A national network for Paediatric Pathology

1. A national network for Paediatric Pathology Prof Jim Bonham Clinical Director Sheffield Children’s NHS FT

2. Background In 2017 the NHSI proposed a model for the delivery of Pathology in England Analysis shows that the 105 hospitals in England which provide pathology services typically do 1.12 billion tests per year at a cost of £2.2 billion. The new pathology networks are expected to save the NHS at least £200 million pounds by 2020-2021. The proposal made by NHSI describes 29 networks for England with a task of improving resilience and quality while reducing unwarranted variation and improving cost effectiveness. The Carter proposals. Clearly this targets high throughput less specialist services where the biggest savings may be made. Initially Paediatric centres such as GOSH , SCH, BCH and Alder Hey were excluded but in Dec 2017 these were contacted and included. It caused some apprehension particularly for the specialist aspects of the services provided. The main concerns were: Would the specialist and distinct nature of Paediatric Pathology be recognised Would specialist services already provided by fewer than 29 providers be protected In April 2018 representatives from those services met and outlined areas where we could benefit from a national plan. NHSI recognised the issues and confirmed that they considered the services high risk/low reward and asked for our planning suggestions and guidance. In September 2018 NHSI recognised the formation of a national Paediatric Pathology Network in their “State of the Nation” publication.

3. Activities in 2018 In April, May and Sept leaders from Pathology in the four Trusts met to discuss possible workstreams In late September NHSI met with leaders from this potential network to discuss the options They welcomed the formation of a network and the proposed work-streams They emphasised the need for Trust based Executive sponsorship and support They emphasised the need for clear deliverables and a work plan In response we summarised the meeting and contacted the Alliance more formally to seek support. This includes: Newcastle, Manchester, Leeds, Alder Hey, SCH, BCH, Bristol, Evelina, GOSH, Southampton.

4. The work-streams proposed • The workstreams proposed are those in which working together as a national network would add value not possible at a local or regional level. They include: • Paediatric Histopathology – underpinned by a digital pathology capability • Paediatric Microbiology targeted to addressing issues of staffing and out of hours provision • Diagnostic Inherited Metabolic Disease services, tackling issues of strategic development, recruitment, out of hours provision and equity • Newborn Screening looking at interoperability, resilience, cost effectiveness and co-ordinated delivery as a national programme • Accreditation and quality management - areas where sharing experience and planning would improve quality and reduce bureaucracy • Research, these services present real opportunities for public and commercial research which could be strengthened by a national offering • Recruitment and retention. In these specialist areas a national workforce strategy needs to be developed to maintain the service. • International commercial development. The potential to network using IT provides the opportunity to market specialist analytical services over a wide geographic area and opens up the potential for wealth creation.

5. What do we need now?What we have done since and what we need to do. • Matt Shaw – the new CEO at GOSH has agreed to act as Exec Sponsor • A meeting is scheduled for June with key stakeholders • A recognised work-plan with staged deliverables • Advocates/leaders in the key areas identified • Financial support for staff time