Pathology Consolidation
to drive quality improvements and budget efficiency
Chris Charlton, Pathology Service Manager
Gateshead Health NHS Foundation trust
May 2016
Overview
Financial
Pressure
Pathology
Automation
Cost Reduction
Programmes
Consolidation
Transformational
Change
Political / Cultural
Considerations
Slide 2 of 36
Background
Tyneside
600 beds
3 Acute Trusts
North Tyneside
Newcastle upon Tyne
South Tyneside
3 CCGs
Gateshead
300 beds
Sunderland
650,000
220m
Population
savings targeted
Pathology chosen
as
900 beds
a key workstream
Slide 3 of 36
Cultural Differences
VS
Slide 4 of 36
Chief Exec Challenge
For a consolidated service South of Tyne and Wear (2010)
Current Position
Desired Position
3 Autonomous facilities
Flexible integrated clinical
support service
Limited flexibility
2 Distinct operating models
ways of
Improve Traditional (set) Budget
Efficiency working
Savings
One agreed way of operating
Align To
Patient
Not fully aware of business
position
Commercially aware
No common IT platforms
Integrated IT and Logistics
Limited capacity
Optimise capacity
Slide 5 of 36
Quality &
Safety
Challenges – All Change at Once
New
Logistics
New
facilities
New
Processes
New
Equipment
New IT
Infrastructure
New
staff structure
Slide 6 of 36
Business Case
Fit for
now
Sustainable
Fit for
future
Slide 7 of 36
Population
trends
24/7
Our Objectives – Business Case
Improved Patient Outcomes
(650,000 Population)
Improve Quality
Every Sample
is a Person
Achieve Savings
7 Day Services (People don’t choose to
be ill at convenient times)
Improved Service
Support for GP
Innovative Solutions
Slide 8 of 36
Vision for the New Service
Care For Life
World Class
Constantly
Improving
Best
Practice
Slide 9 of 36
Innovation
People Care for People
Every sample is a
person
She puts her trust in us
So we
They wait and worry about what the test
will
mean
People
don’t choose when to be ill
owe them our best
They don’t care how or where the test gets done
They never question the results from the
laboratory
They trust us to get it right
at all times
They have no direct recourse to complain
Slide 10 of 36
Trends: In-patient Activity in the NHS
FCEs (millions) England 1993/94 – 2012/13
18
16
14
12
10
8
6
4
2
93/94
95/96
97/98
99/00
01/02
03/04
05/06
07/08
09/10
17.7 million
1.4%
finished consultant episodes
2012/13
more than
2011/12
Source: Social Indicators – Research Paper 14/47
House of Commons Library (3 September 2014)
Slide 11 of 36
11/12
BUT ….. Bed Availability Declines
Bed Availability in England 1988/89 to 2013/14
300,000
General & acute
Mental illness
Learning disability
Maternity
250,000
200,000
150,000
100,000
50,000
88/89
93/94
98/99
03/04
136,895
beds available in wards open 24 hours a
day in NHS hospitals in England. (2013/14)
Source: Social Indicators – Research Paper 14/47
House of Commons Library (3 September 2014)
Slide 12 of 36
08/09
13/14
That is less than half the
beds available in 1987/88
and more than 55,000
fewer than in 1997/98
NHS National Drivers
By 2023 UK population
trend projections
Increase from
53.5 million
to 58 million
People over
75 rising
from 8% to 10%
People over
85 increasing
by 40%
The over 65 yr
currently account for
68% emergency
bed days
1 in 3 population have long-term
conditions & consume…
Half of all GP
64% out-patient
70% all
30% population
appointments
appointments
in-patient
bed days
account for
70% overall spend
2021/22
funding gap
£54bn funding gap in NHS
in England by 2021/22 without
significant productivity gains (PwC)
Slide 13 of 36
A Case for Change
Weekend issues
NHS England’s Sir Bruce Keogh
sets out plan to drive seven-day
services across the NHS,
Feb 2013
Mortality
rates
Patient
experience
Length of
hospital stays
Readmission
rates
(Analysis of over 14 m hospital admissions in 2009/10)
Slide 14 of 36
Challenges
Optimising
use of staff
Less qualified
staff available
Communication,
training and
development
Cover for holiday
and sickness
Create new
roles
Stratify job
descriptions
Slide 15 of 36
Pull staff to
the work
Considerations
90
Central hub to
handle 80% of
workload – cold
tests
3 acute spokes –
tests within 90
minutes
Slide 16 of 36
Hub location
Win the hearts
and minds of all
involved
The Chosen Option
Huge
latent facility
Numbers &
technology
South Tyneside
Existing singlesite infrastructure
Gateshead
Sunderland
Perfect location
Slide 17 of 36
Seeing the Benefits of Consolidation
Clinical scientists
best located for
effective results
Subspecialisation
Larger, more
resilient services
Collaboration
R&D opportunities
Training and
succession planning
Slide 19 of 36
Where are we in terms of Clinical Engagement?
Remote service
Responding visibly
Developing trust
24/7 microbiology service
Gaining the
confidence
of clinicians
Team meetings
Tangible
benefits
Improved TATs
New technology
New name & faces
Slide 20 of 36
Learnings
Single IT system
from day 1
Early
appointment of
Clinical Director
Consistent
communications
strategy
Slide 21 of 36
ALWAYS
prioritise patient
care
Working Together to Make It Work
Financial ‘principles’
agreed
Ownership of
the issues
Leadership
from key
people
Close working
relationships
Constant sense
checking
Trust
Slide 22 of 36
New Laboratory
Slide 23 of 36
A Laboratory Fit for Purpose……
for both now, and the future…..
Slide 24 of 36
Staffing Changes
Original
Volume
Changes
H
GP
278
2014
2015
Hospital
+3%
+3%
Community
253
+12%
+14%
Current
Future
Analyser
Utilisation
-27%
Staff
Savings
£2.922M
Slide 25 of 36
233
Where does Service Quality come from?
The Staff
Slide 26 of 36
Implementation
of the HR Structure
Slide 27 of 36
Considerations
Skill Mix
Dedicated
HR Support
Salary Levels
Relocation &
Transport
Terms and
Conditions
Fixed term Workers
Three Organisations
Slide 28 of 36
Success
Pay Protection
(ACTUAL TBC)
Redundancy
Single figures
Independent HR
Perception
Actual cost
c35% of £2M
anticipated
Partnership working
Regional & local
representatives
Positive working
relationships
Cultural adaptation
Slide 29 of 36
Change Learnings
De-stabilises the workforce
New skills required
?
Uncertainty about their future
New work environment
Reduced staffing numbers
New management arrangements
Transition to new structures
Difficult Transition Period
Slide 30 of 36
The Outcome
The Unexpected
Next Steps
Implementation Timescale
Vacancies
HR Issues
Terms & Conditions
Health & Wellbeing
Skill Retention
Temporary Measures
Structure Meet Service Need?
Slide 31 of 36
People Care for People
Every sample is a
person
Slide 32 of 36