Directorate of Laboratory Directorate of Laboratory MedicineMedicine

Central Manchester and Manchester Children’s University Hospital Central Manchester and Manchester Children’s University Hospital NHS TrustNHS Trust

Directorate of Laboratory MedicineDirectorate of Laboratory MedicineCorporate BriefCorporate BriefAgendaAgenda

Clinical GovernanceClinical Governance

& Developments & Developments (Keith Hyde)(Keith Hyde) People People (Pat Zukowskyj)(Pat Zukowskyj) PFI and Facilities PFI and Facilities (Pat Zukowskyj)(Pat Zukowskyj) Finance Finance (Pat Zukowskyj)(Pat Zukowskyj) CPA Accreditation CPA Accreditation (Malcolm Dunlop)(Malcolm Dunlop) Fire Lecture Fire Lecture (Malcolm Dunlop)(Malcolm Dunlop)

Directorate of Laboratory Directorate of Laboratory MedicineMedicine

Central Manchester and Manchester Children’s University Hospital Central Manchester and Manchester Children’s University Hospital NHS TrustNHS Trust

Directorate of Laboratory MedicineDirectorate of Laboratory Medicine

PATHOLOGY NETWORKSPATHOLOGY NETWORKS

REPORT DUE SOONREPORT DUE SOON

Directorate of Laboratory Directorate of Laboratory MedicineMedicine

Central Manchester and Manchester Children’s University Hospital Central Manchester and Manchester Children’s University Hospital NHS TrustNHS Trust

Directorate of Laboratory MedicineDirectorate of Laboratory Medicine

Clinical DiagnosticsClinical Diagnostics

Capacity ProjectCapacity Project

PROJECT DIRECTORPROJECT DIRECTORGILBERT WIERINGAGILBERT WIERINGA

Directorate of Laboratory Directorate of Laboratory MedicineMedicine

Central Manchester and Manchester Children’s University Hospital Central Manchester and Manchester Children’s University Hospital NHS TrustNHS Trust

Directorate of Laboratory MedicineDirectorate of Laboratory Medicine

DOH Diagnostics AgendaDOH Diagnostics Agenda

Drivers:Drivers:

- Better chronic disease management- Better chronic disease management

- Reduced hospital - Reduced hospital admission/attendanceadmission/attendance

- Improved services- Improved services

- Patient choice and demand- Patient choice and demand

Directorate of Laboratory Directorate of Laboratory MedicineMedicine

Central Manchester and Manchester Children’s University Hospital Central Manchester and Manchester Children’s University Hospital NHS TrustNHS Trust

Directorate of Laboratory MedicineDirectorate of Laboratory Medicine

Capacity planning: 2003-2008Capacity planning: 2003-2008

Two phases:Two phases:1)1) To determine To determine current capacitycurrent capacity in in

staffing, facilities and technology at staffing, facilities and technology at primary and secondary careprimary and secondary care

2)2) To determine To determine capacity needs in 2008capacity needs in 2008

Phases led by healthcare professionals drawn from GMSHA secondary care geographical sectors

Directorate of Laboratory Directorate of Laboratory MedicineMedicine

Central Manchester and Manchester Children’s University Hospital Central Manchester and Manchester Children’s University Hospital NHS TrustNHS Trust

Directorate of Laboratory MedicineDirectorate of Laboratory Medicine

Initial findings: Initial findings: Lab. medicineLab. medicine

Services have Services have little impact on waiting little impact on waiting listslists, access targets, access targets

Secondary care capacity Secondary care capacity well organisedwell organised GP referred workloads GP referred workloads rising rapidlyrising rapidly Point of Care testing in the communityPoint of Care testing in the community

needs to be developedneeds to be developed Where should Where should future work be locatedfuture work be located??

Directorate of Laboratory Directorate of Laboratory MedicineMedicine

Central Manchester and Manchester Children’s University Hospital Central Manchester and Manchester Children’s University Hospital NHS TrustNHS Trust

Directorate of Laboratory MedicineDirectorate of Laboratory Medicine

GP GP phlebotomy phlebotomy demandsdemands

2000 2001 2002 2003

70000

55000

40000

Nos. of samples

Directorate of Laboratory Directorate of Laboratory MedicineMedicine

Central Manchester and Manchester Children’s University Hospital Central Manchester and Manchester Children’s University Hospital NHS TrustNHS Trust

Directorate of Laboratory MedicineDirectorate of Laboratory MedicineGP GP glucoseglucose & & HbA1CHbA1C requestingrequesting

2000 2001 2002 2003

Nos. of tests

15000

24000

33000

Directorate of Laboratory Directorate of Laboratory MedicineMedicine

Central Manchester and Manchester Children’s University Hospital Central Manchester and Manchester Children’s University Hospital NHS TrustNHS Trust

Directorate of Laboratory MedicineDirectorate of Laboratory MedicineDOH supported DOH supported developmentsdevelopments

Development of Development of Withington DTCWithington DTC/ / establishing new models of access to MR establishing new models of access to MR capacitycapacity

