Transcript Bringing microbiology out of the back

Pathology Modernisation: The
Carter Report and implications
Brian I. Duerden
Inspector of Microbiology and Infection
Control,
Department of Health
The opportunity
The past : 1970 – 2000
– “Infection is conquered”
– A nuisance – impedes the modern medical success
story
– Microbiology/IC sort it out!
Now – infection matters again
– MRSA/C. difficile/HCAI
– Pandemic/avian flu; TB; BBV/STI
The future: an Infection Service for the 21st
century
Pathology Modernisation
1999 Modernisation of Pathology Services:
Modernisation Funding
– HSC 1999/170; £10m
June 2002 Pathology: the essential service
(Draft guidance for consultation)
February 2004 Modernising Pathology Services
– £9.1m revenue, £54m capital
September 2005 Modernising Pathology:
building a service responsive to patients
– Carter Review
IoM Report July 2006
August 2005 – May 2006
– 20 meetings with SHA leads for Pathology
Modernisation
– Jointly with HPA Regional Microbiologist
Report on DH IoM web page
Network development
Managed network operational 1
Managed network planned
– 1 well advanced; 3 proposed
Formal network collaboration 6
– Not single management/budget
Planned formal network
– board in place 2; planning only 3 (1 SHA)
Professional network 8
Review of Pathology Services
No plans 6
5
Modernisation funds
IT investment
Service redesign
Equipment
Not allocated
5
4
7
16
Network IT programmes
– In full or part
7
Network activities
Transport – recognised but not actioned
TB services
– Fully coordinated 2
– Under review 10
– Individual responsibility 6
Chlamydia
– Fully coordinated 4
– Part coordination 1; funding problem 2
– Under review 2
Molecular diagnostics 1
Problems
Staffing
– Medical; biomedical and clinical scientists
On call services
Distant site working
Funding – lack of!
– Both existing services and network
development
Commitment
Foundation Trusts
Carter report – August 2006
Commissioned end-to-end core clinical service
– Stand alone service
National specification/plan
Contestability/competitiveness/plurality
Economies of scale/rationalisation
– 10% gain
Define what we provide for patient care and
health protection
Key drivers
Close to patients
Streamlined around user requirements
Competitiveness, plurality of provision
Commissioner-led
Clinical leadership, business infrastructure
Productivity
Information requirement
Core clinical service
Barriers to change
IT end-to-end connectivity
Sample collection fragmented service
Lack of commissioner understanding
Logistic/transport support
Variability of test repertoire
Inconsistency of configuration
Complex workforce/skill mix
Lack of investment
Separate point of care testing
Priorities for change
National specification/plan
Creation of stand-alone providers
IT connectivity (including health protection)
National reimbursement/tariff
Large-scale workforce change – multidisciplinary working
Strong clinical leadership and
management skills
Carter recommendations
“Reform of supply of Pathology must precede
commissioner-led provision”
Managed pathology networks
– Free standing organisations
– Economies of scale
NHS Trusts to have SLA for Pathology
Commissioners draw up specification
DH commissioning specification
– Tariff, new technology, workforce reform
– Standardisation, independent accreditation
Carter Pilots – 12 sites; £1m
Objectives
New commissioning model
New organisational model
Increased quality and responsiveness to
patients
Reduce NHS costs
1 per SHA (+2)
Oxford in SE SHA
Progress November 2006
Pilots Project Board established
Recognised need for inclusion of
– Infection Control
– Public health/Health Protection functions
– Data
– PH/HP investigation; CCDC support
– Specimens/cultures for typing etc
Will have a national stakeholder group
– Inspector of Microbiology member
Actions for Microbiology
IoM to provide national input based on
– ‘HP functions of NHS Labs’
– HCAI programme
Regional Microbiologist (HPA) to liaise
with Pilot Sites
– Project leaders
– Microbiology laboratories
Microbiologists in Pilot sites
– Ensure local input
Blue Skies Agenda
Vision and Goal
*An integrated and cohesive, quality
assured infection service for the
clinical care of infected patients,
infection control and health
protection.
*Investigation, diagnosis, treatment,
control and prevention of infection
Workforce – trained professionals
Medical – range of competencies; training
– Laboratory, clinical advice/care/infectious disease,
infection control, health protection
Biomedical/clinical scientists
Nurses/nurse consultants
Pharmacists
IT specialists
multi-professional teams
In laboratories, clinical settings, hospital and
community/primary care, health protection units
(and even management and government)
Laboratory services
Clinical
– diagnosis, treatment, infection control
Health protection
– surveillance reporting, outbreak investigation, samples for
reference testing
Near patient testing
Communication and IT
Standards and SOPs
Safety and biosecurity
Accreditation
Compliance: HCC annual healthcheck
Code of Practice (HCAI)