• Pathology labs might seem boring and remote but without them the NHS couldn’t function – many diagnoses would be impossible, so doctors wouldn’t know what treatments patients needed.
• In order to cut costs, the government’s quango NHS Improvement has ordered all acute hospitals to centralise their pathology services into regional networks.
• In West Yorkshire, this is being carried out by the secretive West Yorkshire Association of Acute Trusts. It is estimated this will cut costs by £8.8m – helping the West Yorkshire and Harrogate Integrated Care System to make its required efficiency cuts of over 1.1% this financial year. If it fails to do this, it will lose extra NHS funding which has been earmarked to stop the System running a deficit. Then all hell would break loose from the government’s NHS quangos and more NHS cuts would follow.
Call to action! Ask your elected representatives and/or local newspaper questions about the cost-cutting enforced centralisation of West Yorkshire hospitals’ pathology labs – particularly questions about patient safety, effective staff working and commercial interests. (More info about these issues below.)
In early August, Leeds Teaching Hospitals received £12m capital funding to set up a single pathology Laboratory Information Management System across West Yorkshire and Harrogate.
Boris Pants On Fire Johnson claimed it was part of a new £1.8bn capital funding splurge he was bestowing on the NHS. This lie was rapidly exposed.
We had many questions about the rationale and merits (or not) of this significant change to the area’s vital NHS pathology services
We put them to the West Yorkshire and Harrogate Integrated Care System (aka Health and Care Partnership)
This is the non-statutory, non-organisation that somehow now controls all the NHS, social care and public health services in West Yorkshire and Harrogate, except those specialised services commissioned by NHS England.
The Integrated Care System have sent some interesting answers.
All the £12m will be spent on a digital technology company
The Integrated Care System expects that the £12m will all be spent on a digital technology company that supplies the Laboratory Information Management System .
They say NHS England have a limited “framework” of suppliers for Laboratory Information Management System.
The centralised pathology network was imposed on the Integrated Care System by NHS Improvement in order to cut costs
What were the grounds for West Yorkshire Association of Acute Trust’s decision in January this year to establish a single pathology network for the area and apply to the Dept of Health for capital funding for a single Laboratory Information Management System? What evidence supported this decision?
They replied that the hospitals’ pathology services in West Yorksire had been “collaborating informally” since 2017 and admitted the pathology network had been imposed on the Integrated Care System by NHS Improvement as part of the Carter Report’s cost-cutting measures.
Independently, after reading our blog post about the £12m capital funding, a West Yorkshire clinician told us that,
‘It seems clear to me that WYAAT plans are a cost cutting exercise that will significantly reduce quality in hospitals that lose all or part of their pathology services.
I am not opposed to a Pathology network in principle, and believe that significant improvements to quality and staff development are achievable. Having said that, it was clear from the outset that the driver for the proposals from NHSI, as pushed by the consultants [LTS Health] that were brought in to lead the project, was to centralise as a cost-cutting exercise.”
The clinician’s view is borne out by the West Yorkshire and Harrogate Integrated Care System’s response to our questions:
“Building on the recommendations from Lord Carter’s reviews in 2008 and 2016, in September 2017 NHS Improvement signalled to all acute hospital trusts in England that they should form pathology networks to drive out unwarranted variation in services. For WY&H, NHS Improvement proposed a network covering the WYAAT trusts. They published a national case for change highlighting variation in costs and prices for pathology services, variation in efficiency, lack of investment in advanced technology, lack of estates capacity, pressure to maintain quality accreditation, competition from private pathology providers, increasing demand, the need to contribute to financial sustainability and staff issues (e.g. ageing workforce, staff shortages).
The same drivers for change also apply to WY&H and in January 2019 the trusts agreed that collaborating on pathology services by forming a WY&H Pathology Network would better enable them to address challenges and improve pathology services for both staff and patients.”
The Integrated Care System refused to show us WYAAT’s supporting documents and capital funding application to the Dept of Health
We asked for this because we wanted to know what evidence – if any – underpinned West Yorkshire Associate of Acute Trust’s decision to centralise pathology services.
