South East London Pathology
Improving access to vital pathology services to enable better treatment
The National Health Service (NHS) in the UK is starting a new process of transformation. In line with the Long Term Plan, the NHS must continually evolve so that healthcare services are fit for the future. Part of that transformation is a new ‘hub and spoke’ model for pathology services that aims to make it easier for NHS doctors to access specialist pathology services to inform diagnosis and treatment for millions of people.
Working with two leading London hospital trusts and the wider South East London system partners, we helped establish one of the first central pathology hubs in the UK. Combining extensive experience of managing complex health transformation programmes and enabling pathology transformation, PA supported this complex and sensitive public-sector procurement through a competitive dialogue process.
We supported the partners to agree a 15-year contract with a new supplier for pathology services, which is expected to deliver over £100 million in savings over the contract term. It will give doctors in South East London access to cutting-edge diagnostic services, enabling them to deliver better, more integrated and effective healthcare for more than 2 million people.
- Provided programme and project support for a £2.2 billion procurement programme to establish a new ‘hub and spoke’ model for pathology services
- Acted as independent, trusted partner to enable collaboration among stakeholders in a complex health landscape and political environment
- Ensured a watertight tender process to protect against the possibility of challenge
- Developed a robust business case to demonstrate the value of transformation, which included £100+ millions of anticipated savings
Providing better access to specialist services
Pathology tests are vital to the effective diagnosis and treatment of disease. Many tests – and particularly those that don't require instant or rapid turnaround – are carried out in pathology labs in individual hospitals.
As part of the NHS National Pathology programme, NHS trusts are exploring the benefits of central hubs that will provide pathology services across geographies. Through better integration and collaboration, this 'hub and spoke' model aims to provide cost savings, improve quality, sustainability and accessibility for patients needing pathology services.
Also, by consolidating services, the NHS aims to make it easier for service users in hospitals or local GP practices to capitalise on advances in digital pathology. Automated analysis of digital images can be faster and more accurate than conventional analysis that will help ease workforce shortages and enable pathologists to collaborate more easily with colleagues.
Delivering an innovative and world class model
In London, two leading hospital trusts – Guy's & St Thomas' and King's College Hospital – had been using an innovative joint venture to run pathology services for some years. But with this contract coming to an end, the opportunity arose for them to build on their pioneering reputation and establish a new model in line with the NHS's vision.
Across a highly complex, three-year project, PA provided robust programme management to enable the system partners to assess and select a contract with a new supplier to realise this opportunity.
With extensive procurement expertise – from creating an integrated platform delivering better more effective medical services for the Black Country Pathology Service, to developing a sourcing strategy from scratch for the UK Ventilator Challenge – our team were able to successfully support the delivery of this multi-billion-pound procurement.
Our initial challenge was to establish requirements across a range of workstreams, including IT, HR, Finance, Clinical and Governance. We worked closely with senior stakeholders in Trusts, Primary Care and Clinical Commissioning Groups to understand their diverse needs.
For example, what type of IT system was needed to manage the tens of millions of tests that would be performed each year? How quickly did the new organisation need to turn around tests to meet clinical demands? How to seamlessly transfer the existing pathology workforce to the new organisation?
Balancing these requirements, absorbing complex and often technical detail while keeping stakeholders engaged throughout, we consolidated these requirements into material to engage the market through a formal public sector procurement process. Due to the risk of challenge in the initial down-selection, we put in place the necessary assurance to guarantee that supplier qualification responses were transparently and consistently evaluated.
We designed and implemented a robust governance process to support the necessary decision making to confirm the outcomes from the qualification review, which resulted in three bidders being shortlisted.
Running a competitive dialogue process
The three potential suppliers had a six-week period to prepare their bids. During this time, we supported the intensive clarification question process to ensure consistent and accurate responses to supplier questions from the relevant subject matter experts across the partner organisations.
With initial bids submitted, each bidder was invited to a first round of 'competitive dialogue' sessions. These were intended to help them understand requirements in greater depth and refine their bids. We applied robust and agile programme governance, facilitating collaboration across multiple stakeholders from multiple organisations to conduct 40+ sessions, covering each of the different workstreams and repeating each session for all three bidders.
Strict and careful evaluation of each bidder's revised bid saw all three progress to a second round. Once again, we facilitated dialogue sessions. Following a further round of proposals and evaluations, all three were invited to submit their 'best and final offer'.
To ensure unquestionable fairness in the evaluation of these proposals, we worked closely with specialist procurement lawyers. This enabled the evaluation team to recommend a preferred bidder and the programme entered a period of preparation for transition to the new provider.
During this process, COVID-19 hit and threatened to overwhelm services, as well as the programme's timelines. To make up for time lost to pandemic disruption, we accelerated the development of the Full Business Case – which was approved and demonstrated that the approach continued to be viable economically, financially and practically.
Managing contract negotiations
As the programme approached its conclusion, we played a critical role in facilitating and project managing the contract negotiations.
We brought together directors from the Trusts and representatives of the successful bidder in a series of day-long, COVID-secure working sessions, along with subject matter experts in genomics, to inform the discussions. We managed the process to incorporate the Trusts' requirements, bidder's tender response and new principles from the negotiations into a consistent set of agreements across multiple contracts with hundreds of schedules and appendices.
Setting transformation in progress
The final contract, agreed some three years after this complex programme began, promises a transformation of pathology services for healthcare providers serving more than 2 million people in South East London. It is also expected to deliver more than £100 million in cost savings over the next 15 years.