the union’s health sector committee, said the pathology centralisation strategy would lead to delays in analysing samples and in some cases incorrect analysis leading to misdiagnosis – including for killer diseases like cancer. He saw centralisation was not about increasing efficiency, but to make it cheaper and primed for privatisation.

Now a West Yorkshire clinician says,

“The centralisation of pathology services, since the Sustainability and Transformation Plan started, has risked patient safety. The problem has been they took local labs doing local work away and invented some half cocked system where some samples were going to Airedale some to Leeds and all over. No-one had a clue what was going where. Samples were going missing and all the laboratory equipment was apparently not ideal – some was very old and staff were working on systems they were not trained on. I imagine they created such interim chaos, following the dismantling of the old system, in order to pave the way for a centralised new streamlined pathology network service.”

West Yorkshire Association of Acute Trusts applied for the £12m funding in January

According to a news release from the cost-cutting West Yorkshire and Harrogate Integrated Care System, this £12m is the result of a funding application to the Dept of Health in January this year by the secretive West Yorkshire Association of Acute Hospital Trusts (WYAAT).

This body meets in private and its Minutes and papers are not publicly available.

WYAAT was established by the acute trusts in West Yorkshire and Harrogate in late 2016, as part of the West Yorkshire and Harrogate Sustainability and Transformation Plan. It started collaborating on pathology services in 2017.

This was on the basis of the 2016 West Yorkshire and Harrogate Sustainability and Transformation Plan which required the area’s hospitals to make “operational productivity” savings of £101m by 2020/21. This included sharing corporate services including pathology services.

West Yorkshire and Harrogate Pathology Network to cut £8.8m costs

NHS Improvement requires all 105 hospitals in England which provide pathology services to become part of one of 29 pathology networks by 2021. It anticipates that this will save the NHS at least £200 million.

In line with NHS Improvement’s national strategy for 29 pathology networks across England, in January 2019 the West Yorkshire Association of Acute Trusts agreed to create a West Yorkshire and Harrogate Pathology Network.

NHS Improvement’s Sept 2018 report shows that this is estimated to cut costs in West Yorkshire and Harrogate by £8.8m

Lab staff cuts risks loss of key skills

Professor Jo Martin, President of the Royal College of Pathologists, commented in April 2018 that the formation of Pathlology Networks risks large cuts to lab staff, with the related risk of loss of key skills:

“Network business plans have been put together that suggest approximately a 30% reduction in lab staff, mainly senior lab staff. Savings of the magnitude suggested by NHSI’s modelling in England were unlikely to be achieved without staff reductions, but the major concerns are not only around the individual staff involved, but also around the stability of patient services that require key expertise, especially in particular areas, for example transfusion.

There is a real risk that uncertainty over these changes may result in loss of key skills. We know that a previous reconfiguration of pathology services in one region of England resulted in unintended loss of transfusion expertise and risk to service.”

Is the £12m really for a digital technology company?

The West Yorkshire and Harrogate Pathology Network is currently working on the future model for a single NHS pathology system for West Yorkshire and Harrogate. It has identified a single Laboratory Information Management System as “a critical enabler of the single pathology system.”

Pathology services, along with the rest of the NHS, are being digitised. A Laboratory Information Management System is a digital doodah that inputs, holds and shares information about pathology testing activity in multiple Trusts across multiple sites. An example is the CliniSys Group’s WinPath Enterprise:

“Developed specifically to meet the needs of the UK’s NHS.”

Confidential patient data mining and analysis

Laboratory information systems enable data mining and analysis, but to date haven’t been widely used for this purpose, according to NHS England’s National Pathology Programme Digital First: Clinical Transformation through Pathology Innovation.

While this data mining and analysis may have its uses – such as “informing the delivery of care and identifying trends and links between treatments and outcomes” – it also raises questions about corporate access to confidential patient data and the rise of surveillance medicine.

Moving care into the ‘community’

When Barts Trust in London bought the CliniSys WinEnterprise Laboratory Information Management System in 2013, the Trust included:

“the provision of reporting algorithms to deliver enhanced levels of clinical interpretations and advice. This data interpretation can then be used to reduce hospital appointments and hospitalisation by moving the care pathway into the community which is a faster and more cost effective approach.”

Confusing – what’s happened to last year’s £2m National pathology exchange funding to connect Lab Info Management Systems across the area?

The £12m capital funding for a single shared pathology Laboratory Information Management System across West Yorkshire and Harrogate, is a bit confusing.

Because in 2018, West Yorkshire and Harrogate STP announced that the Dept of Health had given it £2m National pathology exchange funding 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 was to be led by the Health Informatics Service – a shared service hosted by Calderdale and Huddersfield NHS Foundation Trust.

So there is now apparently to be a Single Laboratory Information Management System. Is that going to replace the lab to lab messaging solution that connects Laboratory Information Management System across the area?

Questions for West Yorkshire and Harrogate Integrated Care System

Calderdale and Kirklees 999 Call for the NHS asked the Integrated Care System a bunch of questions about all this. You can find their answers here.

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