Consolidation of pathology services in England: have savings been achieved?

BACKGROUND: During the last decade, pathology services in England have undergone profound changes with an extensive consolidation of laboratories. This has been driven by some national reviews forecasting a national reduction of costs by £250-£500 million ($315-$630 million) a year as a result. The main aim of this paper is to describe the financial impact of such consolidation, with a specific focus on the forecasted savings. A secondary aim is to describe the development of private sector involvement in laboratory services in a traditionally publicly funded healthcare system and the development of pathology staff size. METHODS: In the English scenario, the majority of hospitals and laboratories are publicly funded and a survey was sent as Freedom of Information request to all directors of pathology. A descriptive comparison of savings among consolidated and non-consolidated pathology services was made by using the pathology budgets in two different periods (2015 versus 2010), adjusted by inflation and increased activity. RESULTS: The hub-and-spoke model has been implemented as part of the consolidation process of pathology services in England. Consolidated pathology networks have achieved higher savings compared to non-consolidated single laboratories. There has been an increased role of private providers and savings were achieved with negligible personnel redundancies. CONCLUSIONS: Consolidated units have on average achieved larger cost savings than non-consolidated units but further analysis with stronger research design is required to independently evaluate the impact of pathology consolidation on both savings and quality.

Organisational learning.

Purpose The understanding of "organisations" has changed fundamentally from seeing them as concrete entities to viewing them as communities of meaning. Mature adults in healthcare learn best when addressing pressing problems in company of their peers. Healthcare is unlike other sectors because of the emotional labour which is part of the experience of clinical staff. Absorptive capacity offers a conceptual model for viewing organisational learning and the encouragement of systemic eloquence can be enabled through a variety of approaches, provided they are designed and delivered as part of a well-thought-through approach to developing local absorptive capacity. Design/methodology/approach This is a viewpoint paper. Findings Healthcare differs from other sectors. Organisational learning can be enabled by a range of approaches, but these need to be sensitive to local circumstances. Originality/value The paper asserts that healthcare is unlike other sectors because of emotional labour on the part of clinical staff. It maintains that organisations are communities of meaning, rather than concrete entities. Systemic eloquence can be enhanced by the concept of absorptive capacity, applied in local contexts.

Effective medical leadership development for a complex NHS.

The NHS Leadership Academy in England is investing £46 million in a standardized model of development, with academic qualifications becoming essential in future NHS leadership roles. This represents a cul-de-sac for medical leaders because it is based on a series of misplaced assumptions about health-care leadership and its development.

Clinical leadership: the challenge of making the most of doctors in management.

The need to develop the leadership and management capability of clinicians is deemed fundamental to address the cost and quality issues associated with health-care provision. The challenge facing the NHS is how best to bring this about.