Select Committee on Health Appendices to the Minutes of Evidence


Supplementary evidence by Quest Diagnostics (PS55A)



    "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."

    . . ."What has prevented a bigger West London consortium coming together for that service?"


  Budgets in pathology vary considerably throughout England and the rest of the UK. Service quality also varies considerably however, these two factors are not directly related. Identifying costs in pathology is not straightforward as many laboratories identify and record costs differently. As would be expected, this also makes valid comparisons difficult.

  At the time the partnership with the West Middlesex University Hospital NHS Trust (WMUH) was developed, running costs for pathology were identified as being around £2.8 million. The contract signed in 1996 was for a base contract value of £2,451,000 giving the Trust a saving of just over 10 per cent.

  These running costs did not include capital costs for facilities or equipment or certain overheads such as purchasing, payroll, finance and HR.

  Quest Diagnostics assumes the responsibility for capital investment, the risk management associated with a high profile clinical support service, and the risk associated with managing the variable costs associated with a demand-led service.


  Despite the commitment and dedication of staff, service delivery was sub-optimal with a number of problems from specimen collection, through turnaround times to results delivery. Some of these problems arose because of lack of investment, some because of lack of change management skills, and some because of there being no incentive to make the changes necessary. The partnership with Quest Diagnostics introduced these factors. Through a series of discussions with users, revised service levels were agreed and implemented followed by questionnaires to evaluate user satisfaction.

  Attached is an example of a Customer Satisfaction Survey. The survey results and commentary are shown in a number of formats; the questionnaire itself, the follow-up report showing the survey findings, the raw data from which the report was drawn up and a report for the staff newsletter so that all staff are aware of performance.


  The staff in pathology are scientists and as such are well used to their subject changing and developing however, this has not extended to its operational and working practice to the degree that is required for the modern National Health Service. Some collaborative working is beginning to happen however, this has invariably been the result of pressure from Trust management and would not otherwise have happened. The type of collaboration is limited and is usually confined to developing shared IT systems and moving small amounts of work by mutual consent. The majority of NHS pathology laboratories are still configured in the same way as they were 20 or more years ago.

  The changes that have taken place have moved the service very little in terms of best practice (scientific, technical or managerial), transparency and accountability with respect to Quality Assurance, improving staff morale (including recruitment and retention), better use of expensive assets and developing technology, and more resilient operational systems that can cope with increasing workloads effectively.

  Strategic direction needs to be set in line with other regional priorities. In a similar approach to the way that cancer centres have been developed, pathology centres should be developed. Expertise and resource based in a centralised operation that supports other acute, non-acute and primary care facilities. The Pathology Modernisation Fund has highlighted the many problems in pathology, developing solutions has been more difficult. Larger groupings and more importantly, the development of Public Private Partnerships would have enabled the introduction of changes that have been proven to raise standards and service quality. The partnership between the West Middlesex University Hospital NHS Trust and Quest Diagnostics is perhaps the best example of significant change with respect to quality systems and working practice.

  The laboratory is currently operating at approximately 25 per cent of capacity and yet plans are being drawn up to build additional NHS laboratory space in the local area.

  The scepticism and concern of the professionals will only be overcome if an expertly managed and objectively monitored pilot or development site is established. The relevant professional bodies and trades unions should be an integral part of this, not merely as observers or monitors, but as active participants. This option has already been raised with both the Royal College of Pathologists and MSF and there is tentative support.



  Quest Diagnostics has a customer survey strategy that is designed to gauge our success in the eyes of our customers and identify areas for improvement and development. Questionnaires are developed for each market segment (eg General Practitioners, Private Physicians, hospital clinicians etc). An important point to remember about customer satisfaction questionnaires is that in order to find out how you can improve you need to find out where you don't measure up to your customers expectation of you. In order to get sufficient numbers of responses to make the exercise valid, the questionnaire must be easy to understand and complete and not take up too much time. Reply paid envelopes, fax back sheets and telephone follow-ups for non-returns are all ways to increase participation. There is merit in focusing on specific areas for each questionnaire.[13]

13   Examples of a questionnaire can be obtained from Quest Diagnostics. Back

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