Tony Cambridge is Lead Biomedical Scientist at University Hospitals Plymouth NHS Trust, and Managing Director of Thornhill Healthcare Events and Consultancy. He frequently speaks at national and international healthcare events and is a key opinion leader for point-of-care testing, organising his own national events throughout the year
Since the formation of the pathology networks under NHS Improvement proposed in 2017, there has been a steady increase in collaborative working across healthcare systems. The original strategy was to promote cost efficiencies and remove unwarranted variation, leading to improved patient care and delivering the objectives of the NHS Long Term Plan.
To effect change, pathology networks needed to engage with end users on a scale not necessarily seen before. Stakeholders are identified, incorporated into working groups, and decisions made around the provision of pathology services across regions, headed by Network Directors appointed by NHS England. The goal is to drive effective transformation of existing services. A levelling up of sorts.
Delivering care
New models of care delivery are now being presented, becoming serious contenders for adoption. For instance, there is more focus on decentralised testing such as point of care and rapid diagnostics. The hospital at home model has now developed to include virtual wards where physiological and diagnostic tests can be performed to monitor patients safely in their homes, releasing essential beds and resources in the hospital setting. Acute respiratory infection hubs (ARIs), post-pandemic, are also gaining popularity alongside the ongoing battle against antimicrobial resistance through the antimicrobial stewardship programme.
The digital agenda is moving at speed, not only at a specialty level such as digital pathology, but to include a national electronic patient record (EPR) accessible to care providers wherever that care is being delivered. The NHS has access to an ever-growing repository of healthcare data. The use of artificial intelligence and algorithms in analysing this data for the purpose of health improvements has been under serious review for some time.
The proposed community diagnostic centres (CDCs) are moving forward in some regions, following the brakes being applied and funding removed from some very mature plans. A reversal of fortune for public health which aligns with the ethos of healthcare equality. These centres will need advice and guidance from pathology specialists, including clinicians, to ensure the most appropriate tests are adopted to deliver highly effective, quality services.
Links between the community and secondary care have never been stronger, with Integrated Care Systems (ICS) working more closely to develop a modernised healthcare system from general practice to emergency and hospital care. Initiatives such as Get it Right First Time (GIRFT) and the NHS Long Term Plan have refocused efforts in delivering efficiencies and standardisation. This has led to a new approach towards sustainability thrusting the green agenda into full frame.
Designing new centres for care which provide modernised care pathways has seen extensive engagement with architects and sustainability experts tasked with producing energy efficient solutions built using sustainable and ethically sourced materials. Existing structures undergoing refurbishments and repurposing will have the same ethics applied.
The independent report by Professor Sir Mike Richards, ‘Diagnostics: Recovery and Renewal’ recommends the need for a new diagnostics model, incorporating healthcare locations away from main hospital sites for quicker and easier access to tests on the same day. New services will support earlier diagnosis, greater convenience to patients and promote healthcare equality, removing the postcode lottery element of receiving optimal care.
Collaboration
Regardless of the project, through collaborative working each stakeholder can influence the direction developments head. More regional networks are now being created and becoming more mature in their activities. The membership of these groups needs to be diverse with attendance from all specialties influencing patient pathways. Agreed terms of reference, a vision statement and strategy to reach set goals and objectives, is key to successfully delivering improved outcomes.
Who are the stakeholders? This can differ from project to project, service to service, but within healthcare there needs to be executive buy-in for any new service or service improvement. Depending on the size of the proposed change an outline business case may be required which would require the author to assess the impact on multiple elements of the service. The performance team, finance and procurement will be involved to ensure the scheme is viable. Clinical teams need to state the perceived improvements to patient outcomes, making the argument as compelling as possible through data, reference to publications, or national guidance.
For instance, introducing a new test in a blood sciences laboratory would require a statement of clinical need. This would come through engagement with specialty leads who are requesting the new test and be based on clinical evidence gathered from several sources. This may also be a network decision with agreements to centralise certain tests in one location to promote efficiencies and sustainability. Consolidation can deliver significant service improvements, from turnaround times to quality of results. It reduces capital investment, ongoing revenue costs and specialist training requirements.
Another example of collaboration is multi-site tenders. Networks and regions have a lot to gain by partnering for equipment, IT solutions or service tenders. When the adoption of like for like equipment and testing provision is aligned, unwarranted variation is removed. If the individual members work together as an extended service, there would be no need to validate new equipment and tests across all sites adopting those solutions. Instead, the burden can be shared whereby individual sites take on an equitable amount of work. The result is that for any one test or platform, the members adopting the solution would only be required to locally verify performance against the manufacturer’s stated characteristics.
Using the networks
With pressures on workforce development and retention high, there is a renewed need to share the workload, specialist training and knowledge, along with working as efficiently as possible. Achieving the best value for money for the investment has always proven difficult within the NHS where a reputation of waste has been present for decades, with each political era seemingly failing to restore the balance.
The recent government announcement of significant plans to increase the numbers of medical staff and healthcare workers in the NHS, may give renewed hope. To ensure a sustainable workforce for the future of our healthcare system, the direction of travel and priorities needs to be clear to every member of a network, and the leadership of every organisation within the system. With so much ground having already been covered through network formation, integrated care and transformation in healthcare access, to not deliver the strategy would be categorised as the latest in a long catalogue of failures.
Tony Cambridge BSc MSc
Lead Biomedical Scientist
Tony Cambridge
Tony Cambridge is Lead Biomedical Scientist at University Hospitals Plymouth NHS Trust, and Managing Director of Thornhill Healthcare Events and Consultancy. He frequently speaks at national and international healthcare events and is a key opinion leader for point-of-care testing, organising his own national events throughout the year. He is active across healthcare platforms offering advice and guidance. He is also a member of a number of scientific advisory committees and boards. Tony set up a free online resource focusing on point of care and rapid diagnostics, www.POCTInnovators.com, to support the public and commercial sectors