This is particularly important because of the Royal College of Pathologists’ concerns:
“One of the concerns the College raised about enforced consolidation was the lack of reliable data on which to base decisions. This is highlighted in the 2nd Atlas of Variation in NHS Diagnostic Services in England, published in January, which contains no pathology or genetics because “the data could not be accessed”.
West Yorkshire Association of Acute Trusts refused to provide the information because their commercial interests override the public interest
The Integrated Care System informed us that:
“West Yorkshire Association of Acute Trusts is declining to disclose it under Section 43(2) of the Act, which states that information is exempt if “its disclosure under this Act would, or would be likely to, prejudice the commercial interests of any person (including the public authority holding it).”
This is a qualified exemption, which means that its application is subject to the public interest test set out in section 2 of the Act.
Having applied this test, the West Yorkshire Association of Acute Trusts has concluded that the public interest lies in favour of withholding the information requested because, whilst disclosure would facilitate accountability and transparency, it would also prejudice the commercial interests of a third party (for example, the ability of providers to successfully participate in commercial activities) and would adversely affect the West Yorkshire Association of Acute Trusts ability to achieve best value for money when securing services.”
Evasive answer about risks to patient safety and effective staff working
We received an evasive answer to our question:
Is West Yorkshire and Harrogate Integrated Care System aware that centralisation of pathology services has resulted in risks to patient safety and effective clinical staff working? And that it is opposed by the chair of Unite’s healthcare scientists’ committee?
Here’s their denial of a question we didn’t ask:
“The network is not about centralising all of pathology into a single “hub” laboratory, its aim is to enable the laboratories in the five pathology services in WY&H to collaborate to improve quality, sustainability and efficiency, for instance by reducing unwarranted variation, enabling investment in technology and facilities, managing demand, addressing workforce shortages and developing new roles. The network is clinically led by the consultant clinical leads and senior pathology scientists from the five services. Patient safety and clinical effectiveness are fundamental requirements of the network.
The £12m funding allocated to WY&H is to implement a single LIMS to connect all the laboratories together which was identified by pathology clinicians and scientists as a critical enabler of the network.”
This is a disingenuous answer. Even if each West Yorkshire District General Hospital retains its own limited pathology lab, the shortlist of options for creating a pathology network shows this involves a significant centralisation of pathology labs. Our questions about patient safety and effective staff working need answers.
The shortlisted options for pathology labs centralisation
The shortlisted options for Blood Sciences and Microbiology hubs were given in the West Yorkshire Association of Acute Trusts Pathology Collaboration Group document, ‘Creating a pathology network for West Yorkshire and Harrogate Scoring criteria and shortlisted models – 8 August 2019’.
This explains that:
- “the hub providing specialist services for each discipline will need to be at St James’ University Hospital” (in Leeds).
- And that they’d not yet decided how many hubs to have.
- There could be one hub or two for microbiology.
- There could be either 2 or 3 hubs for Blood sciences.
- For cellular pathology they’d not decided whether to consolidate into 1, 2 or 3 hubs, or whether to keep things as they are.
This IS a significant centralisation of pathology labs – even though:
“as a minimum each acute hospital will have an acute hospital laboratory (AHL) to support its services, particularly the urgent testing requirements. Some of the larger AHLs will also do some routine testing or GP work to make the most of their capacity. The rest of the routine testing and all specialist testing for the network will be carried out in ‘hubs’ for each discipline, which will be sited at one or more of the AHLs.”
LTS (specialist pathology consultants) were to fully model the short-listed options and bring back an initial analysis for scoring at a final workshop to later in August. The preferred model was to be shared with staff, probably at the start of September.
Update: the recommended Pathology Network model
In the event, the recommended model was presented to West Yorkshire Association of Acute Trusts Programme Board on 10.10.19.
There will be an acute hospital laboratory (AHL) at each hospital to support the Pathology Network’s services, particularly the urgent testing requirements.
There are to be 3 Blood Sciences hubs at St James, Leeds, Airedale and Pinderfields hospitals and one Microbiology hub at St James.
A West Yorkshire clinician has told us,
“I have reservations with regard to the effects of centralisation on quality and timeliness of Microbiology services, particularly for those hospitals who provide emergency services and who have speciality services with a requirement for specific Microbiology services – e.g at Pinderfields there are close links between Micro and burns, spinal injuries and ICU.”