Proviision of Proviision of DIAGAMDIAGAM – mobile diagnostics – mobile diagnostics

Introducing clinical/diagnostic services at Introducing clinical/diagnostic services at the point of care in the point of care in Pharmacy outletsPharmacy outlets

Directorate of Laboratory Directorate of Laboratory MedicineMedicine

Central Manchester and Manchester Children’s University Hospital Central Manchester and Manchester Children’s University Hospital NHS TrustNHS Trust

Directorate of Laboratory MedicineDirectorate of Laboratory MedicineDrivers for Drivers for clinical/diagnostic services clinical/diagnostic services

at the point-of-careat the point-of-care Diagnostics agenda, Diagnostics agenda, new pharmacy contractnew pharmacy contract Advances in Point-of-Care Advances in Point-of-Care technologytechnology Increased Increased workloadsworkloads from NSFs, from NSFs, NICE NICE

guidelines implementationguidelines implementation Increase in Increase in OTC prescribingOTC prescribing Patient Patient choicechoice GMS contractGMS contract

Directorate of Laboratory Directorate of Laboratory MedicineMedicine

Central Manchester and Manchester Children’s University Hospital Central Manchester and Manchester Children’s University Hospital NHS TrustNHS Trust

Directorate of Laboratory MedicineDirectorate of Laboratory MedicineApplications of Pharmacy-Applications of Pharmacy-basedbased

point-of-care testingpoint-of-care testing

Condition/disease POCT Patient supportDiabetes Glucose Detection

Anticoagulation INR Manage/prescribewarfarin

Hyperlipidaemia Cholesterol Manage/prescribelipid lowering

Diabetes HbA1C Monitoring,repeat prescribing

Directorate of Laboratory Directorate of Laboratory MedicineMedicine

Central Manchester and Manchester Children’s University Hospital Central Manchester and Manchester Children’s University Hospital NHS TrustNHS Trust

Directorate of Laboratory MedicineDirectorate of Laboratory Medicine

What is What is DIAGAMDIAGAM ? ?

Taking Diagnostics closer to patients Taking Diagnostics closer to patients ….….

A vision for a mobile A vision for a mobile

DIAGDIAGnostic nostic AMAMbulance servicebulance service

Directorate of Laboratory Directorate of Laboratory MedicineMedicine

Central Manchester and Manchester Children’s University Hospital Central Manchester and Manchester Children’s University Hospital NHS TrustNHS Trust

Directorate of Laboratory MedicineDirectorate of Laboratory Medicine

DIAGAMDIAGAM : the opportunities : the opportunities

RadiologyRadiology X-rayX-ray MRIMRI UltrasoundUltrasound

Physiological Physiological measuresmeasures DVTDVT ECGECG Exercise toleranceExercise tolerance

Laboratory medicineLaboratory medicine DiabetesDiabetes AnticoagulationAnticoagulation LipidsLipids PhlebotomyPhlebotomy

EndoscopyEndoscopy GastroscopyGastroscopy

Directorate of Laboratory Directorate of Laboratory MedicineMedicine

Central Manchester and Manchester Children’s University Hospital Central Manchester and Manchester Children’s University Hospital NHS TrustNHS Trust

Directorate of Laboratory MedicineDirectorate of Laboratory Medicine

Issues for discussion:-Issues for discussion:-

Role of the Role of the independent sectorindependent sector in in capacity provisioncapacity provision

Role of the Role of the professions professions in new service in new service developmentdevelopment

Overlap of Overlap of pathology modernisationpathology modernisation programme with diagnostics agendaprogramme with diagnostics agenda

Directorate of Laboratory Directorate of Laboratory MedicineMedicine

Central Manchester and Manchester Children’s University Hospital Central Manchester and Manchester Children’s University Hospital NHS TrustNHS Trust

Directorate of Laboratory MedicineDirectorate of Laboratory Medicine

ACKOWLEDGEMENTACKOWLEDGEMENT

PROJECT DIRECTORPROJECT DIRECTOR

GILBERT WIERINGAGILBERT WIERINGA

Directorate of Laboratory Directorate of Laboratory MedicineMedicine

Central Manchester and Manchester Children’s University Hospital Central Manchester and Manchester Children’s University Hospital NHS TrustNHS Trust

Directorate of Laboratory MedicineDirectorate of Laboratory Medicine

Pat ZukowskyjPat Zukowskyj

Directorate of Laboratory Directorate of Laboratory MedicineMedicine

Central Manchester and Manchester Children’s University Hospital Central Manchester and Manchester Children’s University Hospital NHS TrustNHS Trust

Directorate of Laboratory MedicineDirectorate of Laboratory Medicine

PeoplePeople

Agenda for ChangeAgenda for Change

Format of Lab Managers meetingsFormat of Lab Managers meetings

Central Manchester and Manchester Children’s University Hospital Central Manchester and Manchester Children’s University Hospital NHS TrustNHS Trust

