Select Committee on Health Minutes of Evidence

Memorandum by The Doctors Healthcare Company (PS57)



  TDHC are a leading provider with 15 years experience of a wide range of services to support NHS and private pathology.

  It is our view that the NHS pathology service suffers from strategic neglect, misses opportunities to improve and efforts to modernise to date have been slow, small scale and in the need of more support.


    —  The NHS identify leadership for change in NHS pathology.

    —  The NHS establish pilot sites to demonstrate modernised pathology providing services to populations of at least one to two million.

    —  The NHS allow local solutions to emerge but subject plans to scrutiny and review.

    —  The NHS regard the private sector as a partner who can assist the process of change.


  1.1  TDHC own The Doctors' Laboratory (TDL), the UK's leading independent pathology services provider and www.sysmed (WWA) a major supplier of IT and technology services to the public and private laboratory worlds in the UK and overseas.

  1.2  The two companies are UK owned and based, with over 15 years experience of working with the NHS in pathology.

  1.3  TDHC secured two of the four outsourced pathology contracts with the NHS and has operated these very successfully. It also supplies IT systems to 50 NHS sites and would welcome further opportunities to help the NHS modernise pathology.

  1.4  Pathology is a rapidly expanding service, increasingly embracing predictive diagnosis involving new genetic technology, and relying more and more on IT to disseminate large amounts of clinical data.


  TDHC have a wide experience of working with the NHS, the private sector and overseas and would assess the NHS as having the following problems:

  2.1  Pathology suffers from strategic neglect.

  Its laboratories operate on a small scale, are fragmented, unmodernised, lack leadership attention, and find it difficult to change. In comparison to the private sector it is difficult to identify who is empowered to take decisions which would enable pathology to modernise to take advantage of automation, technology, modern communications, economies of scale, new working methods etc. Despite increasing incidence of errors and quality control issues the NHS performs well operationally, but in the circumstances could do a lot better. This is not a reflection on the abilities and the integrity of people within NHS pathology but rather reflects that it is no ones job to restructure pathology services, or can operate objectively with authority.

  2.2  Opportunities are being lost

  Through close contact with our clients in the NHS we see many examples of where there are opportunities for new ways of working, better co-operation between hospitals and departments, better investment in equipment and technology, better utilisation of technology and better use of scarce staffing resources.

  2.3  Efforts to modernise have been slow, small scale and in need of more support.

  Recent initiatives to modernise pathology have been modest and haven't engaged the private sector significantly. Although pathology comprises 3 to 5 per cent of the total NHS budget and pathology contributes 65 per cent of the diagnostic input to the care of a patient only £8m has been earmarked for Pilot schemes for modernisation this year. No effort has been made to attract funds from the private sector for participation in pilot schemes.

  2.4  The private sector is portrayed as a threat rather than a partner.

  There is little recognition that private companies may possess advantages of management focus and expertise, financial and employment freedoms not enjoyed by the NHS and experience of achieving change in a rapidly developing industry where the private sector has to maintain excellent customer relations, continuous innovation and value for money to survive.


  3.1  The NHS should identify who is responsible for modernising pathology and then empower them to lead change.

  3.2  The NHS should quickly establish at least six pilot sites including the NHS and private sectors to demonstrate modernised pathology services in areas covering at least one to two million population.

  3.3  The NHS should allow local solutions to emerge but subject plans to independent scrutiny and review to ensure plans are robust and lessons can be learnt.

  3.4  The NHS needs to regard the private sector as a partner. For example TDHC can supply all of the following services;

    —  Top level Consultancy advice through Pathology Audit Consultants, its Consultancy Division (PAC). PAC was established almost 10 years ago to help the NHS in restructuring and has performed many strategic and operational reviews for the NHS in that time. They are ideally placed to advise health economies to consider and evaluate objectively the options for change.

    —  Financial advice and support. TDHC is an equity partner of Barclays Bank and can arrange financing for pathology proposals with access to significant capital sums to finance large scale change if necessary, with the private sector taking risks as appropriate.

    —  Pathology IT Support Systems. WWA can provide a range of specialist IT systems and system support services. Increasingly this may mean more involvement in systems management as the advantages of modern IT are linked with the ability to use and manage powerful tools rather than the ownership of powerful tools.

    —  Automation and Robotics. WWA provide a range of tools incorporating small scale robotics and scanning facilities to streamline the operation of typical NHS laboratories.

    —  Facilities Management Services. TDL have expertise in devising and maintaining management systems in a variety of hospital settings and could provide a management only solution within NHS settings for laboratory services.

    —  Management Support Services. NHS managers can benefit from ad-hoc or routine support services.

    —  Project Management and Change management. TDL have expertise in leading change in many hospital and laboratory settings.

    —  Laboratory Service Delivery on a contracted out basis. TDL have a successful track record already and good relationships with trade unions, hospitals and staff. TDL would manage the facility, staff and take responsibility for modernisation over a five to seven year contractual period.

    —  Pathman Services. TDL can provide a modernisation package comprising facilities, equipment automation and IT only, with staff retained by the NHS.

November 2001

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