The hubs will carry out routine testing and GP work on behalf of all trusts. Some of the larger AHLs will also do some routine testing or GP work to make the most of their capacity.
The current Cellular Pathology set-up of five hubs will continue until digital pathology is rolled out across all hospitals trusts by the end of 2021. Then the Cellular Pathology set up will be reviewed.
Before the new “model” can be put in place:
- the single pathology Laboratory Information Management System needs to be bought and set up,
- the Pathology Network operating process and standards need to be worked out and
- the new laboratory at St James University Hospital in Leeds needs to be completed.
The centralisation of pathology labs has significant downsides that West Yorkshire and Harrogate Integrated Care System avoided in their reply to our questions
We don’t pretend to understand what goes on in the different pathology labs that are being centralised – but we do know that it involves the collection and analysis of live bugs and pathogens in samples of patients’ organs and bodily fluids (and solids).
If you start transporting this kind of material out of hospitals to labs miles away in another town or city, this has got to to be hazardous. We can think of some fairly obvious hazards.
One is that there are issues with transporting some urgent tasks like positive blood cultures and CerebroSpinalFluid samples, that need swift analysis, because delay can damage the quality of the service. So it’d seem better to leave such tasks with each hospital’s pathology lab.
But if you’ve taken most of your pathology lab staff away from most hospitals to plonk them in a centralised hub (or 2 or 3), who is going to be left in the rump hospital pathology labs, to do the urgent tests of things that can’t be transported to the centralised lab?
Two, if the rump hospital pathology labs couldn’t process positive blood samples, there are World Health Organisation requirements about the transport of positive blood cultures that are known or suspected to come into the category of Class A infectious substances. Dangerous goods regulations require drivers to carry out a lot of training that can involve attending approved courses and passing exams.
Increased carbon emissions and worsened climate change
Apart from this, what about the carbon emissions from couriering samples all over West Yorkshire? The West Yorkshire and Harrogate Integrated Care System 5 Year Strategy for its Operational Plan 2019-24 bangs on about the need to reduce climate change as a serious public health issue.
Increased commutes for staff
This also applies to pathology staff who instead of working in their local hospital would have to commute to another town or city.
And apart from increased carbon emissions, there’s the extra time and expense of longer commutes and dealing with the proposed Leeds congestion charge and parking problems. Hardly going to help with staff retention.
Changes to employment terms and conditions
At the moment, apparently the Integrated Pathology Solutions staff continue to be employed by their NHS hospitals and have not been TUPE’d over to the company.
But in other centralised pathology networks, it seems that staff have been TUPE’d across to Wholly Owned Subsidiaries.
Is the West Yorkshire Association of Acute Trusts thinking of setting up a Joint Venture company or Wholly Owned Subsidiary – and possibly TUPE’ing across NHS staff to that company? Have the unions been involved and if so what is their position?
According to the recommended model, presented to West Yorkshire Association of Acute Trusts Programme Board on 10.10.19,
“The legal constraints for non-foundation trusts and the joint venture’s contractual arrangements mean that we are not able to come together to work as a single entity. The recommended approach is therefore to group the trusts into two operating units, which will be overseen by a joint board composed of all six trusts to make decisions about the operation of the network.”
This sounds a bit weird. What’s the reason for this arrangement? Is it a clumsy attempt to contrive a means so that foundation and non-foundation trusts can circumvent operational restrictions to create a single (market ready!) entity?
West Yorkshire and Harrogate Integrated Care System’s draft 5 Year Strategy for their Operational Plan 2019-24 – to be presented to the Integrated Care System Board on 3rd September in Wakefield County Hall – says that since 2018 they have received £26m capital funding from the Department of Health for the consolidation of pathology services.
It’s not clear whether the £12m for the single pathology Laboratory Information Management System (LIMS) is part of that £26m or on top of it.
The draft 5 Year strategy lists the “system LIMS” under Transformation Funding. This is extra money from the Department of Health that the Integrated Care System can use to pay for significant changes to NHS services in their area.
The deal is that getting this extra Transformation Funding money depends on the Integrated Care System delivering a financial target.
