In September 2017 NHS Improvement (NHSI) published requirements around the development of 29 pathology networks across the NHS. They have looked into pathology services across the UK and believe that implementing 29 networks will provide high quality, rapid and comprehensive diagnostic services for patients, which are delivered in the most efficient manner; and that this will facilitate the introduction of, and widest access to, new investigations and diagnostic systems, and improve future training and career development for scientific and technical staff.
NHSI have proposed a hub and spoke model and the proposal for South Yorkshire and Bassetlaw (SYB) is centred on Sheffield Teaching Hospitals NHS Foundation Trust (STHFT) as the hub for the surrounding Trusts in Barnsley, Bassetlaw, Doncaster and Rotherham. SYB Pathology services are evaluating this model and a number of other variations with the intent of finding the best solution for patients and clinical users in SYB.
There is already a strong partnership across South Yorkshire and Bassetlaw Trusts, and a Pathology Steering Group, which was attended by Clinical Directors and Service Managers, had been in place for some time, and took on the role of the Programme Board for the development of the pathology network. Recently we made some changes to governance, which the Chief Executives of all Trusts (the Acute Provider Chief Executive Group) agreed. With effect from 1st September 2019 the Programme Board was split into an Executive Steering Board and an Operational Board. The Executive Steering Board is made up of an Executive Director from each Trust and the Operational Board has Pathology representatives and the Pathology Delivery Team, as well as representation from HR, Finance, Procurement, IT, Commissioning, Communication and Workforce. We are confident that the change will facilitate better and quicker decision making, with the Executive Steering Board directing and overseeing the work of the Operational Board which will offer more scrutiny over the detail of the proposals being made. Clinical Reference Groups are well established for blood sciences, microbiology/virology, histopathology and specialist laboratory services, attended by service and clinical management from the Trusts.
Sheffield Children’s Hospital is a specialist Trust and was initially excluded from the NHSI Networks, however they have subsequently been asked to work with their locally identified partners. The Trust was involved in the steering group, workstreams and discussions from the outset. They are also exploring working with other paediatric services on specialist tests.
NHSI set a requirement for Trusts to develop a common Memorandum of Understanding (MoU), which sets out a commitment to work together as a network to deliver high quality, resilient and efficient services. An MoU for South Yorkshire & Bassetlaw was agreed by Trust Boards in April 2018. The MoU confirms a commitment to work together as a network and in doing so to make sure we find the best opportunities to ensure high quality, sustainable and efficient pathology services over the coming years. It sets out key principles, governance arrangements and an outline programme plan, which builds in the appropriate consideration of options, feedback from key stakeholders / clinical reference groups, and learnings from other partnerships across the NHS. All partners are committed to conducting the work in the best interests of staff and patients.
The preferred approach is to work together as a formal NHS partnership across South Yorkshire and Bassetlaw.
As we work together we continue to seek opportunities to promote learning and networking across South Yorkshire and Bassetlaw. We were delighted to host a digital pathology event in September 2018, when we welcomed international speakers and clinicians to Sheffield for this very special event. View programme details.
1. Why do we need to change the current way in which pathology services are delivered?
The NHS needs to ensure it is able to provide sustainable high quality, resilient and efficient services in the years ahead. Through greater collaboration across South Yorkshire and Bassetlaw (SYB) pathology services, there are opportunities to benefit both patients and staff in a way that could not be achieved by Trusts in isolation. This includes development of common approaches to respond to increasing demand and use of new technologies over the coming years.
2. What are the NHS Improvement (NHSI) Pathology Networks?
NHSI published 29 proposed pathology networks across the NHS in England in September 2017. These grouped pathology services based on regional alignment, and divided services between “hubs” and “spokes”. Within SYB, Sheffield Teaching Hospitals FT (STHFT) was identified as the hub and the other services were identified as spokes.
As a specialist Trust, Sheffield Children’s FT was not originally included in the SYB network, but this was then confirmed in late December. However, this service delivers a number of specialist tests for which it may be more appropriate to network with other specialist children’s services across the country.
