Supplementary evidence by Quest Diagnostics
FOLLOW UP TO ORAL EVIDENCE THURSDAY 22 NOVEMBER
Q9583, Q658 (ANDY
BURNHAM MP) FURTHER
"This issue of cost and quality goes to
the heart of the inquiry we are doing. It would be extremely helpful
if you could give the Committee more evidence about the quality
gains and more analysis of this 10 per cent saving and what you
think it would be costing the trust to provide the service in
house today, given that you may not have been able to maintain
it and the investment and capital may not have been keeping pace
if you had not gone down a private sector route."
. . ."What has prevented a bigger West London
consortium coming together for that service?"
Budgets in pathology vary considerably throughout
England and the rest of the UK. Service quality also varies considerably
however, these two factors are not directly related. Identifying
costs in pathology is not straightforward as many laboratories
identify and record costs differently. As would be expected, this
also makes valid comparisons difficult.
At the time the partnership with the West Middlesex
University Hospital NHS Trust (WMUH) was developed, running costs
for pathology were identified as being around £2.8 million.
The contract signed in 1996 was for a base contract value of £2,451,000
giving the Trust a saving of just over 10 per cent.
These running costs did not include capital
costs for facilities or equipment or certain overheads such as
purchasing, payroll, finance and HR.
Quest Diagnostics assumes the responsibility
for capital investment, the risk management associated with a
high profile clinical support service, and the risk associated
with managing the variable costs associated with a demand-led
Despite the commitment and dedication of staff,
service delivery was sub-optimal with a number of problems from
specimen collection, through turnaround times to results delivery.
Some of these problems arose because of lack of investment, some
because of lack of change management skills, and some because
of there being no incentive to make the changes necessary. The
partnership with Quest Diagnostics introduced these factors. Through
a series of discussions with users, revised service levels were
agreed and implemented followed by questionnaires to evaluate
Attached is an example of a Customer Satisfaction
Survey. The survey results and commentary are shown in a number
of formats; the questionnaire itself, the follow-up report showing
the survey findings, the raw data from which the report was drawn
up and a report for the staff newsletter so that all staff are
aware of performance.
The staff in pathology are scientists and as
such are well used to their subject changing and developing however,
this has not extended to its operational and working practice
to the degree that is required for the modern National Health
Service. Some collaborative working is beginning to happen however,
this has invariably been the result of pressure from Trust management
and would not otherwise have happened. The type of collaboration
is limited and is usually confined to developing shared IT systems
and moving small amounts of work by mutual consent. The majority
of NHS pathology laboratories are still configured in the same
way as they were 20 or more years ago.
The changes that have taken place have moved
the service very little in terms of best practice (scientific,
technical or managerial), transparency and accountability with
respect to Quality Assurance, improving staff morale (including
recruitment and retention), better use of expensive assets and
developing technology, and more resilient operational systems
that can cope with increasing workloads effectively.
Strategic direction needs to be set in line
with other regional priorities. In a similar approach to the way
that cancer centres have been developed, pathology centres should
be developed. Expertise and resource based in a centralised operation
that supports other acute, non-acute and primary care facilities.
The Pathology Modernisation Fund has highlighted the many problems
in pathology, developing solutions has been more difficult. Larger
groupings and more importantly, the development of Public Private
Partnerships would have enabled the introduction of changes that
have been proven to raise standards and service quality. The partnership
between the West Middlesex University Hospital NHS Trust and Quest
Diagnostics is perhaps the best example of significant change
with respect to quality systems and working practice.
The laboratory is currently operating at approximately
25 per cent of capacity and yet plans are being drawn up to build
additional NHS laboratory space in the local area.
The scepticism and concern of the professionals
will only be overcome if an expertly managed and objectively monitored
pilot or development site is established. The relevant professional
bodies and trades unions should be an integral part of this, not
merely as observers or monitors, but as active participants. This
option has already been raised with both the Royal College of
Pathologists and MSF and there is tentative support.
Quest Diagnostics has a customer survey strategy
that is designed to gauge our success in the eyes of our customers
and identify areas for improvement and development. Questionnaires
are developed for each market segment (eg General Practitioners,
Private Physicians, hospital clinicians etc). An important point
to remember about customer satisfaction questionnaires is that
in order to find out how you can improve you need to find out
where you don't measure up to your customers expectation of you.
In order to get sufficient numbers of responses to make the exercise
valid, the questionnaire must be easy to understand and complete
and not take up too much time. Reply paid envelopes, fax back
sheets and telephone follow-ups for non-returns are all ways to
increase participation. There is merit in focusing on specific
areas for each questionnaire.
13 Examples of a questionnaire can be obtained from
Quest Diagnostics. Back