Our NHS is still on the ropes despite extra funding
Transformation Funding is just one source of funding for the West Yorkshire and Harrogate Integrated Care System, among a ragbag of carrots and sticks designed to drive all the NHS, social care and public health organisations in the area to “deliver” the system’s “shared financial target.”
For 2019-21, this is a £21m surplus.
Why do we need a surplus? What is the government proposing to do with it?
Generating this surplus is a complicated and precarious matter:
- It depends on the Integrated Care System receiving £69m incentive funding from the Dept of Health plus £32m non-recurrent support funding to NHS organisations that would otherwise be in deficit.
- Without this £101 incentive funding and non-recurrent support funding, the Integrated Care System would be £81m in deficit, according to the draft 5 Year strategy narrative.
- However the £101m is not enough on its own to generate the £21m surplus – the Integrated Care System also has to “deliver efficiencies higher than the 1.1% minimum” that the quangos NHS England and NHS Improvement require of all Sustainability and Transformation Partnerships/ Integrated Care Systems.
- The centralised pathology network with the single Laboratory Information Management System is one of the schemes intended to help generate this 1.1%+ efficiency spending cut (p 109, end of Transformation Funding section, refers to to as “one system wide approach for pathology across West Yorkshire and Harrogate acute hospitals“).
- And the £101m is conditional on generating the surplus and making the efficiency cuts.
As the draft 5 year strategy warns:
“Failure to manage either [the surplus position or the more than 1.1% efficiency cuts ] has the potential to impact heavily on how much of that [incentive funding and non-recurrent support funding] money our Partnership may get…continuing to deliver efficiencies locally will present a challenge… This is why it’s necessary to cut costs by working collaboratively and focussing on system-wide efficiencies”(p104-5)
We demand adequate funding for the NHS and an end to the imposition of USA market-based “integrated care”!
Our #NHS4All demands include:
- Much-needed further increases in NHS funding – both for the NHS Mandate (ie the services provided by the NHS England) AND other key Department of Health budgets which are excluded from the NHS Long Term Plan funding settlement.
- The government write-off of all the NHS Organisations’ deficits and debts to the Dept of Health that have accumulated over the last nine years, as a result of sustained government underfunding of the NHS.
- An end to the dismantling of our NHS into fragmented accountable/integrated systems/providers – that force local NHS organisations to clear their “deficits” that were incurred through a decade of damaging underfunding, while siphoning £millions of NHS funding to private companies and charities.
- An end to the hugely wasteful marketisation and privatisation of the NHS.
Useful contacts for NHS campaigners
You can find your Councillors’ contact details here.
Your MP’s details here
Hospital Elected governors are hard to get hold of but if your hospital is an NHS Foundation Trust you can ask your hospital’s company secretary to send your questions to them.
These are the hospitals trusts who make up West Yorkshire Association of Acute Trusts – All but Mid Yorkshire and Leeds Teaching Hospitals are Foundation Trusts as far as we know.
Airedale District Hospital NHS Foundation Trust
Bradford Teaching Hospitals NHS Foundation Trust
Calderdale & Huddersfield NHS Foundation Trust
Harrogate & District NHS Foundation Trust
Leeds Teaching Hospitals NHS Trust
Mid Yorkshire Hospitals NHS Trust
West Yorkshire newpapers include: Wakefield Express
Yorkshire Evening Post
Bradford Telegraph & Argus
Wharfedale & Airedale Observer
Whoever you contact – elected representative or local media – please ask these questions:
Regarding the West Yorkshire Association of Acute Trust’s centralised pathology network:
• Will urgent tasks like positive blood cultures and CerebroSpinalFluid samples, that need swift analysis because delay can damage the quality of the service, still be carried out by each hospital’s pathology lab?
• Will enough staff be left in the rump hospital pathology labs, to do the urgent tests of things that can’t be transported to the centralised lab/s?
• What evidence – if any – underpinned West Yorkshire Associate of Acute Trust’s decision to centralise pathology services?
• How much has the West Yorkshire Associate of Acute Trusts paid LTS consultancy to do the work of setting up the pathology network?
• Is the West Yorkshire Associate of Acute Trusts considering setting up the centralised pathology network as Joint Venture or Wholly Owned Subsidiary?