West Yorks and Harrogate Integrated Care System dodges questions about NHS path labs’ capacity

We asked questions about the West Yorkshire and Harrogate Integrated Care System’s Update on the Coronavirus Pandemic, at the 30 Sept 2020 virtual meeting of the West Yorks Joint Health and Overview Scrutiny Committee.

Yet again, West Yorkshire and Harrogate Integrated Care System has failed to answer our questions.

Such secrecy is a defining feature of the response to the pandemic by what the British Medical Journal Executive Editor refers to as “the medical-political complex”. It is not in the public’s interest, to say the least.

We requested information about the Integrated Care System’s work to build up the capacity of NHS labs to analyse Pillar 1 Covid19 tests. ( These are for people with a clinical need in NHS hospitals, and health and care workers). There was only a bare mention of this in Para 23 of the Update:

“[A]round April 2020,at the height of the pandemic, we had to work together to build up our capacity for COVID testing in West Yorkshire. Martin Barkley, CEO for Mid-Yorkshire Hospitals NHS Trust, has led a programme on behalf of the ICS and Local Resilience Forum to do this. As well as building up the capacity of our NHS labs we worked with the national programme to open regional testing centres in Leeds and Bradford, and also satellite sites in Wakefield, Halifax, Huddersfield and Keighley, as well as additional walk-insites and mobile units, initially operated by the army. We have now tested around 140,000 people through these ‘pillar 2’ sites (accurate at 12 August 2020). At the time of writing the testing system is now under significant pressure as a result of increased demand for tests and limits on lab capacity. This has created difficulties for people requiring tests locally and has led to delays in results of tests becoming available.”

Update on the Coronavirus Pandemic.

At the virtual meeting of the West Yorkshire Joint Health and Overview Scrutiny Committee on 30th September, Ian Holmes, the Director of West Yorkshire and Harrogate Integrated Care System aka Health and Care Partnership, said,

  • Testing capacity had increased and more Pillar 1 (NHS staff and hospital patient) tests were now being carried out.
  • Limits to all lab testing capacity (not just NHS Labs for Pillar 1 tests) are affecting staff who are isolating at home waiting for test results.

Anthony Kealey, NHS England Director for West Yorkshire and Harrogate, added that the NHS Labs’ Pillar 1 testing turnaround time was usually within hours (and well within  24 hours), while Pillar 2 turnaround times had increased recently but were coming down again.

So the problem of lack of capacity was with the hastily set up, privatised NHS Lighthouse Labs, not with the NHS Labs that analyse Pillar 1 tests.

Which begs the question, why did the government choose to set up a parallel privatised path lab system, rather than investing in NHS and university labs?

NHS hospitals’ path labs have been for the chop since 2016

In 2016 the West Yorkshire & Harrogate Sustainability and Transformation Plan (now the Integrated Care System) required the area’s hospitals to make so-called Carter programme “operational productivity” savings of £101m by 2020/21. These “savings” – ie cuts – included hospitals having to “share” pathology services across the area. The Royal College of Pathologists rubbished this proposal.

Since then, on and off we’ve been investigating and reporting on the cost-cutting redisorganisation of West Yorkshire NHS path labs.

When Covid-19 hit, we looked at how and whether local NHS labs were analysing Covid-19 PCR tests (some info here, scroll down to these sections:

  • “What have West Yorkshire hospitals’ microbiology labs done?”
  • “Government scrabbles to expand NHS testing capacity” and
  • “Cost-cutting centralisation of West Yorkshire Pathology Services may affect resilience”)

Here are our questions about the increased capacity at NHS Labs created by the Integrated Care System/Local Resilience Forum programme

When the West Yorks Joint Health and Overview Scrutiny Committee met on 30 Sept 2020, Ck999 emailed a request to the Integrated Care System to answer these questions:

  1. What increased capacity at NHS Labs has the ICS/Local Resilience Forum programme created?
  2. Did this include any increase in the number of PCR machines?
  3. If so, in which NHS Labs?
  4. I understand that Pinderfields microbiology lab was refused funding last year to carry out PCR testing, but was then given some money to procure a PCR machine due to Covid-19. Has this machine arrived? And if so, has it been used for Pillar 1 tests analysis, Pillar 2, or both?
  5. Also with regard to any other increases in W Yorks NHS lab capacity, has this been/is this being used for Pillar 1 tests, Pillar 2 or both?
  6. If no pillar 2 tests are being analysed in W Yorks NHS Labs, do they all go to Lighthouse Labs for analysis? If not where else do they go?
  7. There is widespread public support (74% in a recent survey) for stopping Covid-19 test and trace contracts with private companies and handing funding and responsibility for Covid 19 test and trace to public health and the NHS, and returning to the lawful notifiable diseases processes under the 1984 Public Health (Control of Disease) Act. Is the ICS in favour of this?
  8. Does the Covid-19 reset require any change to plans for path lab cuts and centralisation across the ICS?

Ian Holmes, the Director of West Yorkshire and Harrogate Integrated Care System, aka Health and Care Partnership, said they would send a written response.

