Select Committee on Health Appendices to the Minutes of Evidence


Supplementary evidence by West Middlesex University Hospital NHS Trust (PS 56A)


Q538  "This issue of cost and quality goes to the heart of the inquiry we are doing. It would be extremely helpful if you could give the Committee more evidence about the quality gains and more analysis of this 10 per cent saving and what you think it would be costing the Trust to provide the service in house today, given that you may not have been able to maintain it and the investment and capital may not have been keeping pace if you had not gone down a private sector route"



  Following an extensive option appraisal process in 1995, SmithKline Beecham Clinical Laboratories (SBCL) emerged as the preferred provider of pathology services for the West Middlesex University Hospital in 1996. (SCBL were acquired by Quest Laboratories in 1999). This document describes the quality systems before and after this date.

Before 1996

  The pathology was split into four departments: biochemistry, haematology, microbiology and histology (including cytopathology).

    —  Each department was housed in separate premises—Biochemistry and Microbiology in purpose built accommodation; Haematology and Histopathology in converted wards. The conversions were suboptimal in respect of space and layout and were expected to attract criticism from accreditation inspectors (CPA Ltd).

    —  The departments did not share a common computer system. To retrieve complete patient test results, requests were made to reception staff in each discipline. This was time consuming and could lead to errors as different conventions were used to record patient demographic details. Junior medical staff complained because a disproportionate amount of their time was devoted to "chasing up" hard copy results.

    —  Quality processes concentrated on Internal Quality Control (IQC) and participation in External Quality Assurance (EQA). There were insufficient staff to engage in Quality Assurance (anticipation/avoidance of errors) and Quality Improvement Initiatives (continuous improvement of standard working procedures).

    —  Departments differed in the manner in which they captured and documented errors.

    —  User satisfaction surveys were not carried out because of insufficient resources.

After 1996

  Accommodation was reconfigured. An emergency laboratory was established on the hospital premises. A large, new offsite laboratory (30,000 sq ft) was built in Heston, five miles from the hospital. Each facility housed all pathology disciplines.

    —  The new premises provided optimal accommodation for personnel and machines. The pathology department now holds dual accreditation [CPA Ltd (UK) and CAP—College of American Pathologists].

    —  All pathology disciplines and services now share a common computer system. Patient lookup is reliable because standard rules apply to all entries. The laboratory system is interfaced to the hospital system permitting lookup of results on the ward by junior staff who no longer waste time engaged in protracted searches of paper based systems.

    —  A Quality Assurance (QA) Officer was appointed. She has worked collaboratively with the consultant pathologists in creating a new Quality System suited to the requirements of a major NHS district general hospital.

      —  The QA Officer is supported by a dedicated group of experts in laboratory quality systems. These personnel are employees of the company (Quest) and generally work in corporate headquarters. Some are international experts in their respective fields. Their advice is available to the consultant pathologists and to the clinical scientists.

      —  The QA Officer has established a Quality Action Team (QAT) which directs the strategy and operations of all quality processes within the pathology department. The QAT is chaired by a NHS consultant pathologist.

      —  The QAT implements and monitors Quality Assurance activities and Quality Improvement initiatives. The QAT designed and implemented a formal system to monitor, record and resolve errors.

    —  Since 1996, the pathology department has carried out surveys among users drawn from the hospital and from general practice. This has led to changes and enhancements of the service eg patient reports were completely redesigned because of comments and suggestions from users.


  Quality is an ongoing and expensive process. Before 1996, there were good intentions but delivery was constrained by inadequate budgets and therefore resources. The service to the hospital and surrounding GP's has since benefited from the introduction of a well-resourced and comprehensive quality system.


  In 1996-97 the Trust had a pathology budget of £2,731,528. The baseline contract signed with SBCL in September 1996 was for a base contract value of £2,451,000. This represents a saving of £280,528 or 10.27 per cent on the base budget.

  This saving was achieved mainly from the following sources:

    —  Rationalisation of the use of Trust estate and facilities for the provision of a pathology service to the hospital. In particular, the laboratory was centralised into occupying one building, rather than the several prior to the contract. This generated savings to the Trust in terms of overhead costs such as cleaning, estate maintenance, rates and energy consumption.

    —  The Trust also realised savings in capital costs related to depreciation on equipment which was transferred to SBCL and Capital Charges on the vacated premises.

    —  Savings from reduction in management costs from vacant post and reduction of consultant sessions to maximum part-time.

    —  Additional savings in processing costs for payroll, purchasing, general ledger and accounts payable.

  On the question of what we believe it would cost the Trust to provide the service in-house today, this is not readily easy to quantify. No specific analysis of the comparison between the current service provision and the in-house option has been undertaken during the period of the contract. It is true to state that the cost of pathology has risen over and above the rate of inflation since 1996. This is mainly due to increased volumes of test being performed which are in line with the increases seen nationally through NHS laboratories. It is also difficult to evaluate in retrospect what additional capital and revenue costs the Trust would have incurred in investing in equipment and additional staffing resource to meet the levels of quality and service currently provided by Quest. However, these aspects are being tested and evaluated as part of the current retender of pathology services which the Trust is engaged in with Ealing Hospital.

previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2002
Prepared 15 May 2002