1. Pathology Modernisation: The Carter Report and implications
Brian I. Duerden
Inspector of Microbiology and Infection Control,
Department of Health

2. The opportunity The past : 1970 – 2000 Now – infection matters again
“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

3. 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June 2002 Pathology: the essential service (Draft guidance for consultation)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

4. IoM Report July 2006 August 2005 – May 2006 Report on DH IoM web page
20 meetings with SHA leads for Pathology Modernisation
Jointly with HPA Regional Microbiologist
Report on DH IoM web page

5. 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 5
No plans 6

6. Modernisation funds IT investment 5 Service redesign 4 Equipment 7
Not allocated
Network IT programmes 7
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

8. Problems Staffing On call services Distant site working
Medical; biomedical and clinical scientists
On call services
Distant site working
Funding – lack of!
Both existing services and network development
Commitment
Foundation Trusts

9. Define what we provide for patient care and health protection
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

10. 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

11. 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

12. Priorities for change National specification/plan
Creation of stand-alone providers
IT connectivity (including health protection)
National reimbursement/tariff
Large-scale workforce change – multi-disciplinary working
Strong clinical leadership and management skills

13. 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

14. 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

15. 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

16. 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

17. Blue Skies Agenda

18. 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

19. 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)

20. Laboratory services Clinical Health protection Near patient testing
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)