The Integrated Care System’s written response was rubbish

Although it was written on 6 Oct, the response only reached me yesterday (17 November) due to some oversight in sending it. Here it is:

Many thanks for getting in touch about the Covid-19 testing capacity in West Yorkshire.
The capacity is best understood in terms it being a  pooled national resource that flexes to accommodate demand and, as you, suggest that provision is being increased. Effectively, this means more local capacity is more national capacity and vice versa. While there is local management of some of the delivery of this, it is being provided as part of the national Test and Trace programme. The programme is overseen by the Department of Health and Social Care, which would therefore be best placed to answer your questions in this area.
Learning from the pandemic will, of course, feed into plans for laboratory reconfiguration, which may result in some changes, but the pathology reconfiguration work continues and has progressed during COVID, most notably the procurement of a new laboratory information management system (LIMS).
West Yorkshire and Harrogate Health and Care Partnership would support further close working between national and local elements of the service.

My reply

Thanks,

I don’t really recognise this email as a response to the questions I asked about the Integrated Care System’s work to build up capacity for Covid-19 testing in West Yorkshire.

The 6 Oct response has 2 bits.

The first acknowledges ‘local management of some of the delivery’ of NHS Labs’ capacity, but refers me to the DHSC for information about this. Why? Since there is local management of NHS Labs, surely the ICS knows what’s going on and is capable of answering these questions. If on the other hand the ICS does NOT know what’s going on, it would be good to be told of their ignorance, and the reasons for this. Since ICS member organisations are presumably responsible for managing local NHS Labs, this would suggest a rather alarming communication breakdown. 

In response to a supplementary question I sent on 1st Oct, about something Ian Holmes said to the JHOSC in his presentation of the Covid-19 update paper, Ian emailed me the information I’d asked for and added, “this will be covered more fully in the response to question 1”.

So why isn’t there any response to my question 1? (And questions 2-8?)

Although I suppose the sentence “West Yorkshire and Harrogate Health and Care Partnership would support further close working between national and local elements of the service” is some kind of (vague and lazy) answer to question 7.

And the second bit of the 6 Oct response vaguely refers to my question 8, but it doesn’t provide any information about whether the Covid-19 reset would require any changes to the plans for path lab cuts and centralisation across the Integrated Care System. (And I guess the Covid-19 reset has fallen by the wayside for the duration of the second Covid-19 surge.)

It would be good to have some actual information, please, in response to questions 1-6 . And question 8 – particularly now that Matt Hancock has announced two new big labs that are intended to deal not only with Covid-19 tests but also to build “a permanent part of the UK’s new diagnostics industry” with “a massive diagnostics capacity”.

New mega labs and the UK’s diagnostics industry

There doesn’t seem to be any indication of who is to own and run the proposed new megalabs, although the University of Warwick – close to the location of the new testing mega lab in Leamington Spa – has been asked to help with it and has offered its full support.

Staff are being recruited through the “NHS” Test and Trace portal, but the webpage notes that “employment opportunities are through third party suppliers such as Lighthouse Labs and specialist workforce providers

Will the Mega Labs be like the largely privatised Lighthouse Labs, which the Institute of Biomedical Science has found wanting on all sorts of counts? Not least because the Institute

“have consistently voiced our members’ concerns about the centralised approach to testing. This has led to the creation of the lighthouse laboratories as a parallel but disconnected testing stream for COVID-19 and there has been a lack of transparency around processes of clinical governance and, in particular, the limited IT connectivity of these laboratories to clinical systems already in place.”

Why has the government decided to create a single new megalab for England? Instead of investing in existing NHS labs – as University of Exeter Senior Clinical Lecturer Dr Bharat Pankharia advocates (at about 2min 24 sec in)

And why is Matt Hancock talking about a “new” UK diagnostic industry? What’s wrong with existing NHS diagnostics? Could it be that it’s still largely publicly owned and run? Despite NHS England’s best efforts.

Diagnostics privatisation

Near the start of the pandemic, we looked at how the Government first asked NHS microbiology services and pathology networks to increase their lab capacity, and then turned to business to help with the “challenge” of delivering 100K Covid19 tests by the end of April and, “over time” of building a “large diagnostic industry”.

Later on, it appeared that as part of the post-Covid19 “reset”, NHS diagnostic services are being privatised.

For example, Somerset NHS Foundation Trust has contracted Rutherford Diagnostics to provide a Community Diagnostic Centre (CDC) in Taunton. The press release from Rutherford Diagnostics partner Philips Health UK states,

“In addition to providing services to NHS patients, the centre will be available to private medical insurance and self-pay patients in the South West.”

This is the first of five new community diagnostics centres across the UK that Rutherford Diagnostics and Philips Health UK are due to set up.

FOI response was almost entirely redacted because of ‘commercial sensitivity’

An FOI request about the Rutherford Health & Somerset NHS Trust contract by medical student Ron M @quackophage yielded a big fat set of redactions:

“Almost all of what I’ve asked for has been redacted or simply not supplied. Of what morsels remain, it’s just another tale to add to the pile marked #NHSPrivatisation.”

The whole (redacted) contract is here. The redactions are justified on the grounds that the data are “commercially sensitive”.

Legal challenge to £100bn “Operation Moonshot”

That secrecy is repeated with the Government’s decision to spend £100bn of public money on contracts with commercial third party operators to increase the national coronavirus testing programme. The lawfulness of the Government’s decision-making process that gave rise to this scheme is being challenged by the process of judicial review.

The legal challenge is being made on the basis of

“significant concerns in respect of: a) the lawfulness of the decision making process leading to the decision to commit £100bn of public money to the project; and b) the lawfulness of the decision making process(es) leading to the award or intended award of the Contracts.”

The British Medical Journal executive editor, Kamran Abassi, recently wrote,

“Covid-19 has unleashed state corruption on a grand scale, and it is harmful to public health. Politicians and industry are responsible for this opportunistic embezzlement. So too are scientists and health experts.”

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