Inside the minds of pathology reformers

Reforms to pathology services according to the Carter Report are still doing poorly.  The cover-up of the failures is working better:

Pathology Networks

The morning session provided attendees with different perspectives on Pathology Networks; appropriately titled ‘Networks – a blessing or a curse’.

Dr Cathy Street, Consultant Clinical Biochemist, offered a unique personal insight into Pathology Services in England. She outlined the key themes of the Carter Independent Reviews (both 2005/2008) based on consolidation of Pathology services in England. The aim of this consolidation of Pathology services was to provide improved service quality, responsiveness and cost effectiveness.

She indicated how the transformation of pathology services has moved quite slowly with issues surrounding; differentiation of ‘hot’ and ‘cold’ work, logistics between the ‘hub and spoke’ laboratories, underestimation of costs associated with development/reconfiguration of Pathology Networks, and the unrealistic models for delivery of Pathology services which have been devised. These issues have impacted on staff morale within laboratories leading to the loss of many experienced staff members.

Dr Street also highlighted the pathology related concerns raised by Royal College of Pathologists in their response to Lord Carter’s independent report, ‘Operational productivity and performance in English NHS acute hospitals: Unwarranted Variations’. The RCPath had indicated that the instruction to consolidate is ‘unlikely to save money and is likely to cost more in the long-term, put the lives and well-being of patients at risk and increase litigation’.

She questioned if the transformation of Pathology services has truly been clinically led and asserted that the establishment of managed Pathology Networks has resulted in greater losses than gains with a diminished quality of service providing no tangible benefit to patients and staff.

Dr Chris Fourie, of LTS Consulting, provided a very different perspective, as a consultant supporting consolidation and transformation of Pathology Services in England. LTS works with NHS Improvement for a number of Trusts and private Pathology service providers. LTS are supporting the NHSI to define the roadmap for Pathology through a summary of the current state of Pathology services and by setting a clear set of benchmarks. He suggested that finance and clinical input can be the key enablers or constraints to service delivery with major opportunities in the operational aspects of Pathology service delivery.

He outlined the recipe for success in terms of Pathology Service Consolidation which includes; Clinical Leadership, which plays a key role, Executive Participation, Logistics, Integration of Technology and Change Management Support. He also introduced PinpointBPS which is a performance management system that provides Laboratory Management with detailed analytics and structured process documentation.

Dr Pat Twomey, Consultant Chemical Pathologist (in the absence of Dr David James, Clinical Director, Southwest Pathology Services, SPS), provided a succinct overview of how Pathology services can be delivered through a public private partnership. SPS, formed in 2012, is a joint venture between Taunton and Somerset NHS Foundation Trust, Yeovil District Hospital NHS Foundation Trust and Integrated Pathology Partnerships (iPP). SPS delivers full laboratory services to a population of 500,000 patients and over 100 GP practices in Somerset. Dr Twomey outlined the key ingredients for a successful Pathology Network and the co-operation that can be achieved in a public-private partnership.

Dr Mike Ryan, Consultant Chemical Pathologist, Northern HSC Trust, completed the session with a highly engaging overview of Pathology Networking in Northern Ireland and its progress to date. He outlined the challenges that laboratories face such as rapid advances in technology, the changes in the QA and regulatory environment, unnecessary risks associated with variation in practice, the clinical demand for more effective ICT and constrained resources.

He was firm in his belief that information technology is the key to transforming pathology services and that many of the challenges are now drivers for the modernisation of the Pathology Service.

He presented the three proposals for modernising Pathology services in Northern Ireland currently in the public consultation domain. They include; consolidation of ‘cold’ testing activity, infrastructure development in terms of IT and logistics and an integrated management structure. He asserted that a ‘root and branch’ change is required to the way the Pathology Service is delivered and stressed that ‘there is no right answer but there is a wrong answer: that we do not change!’


‘there is no right answer but there is a wrong answer: that we do not change!’ – a logical statement or a desperate rhetorical flourish in the face of contradictory evidence?

Change will come anyway; it doesn’t have to be the big, bad change brought to other hospitals by the command and control management that pays your salary.

Read more about how bad management survives common sense in this brilliant post from Thinkpurpose who really knows his onions: The secret management model that must not be named…

He even explains to NHS managers where performance management comes from.


Lessons from recent history

The collapse of UKAS-accredited, ISO-compliant pathology partnerships brought about by supposedly inevitable change should be more widely known.  Labs were doing so much more with so much less that they couldn’t function any more.  Leading to expensive waste when a functional service had to be re-established.

UKAS won’t do much that might upset the inflow of cash from public services that will pay for whatever UKAS demands.  Nobody blames them for blessing the mistakes of others.

Here is an expensive management failure, accredited but not caused by UKAS, passed off as restructuring:

Wikipedia explains the multi-million pound deficit a little more fully:

The HSJ explains in more detail for those with a subscription,

Host trust quits financially ‘fragile’ NHS pathology venture

Blair-appointed life peer, Lord Carter’s promised savings from lab mergers have turned into wastes.  Some predicted these events.  Many just went along for the ride.

On Boss Level Podcast, watch John Seddon explain the creation of failure demand because in “a contingent relationship – ‘do this to get that’, we focus on ‘get that’.”



Clearly foreseeable


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