3. Do Networks have to implement the NHSI hub and spoke model?
The requirement on Trusts is for Networks to consider the implications of implementing the hub and spoke model and adopt the most appropriate networked model for the geographical area. This scoping work is underway and is overseen by the Pathology Executive Steering Board, and the Operational Board attended by Pathology Managers and Clinical Leaders, and chaired by a Trust Chief Executive.
4. Don’t we already have a form of hub and spoke model in place across SYB?
There is already a form of hub and spoke model in place across SYB, with services referring a number of specialist tests to one of the Trusts in the network (most commonly STHFT). However the NHSI model assumes a much higher level of work undertaken by the hub on behalf of Trusts and primary care.
5. When will a decision be taken on whether to implement the NHSI Hub and Spoke model?
No formal decisions have yet been taken on implementing all, or part of the NHSI model, but all Trusts have confirmed their support, subject to agreeing the best model. This will be informed by a full option appraisal, taking into account feedback from potential suppliers and other stakeholders, and the development of a business case over the coming months. This will be overseen by the Pathology Executive Steering Board and Operational Board with engagement of Reference Groups for blood sciences, microbiology/ virology, histopathology and specialist laboratory services.
There are a number of key implications in relation to increased networking between services, which will need to be scoped as part of the business case. This includes the need to ensure continued accreditation with ISO requirements and maintained clinical quality / patient safety, implementation of common IT systems and robust logistics.
A Memorandum of Understanding has been developed which sets out Trust commitment to work together in a (as yet to be agreed) networked model.
6. How is any investment that is required (e.g. IT) going to be found?
Investment requirements will include IT, logistics, and potentially estate, and will be incorporated into the business case over the coming months.
Trusts will need to confirm through the business case that the benefits justify any investment requirements. There may also be some national funding that becomes available to support networks.
7. Does STHFT have the capacity as hub to take on extra tests?
The capacity at STHFT to take on additional tests is being scoped, as are the associated requirements including IT and logistics.
8. What are the timescales for implementation of any new model?
The option appraisal to consider the NHSI model and the development of a business case will take a number of months to complete as we ensure that any decisions are based upon sound understanding of implications of any change. These will include key risks, issues or investment requirements of the NHSI model compared to continuing with existing services.
Any implementation of service changes that are agreed will be phased to mitigate disruption to service delivery and staff. Some changes may take years to implement owing to requirements such as IT and alignment with contract end points.
9. Will there be any job losses?
Our workforce is the backbone of pathology services and we are very keen to ensure this process does not create unnecessary anxiety for colleagues about job losses.
At this stage the focus is simply to scope the implications of implementing the NHSI model across SYB, which would be likely to take some time to implement in full. In the long term any service changes that do take place will be managed to mitigate negative impact on staff, and by working together on a longer term plan there will be an opportunity to realign services as posts become vacant.
10. Are medical consultants included within scope the NHSI model?
Medical consultant roles are a key part of pathology services and so are included within the scope of the SYB review but have not been included in the NHSI assumptions.
11. How will staff be kept updated on the SYB Network?
A full communications and engagement plan was launched in March 2018 which includes regular updates and web resources which colleagues can access to be kept abreast of developments, and to understand how to be involved in the process.
If you have any queries please contact your service manager, and we will use your queries to support the ongoing development of this FAQ.
Digital Pathology Event
On Tuesday 4th September, over 140 people gathered at Sheffield University’s Medical School to attend a whole day event hosted by the Pathology Transformation Programme.
The event focused on planning for and implementation of Digital Histopathology and was hosted by Dr Branko Perunovic, Clinical Director for the ICS Pathology Transformation Programme.
The local workforce had the chance to hear from a number of high profile speakers including household names in Digital Pathology from the UK, Netherlands, Romania and Germany.
Digital developments have the opportunity to bring about a new era of pathology – by combining the skills of Pathologists with computer-based tools and artificial intelligence as the speakers discussed during their presentations.
There was a uniform acknowledgement that adoption of digital pathology will be a key technological enabler for developing a new service model and address the widening gap between the demand and capacity of histopathology services in the UK and prevent serious adverse impact on cancer services. Currently, only 3% of histopathology departments in the UK have enough staff to meet the demand and the number of consultant vacancies is exceeding 25%.
View the presentations from the event:
View the videos recorded at the event below: