Pathology continues to move up the agenda

At the beginning of the month I was at a launch event for a new approach to sending pathology samples between UK laboratories conceived by X-Lab, a service that will be hosted by the HIS (http://www.this.nhs.uk/npex). I worked for a medical reference laboratory (Pathology Associates Medical Laboratories (PAML) – www.paml.com) in Washington State that offered a very similar service – essentially a tool that translates the pathology request from one system into a readable and translatable form for any other system (and back again). The concept is similar to that of a telephone exchange.

I mention PAML because they offer a service to hospitals – using CRM to manage client services, using Fedex style logistics to manage pathology sample shipping, etc. Some features of the service could be very beneficial to the UK pathology service– however this will lead me into a comparison between business models that is for another time.

Pathology service savings – now is the time?

With the potential to save huge amounts of cost and increase the quality of service, it has taken a long time for pathology to move to the top of the agenda. We have all known the change is coming, presentations and whispers at two conferences I attended in late-2009 (SBK Pathology Toolkit – Service reconfiguration and implementing change) and late-2008 (Laboratory IT Strategy conference) predicted the change. We’ve all seen the two Carter reviews as well.

It’s one way of saving cost and improving productivity without closing front-end services which could ultimately result in protests and national newspapers front page headlines. At the minimum organisations are starting to pass ideas around about how pathology services can save cost locally (even if at Trust Chief Executive Level), if not already entering into a challenging process of change.

How NPEx and the advent of GP commissioning could impact this

NPEx is a concept that, if used widely enough, could change the shape of the pathology market. Two key examples:

1) Choosing an alternative reference laboratory for specialist reference testing. Laboratory X is charging the Trust £91 per test but the NPEx system states Laboratory Y can offer the same test for £68. This raises a number of interesting questions:

• Why is it cheaper?
•  Is the quality of testing going to be as robust as Laboratory X if I switch to Laboratory Y?

2) After the release of the new whitepaper could pathology rise to the top of the agenda for GPs, just as it is for Trust Chief Executives right now? GP work is typically automated and bulk accounting for a high volume at low cost.

• If information is realised about NHS Trusts cost per test compared to Quest, Serco or TDL how will GP consortia react?

The second point is one that is prominent and non-dependant on the X-Lab system. If private providers take all of the GP work then pathology services within NHS Trusts will not be able to sustain themselves performing the expensive specialist work.

Some key points...

• As a result NHS Trusts are under pressure to understand their true service costs and make the needed changes to increase quality and productivity throughout; otherwise they may find themselves fighting to keep the GP work from the hands of private providers.
• The model of delivery has to change. Using paediatric allergy testing as an example – within an SHA region it is most likely being performed in most DGHs and specialist centres. Such a service can be operated from one or two specialist paediatric centres across the region because the work is cold. This will result in:
• Decreased service cost for DGHs operating the service
• Reduced cost per test across the test repertoire
•  Increased service quality for allergy testing
•  Now only operating in one or two specialist centres
• A new process that has been implemented
• Achieving maximum productivity

Some key questions for thought...

• Can the logistics cope and will this be a telling point for enabling GPs or hospitals to choose where they order a test?
• If consolidation is to happen will the technology be a stumbling block?
• How will NHS Trusts actually react to a changing market? 

Planning is the only the beginning

“Efficiency is the ‘main game’ in the NHS” and “the eight ways to save cash and improve care” are just two headlines I’ve seen recently on one healthcare news website (HSJ) regarding cost and productivity improvement. On my twitter feed the word efficiency is always ‘popping’ up. It’s interesting that the way to address efficiency has, in one way or another, been wrapped inside an acronym, QIPP, which still remains somewhat mysterious to me. Kate Hall, a Health Leadership Fellow, recently blogged on HSJ (http://www.hsj.co.uk/a-pinch-of-qipp/5021132.blog) identifying that QIPP and national workstreams were published so long ago yet she states:

“I’m not sure why there is little or no information published on them nor why it is not available for people to look up and heaven forbid, see how they can support, help or get ideas “

The only website I’ve found is on NHS Evidence (http://www.library.nhs.uk/qipp/) but resources are still short of what they should be and examples are not updated regularly enough. The one problem I find with QIPP is that it’s been made into something apart from driving productivity and quality improvement that means it could easily viewed, quite dangerously, as a project or programme. In PRINCE 2 terms I’m talking here, as something that exists temporarily, when it should be instilled in the hearts and minds of NHS leaders throughout the country. Few NHS organisations are talking about QIPP, they’re talking about Cost Improvement Programmes which may be due to the lack of resources and a lack of understanding for what QIPP is really about.

The obvious action for Trust directors at the moment is to plan for big change, in anticipation of what may be 6% of budget savings. With QIPP in mind it's positive that such a concept will encourage more analysis around cost and productivity improvement, however the problem still remains that the output from this needs to driven. This is where the problem lies because only the ‘easy wins’ get a high profile and the real meaty cost saving ideas are left alone for fear of multiple reasons – before you know it CIP values are falling away and become at serious risk of under-achieving.

Perhaps this is too simple a view – I intended to summarise it but the hard fact remains that implementation is challenging. It requires tough project management with solid plans and well managed risks with an understanding of change management thrown in the mix– right now that’s what NHS organisations need to realise savings and looking to QIPP is only going to produce ideas for this process – at the very best.

End of the most competitive season in history..

An epic Formula 1 season came to a close today. Listen to Alistair Griffin's 'Just Drive' with the highlights of the year here: http://www.youtube.com/watch?v=RsyOgYjrV8I

Welcome!

If you’ve just stumbled upon this page you might be wondering what this is all about - well, I see few blogs about improvement of clinical services and health informatics - so this will not only give some vision into what I do as a management consultant, but also offer a view as to how we (meaning my colleagues and I) go about helping organisations, at every level, to improve quality and cost of their services. It will also discuss in terms of the latest new initiative - so right now that will be QIPP which is on everyone’s mind!

I welcome you’re comments and questions. I hope to create some healthy discussion.

Happy reading-

Steve