Using evidence, analysis and discussion to achieve consensus on the options for change

Pathology services throughout the NHS are being challenged to achieve significant gains in productivity.  Collinson Grant was asked by NHS West Midlands (NHSWM) to prepare a detailed plan for Pathology in the West Midlands.  This should set out how it could reduce costs by 20% in four years without compromising service, accessibility, or patients’ safety.  There were varied stakeholders and many vested interests as well as enthusiastic disciples for change.

We worked with seventeen local Trusts (forming 16 pathology services); met many clinicians, Pathologists and managers; and issued qualitative and quantitative questionnaires.   This generated copious data on the workforce, its activities and costs.  41 million tests were done each year by a staff of 2,717 whole time equivalents (WTEs).  But effort was concentrated in the six main pathology departments where 38 million tests were done by 2,435 WTEs.

We analysed fully-loaded costs of £194m – 56% being the cost of people with a further 20% consumed on marginal costs.  So 76% of the fully-loaded cost of pathology was spent on the direct costs of providing the service.  The indirect costs of pathology (£20m) and Trusts’ overheads (£26m) made up the rest.

Using the data that we had gathered, we considered seven economic cases.  The most conservative model indicated economic benefits to the health economy of the West Midlands of £19.1m (9.9%) by boosting technical efficiency.  At the other end of the spectrum, a model of maximum consolidation (a single regional hub with supporting spokes) could save £54.5m (28.0%) based on current demand.

To summarise our recommendations we wrote a comprehensive Project Initiation Document and led a workshop of senior clinicians and laboratory managers to debate the findings.  The assembled representatives of the Trusts agreed:

• that the formation of networks was the only credible answer
• that the radical option (a single hub) was too ambitious given the time available to achieve savings
• that having two hubs per network was a pragmatic approach to achieving consolidation and savings without breaking the system and
• that IT, transportation and the costs of transition were the only real show-stoppers.

Managers at NHS West Midlands were pleased with the way we engaged with Trusts, the methodology used, the acceptance by local clinicians to our work and its findings, and the lack of effort required on their part to ‘enforce’ participation.