Memorandum by The Doctors Healthcare Company
(PS57)
PUBLIC PRIVATE PARTNERSHIP
EXECUTIVE SUMMARY
TDHC are a leading provider with 15 years experience
of a wide range of services to support NHS and private pathology.
It is our view that the NHS pathology service
suffers from strategic neglect, misses opportunities to improve
and efforts to modernise to date have been slow, small scale and
in the need of more support.
TDHC RECOMMEND:
— The NHS identify leadership for change
in NHS pathology.
— The NHS establish pilot sites to
demonstrate modernised pathology providing services to populations
of at least one to two million.
— The NHS allow local solutions to
emerge but subject plans to scrutiny and review.
— The NHS regard the private sector
as a partner who can assist the process of change.
1. BACKGROUND
1.1 TDHC own The Doctors' Laboratory (TDL),
the UK's leading independent pathology services provider and www.sysmed
(WWA) a major supplier of IT and technology services to the public
and private laboratory worlds in the UK and overseas.
1.2 The two companies are UK owned and based,
with over 15 years experience of working with the NHS in pathology.
1.3 TDHC secured two of the four outsourced
pathology contracts with the NHS and has operated these very successfully.
It also supplies IT systems to 50 NHS sites and would welcome
further opportunities to help the NHS modernise pathology.
1.4 Pathology is a rapidly expanding service,
increasingly embracing predictive diagnosis involving new genetic
technology, and relying more and more on IT to disseminate large
amounts of clinical data.
2. PERCEPTIONS
OF PATHOLOGY
IN THE
NHS
TDHC have a wide experience of working with
the NHS, the private sector and overseas and would assess the
NHS as having the following problems:
2.1 Pathology suffers from strategic neglect.
Its laboratories operate on a small scale, are
fragmented, unmodernised, lack leadership attention, and find
it difficult to change. In comparison to the private sector it
is difficult to identify who is empowered to take decisions which
would enable pathology to modernise to take advantage of automation,
technology, modern communications, economies of scale, new working
methods etc. Despite increasing incidence of errors and quality
control issues the NHS performs well operationally, but in the
circumstances could do a lot better. This is not a reflection
on the abilities and the integrity of people within NHS pathology
but rather reflects that it is no ones job to restructure pathology
services, or can operate objectively with authority.
2.2 Opportunities are being lost
Through close contact with our clients in the
NHS we see many examples of where there are opportunities for
new ways of working, better co-operation between hospitals and
departments, better investment in equipment and technology, better
utilisation of technology and better use of scarce staffing resources.
2.3 Efforts to modernise have been slow,
small scale and in need of more support.
Recent initiatives to modernise pathology have
been modest and haven't engaged the private sector significantly.
Although pathology comprises 3 to 5 per cent of the total NHS
budget and pathology contributes 65 per cent of the diagnostic
input to the care of a patient only £8m has been earmarked
for Pilot schemes for modernisation this year. No effort has been
made to attract funds from the private sector for participation
in pilot schemes.
2.4 The private sector is portrayed as a
threat rather than a partner.
There is little recognition that private companies
may possess advantages of management focus and expertise, financial
and employment freedoms not enjoyed by the NHS and experience
of achieving change in a rapidly developing industry where the
private sector has to maintain excellent customer relations, continuous
innovation and value for money to survive.
3. RECOMMENDATION
TO IMPROVE
PATHOLOGY IN
THE NHS
3.1 The NHS should identify who is responsible
for modernising pathology and then empower them to lead change.
3.2 The NHS should quickly establish at
least six pilot sites including the NHS and private sectors to
demonstrate modernised pathology services in areas covering at
least one to two million population.
3.3 The NHS should allow local solutions
to emerge but subject plans to independent scrutiny and review
to ensure plans are robust and lessons can be learnt.
3.4 The NHS needs to regard the private
sector as a partner. For example TDHC can supply all of the following
services;
— Top level Consultancy advice through
Pathology Audit Consultants, its Consultancy Division (PAC). PAC
was established almost 10 years ago to help the NHS in restructuring
and has performed many strategic and operational reviews for the
NHS in that time. They are ideally placed to advise health economies
to consider and evaluate objectively the options for change.
— Financial advice and support. TDHC
is an equity partner of Barclays Bank and can arrange financing
for pathology proposals with access to significant capital sums
to finance large scale change if necessary, with the private sector
taking risks as appropriate.
— Pathology IT Support Systems. WWA
can provide a range of specialist IT systems and system support
services. Increasingly this may mean more involvement in systems
management as the advantages of modern IT are linked with the
ability to use and manage powerful tools rather than the ownership
of powerful tools.
— Automation and Robotics. WWA provide
a range of tools incorporating small scale robotics and scanning
facilities to streamline the operation of typical NHS laboratories.
— Facilities Management Services. TDL
have expertise in devising and maintaining management systems
in a variety of hospital settings and could provide a management
only solution within NHS settings for laboratory services.
— Management Support Services. NHS
managers can benefit from ad-hoc or routine support services.
— Project Management and Change management.
TDL have expertise in leading change in many hospital and laboratory
settings.
— Laboratory Service Delivery on a
contracted out basis. TDL have a successful track record already
and good relationships with trade unions, hospitals and staff.
TDL would manage the facility, staff and take responsibility for
modernisation over a five to seven year contractual period.
— Pathman Services. TDL can provide
a modernisation package comprising facilities, equipment automation
and IT only, with staff retained by the NHS.
November 2001
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