Division of Clinical Scientific ServicesDivision of Clinical Scientific Services

Directorate of Laboratory Directorate of Laboratory MedicineMedicine

DLM IM&T

StrategicGroup

Estates DLM

QuarterlyReview(3/12)

DLMExecutive

SIRT

DLM BOARD

STRATEGIC

DLMVFM

Group(2/12)

Pathology Modernisation

StrategicSteeringGroup

(2-2/12)

Simon WalshPathologyStrategic

CRESMeeting inc.Children’s

(1/12)

DLMAfC

Steering Group

Lab Managers WEEK 4

Finance in attendanceCRESProcurement

Lab Managers WEEK 3

PlanningITCPABenchmarkingKPIsIT Manager in attendance

Lab Managers Week 2

FacilitiesPFI

Lab Managers WEEK 5

Adhoc

Lab Managers WEEK 1

HR in attendanceAfCH & SEducationQuality

OPERATIONAL

Departmental Meeting }Team Brief Meeting }“Chiefs” Meetings } through Lab Managers Departmental Senior Staff Meetings }DLM Safety Committee → through MSD → Lab ManagersDLM Quality Board → through MSD → Lab Managers = Terms of ReferenceMortuary Working Group → through CH & A D-G → DLM Executive (Mortuary) SIRT (½) documentedDLM Joint Consultative Committee → through PZ → Lab ManagersDLM Education and Training Group → through BW → Lab ManagersMMMPTM → through RM → Lab Managers

Directorate of Laboratory Directorate of Laboratory MedicineMedicine

Central Manchester and Manchester Children’s University Hospital Central Manchester and Manchester Children’s University Hospital NHS TrustNHS Trust

Directorate of Laboratory MedicineDirectorate of Laboratory Medicine

FacilitiesFacilities

PFI – CSB III Plans and PFI – CSB III Plans and DevelopmentDevelopment

Directorate of Laboratory Directorate of Laboratory MedicineMedicine

Central Manchester and Manchester Children’s University Hospital Central Manchester and Manchester Children’s University Hospital NHS TrustNHS Trust

Directorate of Laboratory MedicineDirectorate of Laboratory Medicine

Finance UpdateFinance Update

Clinical & Scientific Support Services Division Clinical & Scientific Support Services Division overspent by £270k to July 04overspent by £270k to July 04

Laboratory Medicine underspent by £179.8kLaboratory Medicine underspent by £179.8k Variance due to payVariance due to pay

Directorate initial share of Divisional CRES target for Directorate initial share of Divisional CRES target for the year (£80k) has been implementedthe year (£80k) has been implemented

Finance to be focus of the final Lab Managers Finance to be focus of the final Lab Managers meeting each monthmeeting each month

New Directorate Accountant to be announcedNew Directorate Accountant to be announced

Directorate of Laboratory Directorate of Laboratory MedicineMedicine

Central Manchester and Manchester Children’s University Hospital Central Manchester and Manchester Children’s University Hospital NHS TrustNHS Trust

Directorate of Laboratory MedicineDirectorate of Laboratory Medicine

Malcolm DunlopMalcolm Dunlop

Directorate of Laboratory Directorate of Laboratory MedicineMedicine

Central Manchester and Manchester Children’s University Hospital Central Manchester and Manchester Children’s University Hospital NHS TrustNHS Trust

Directorate of Laboratory MedicineDirectorate of Laboratory Medicine

Accreditation statusAccreditation status

Biochemistry – fullBiochemistry – full Cytology – fullCytology – full Haematology – fullHaematology – full Histology – (conditional)Histology – (conditional) Immunology – fullImmunology – full Bacteriology – conditionalBacteriology – conditional Virology – conditionalVirology – conditional HPA – conditionalHPA – conditional

In communication

Directorate of Laboratory Directorate of Laboratory MedicineMedicine

Central Manchester and Manchester Children’s University Hospital Central Manchester and Manchester Children’s University Hospital NHS TrustNHS Trust

Directorate of Laboratory MedicineDirectorate of Laboratory Medicine

ProgressProgress

Audit training completedAudit training completed Standardised document templatesStandardised document templates Departments updating documentsDepartments updating documents Document control roll out startedDocument control roll out started Quality Policy publishedQuality Policy published Management procedures being preparedManagement procedures being prepared Management review plannedManagement review planned User Survey Completed and ReportedUser Survey Completed and Reported

Directorate of Laboratory Directorate of Laboratory MedicineMedicine

Central Manchester and Manchester Children’s University Hospital Central Manchester and Manchester Children’s University Hospital NHS TrustNHS Trust

Directorate of Laboratory MedicineDirectorate of Laboratory Medicine

What’s happeningWhat’s happening

Departments have formed quality Departments have formed quality groups to prepare for CPAgroups to prepare for CPA

Vertical audits startedVertical audits started Witness audits to be plannedWitness audits to be planned Baseline audit to establish Baseline audit to establish

compliance with the new standards compliance with the new standards ongoingongoing

Series of DLM audits plannedSeries of DLM audits planned Step wise approach to standardsStep wise approach to standards