Through the NENC Diagnostic Programme the Provider Collaborative is in the third year of a three-year programme of investment in digital diagnostics across the region. The focus of the programme is to put the patient at the centre of the new investment, to facilitate the choice and access that patients have to diagnostic services, irrespective of where the patient resides.
Developments include improving the interoperability of different technical systems between providers so that they can work collaboratively, streamline the referral processes, and virtualise our clinical teams to facilitate collaborative working and make better use of diagnostic capacity across the region.
In total, this has seen £13.5 million of the £17.8 million of national funding invested in the digital infrastructure, with £4.3 million allocated for the final elements to be delivered in 2024/25. This includes several key projects:
- The new integrated digital system is currently being implemented to allow real time visualisation of diagnostic referrals and appointments across the region to better use capacity and reduce waiting lists.
- The new electronic Order Communications System is currently being implemented to allow diagnostic tests (pathology, radiology and endoscopy) to be ordered using the same system across all providers. This will allow GPs, community staff and Consultants in hospitals to work in a collaborative manner allowing access to all patient test requests, irrespective of where they have been taken. This will reduce unnecessary duplication and help speed up treatment with quicker decisions on next steps.
- The new ‘global’ reporting tool is currently being implemented to allow network wide reporting of pathology and radiology results across all providers in the region. This means that providers of radiology and pathology can work together as a virtual team to improve the time taken for diagnostic examinations to be reported and allows the clinicians involved in a patient’s care to be able to see all relevant results wherever they were performed.
A key recommendation of the Richards’ Review of NHS diagnostic services was the development of community diagnostic centres (CDCs) to provide separate, dedicated locations for carrying out elective diagnostic procedures. There are six primary aims of the CDC Programme – improved population health outcomes; increased diagnostic capacity; improved productivity and efficiency; reduced health inequalities; improved patient experience; and support for the integration of primary, community and secondary care. Alongside this are cross-cutting programme aims and objectives, including: improving staff development and satisfaction; making every contact count and supporting health promotion; acting as test sites for quality improvement, research and innovation; contributing to the NHS Net Zero ambitions; sharing learning across CDCs and systems; and acting as anchor institutions.
North East and North Cumbria were early adopters of this programme with 13 sites stepped up to provide additional activity in late 21/22. Some of these sites were temporary as full plans were developed.
The final shape of the programme was agreed in 22/23 after full consideration of factors such as health inequalities, demand, and accessibility.
The system attracted a total of £85.75m to develop 4 Community Diagnostic Centre Hubs and 3 spoke sites.
- Workington CDC – new build due to open in June 25
- Tees Valley CDC - new build due to open in early 25
- Supported by 3 spoke sites:
- Friarage CDC (open)
- Redcar CDC (fully open in Feb 25)
- Hartlepool CDC (open)
- Metrocentre CDC – open
- Bishop Auckland CDC – open
These centres will be delivering a range of tests including CT, MRI, Non-obstetric ultrasound, echocardiograms, full lung function tests, and blood tests.
In 23/24 the programme delivered an additional 182,877 tests across the system.
The NENC Imaging Network is a collaboration of the region’s eight acute and community provider Trusts working alongside partners such as Northern Cancer Alliance and Primary Care. The network vision is:
“To achieve, through collaboration, safe, high quality and equitable access to Imaging services. With support of a highly skilled workforce, enhanced digital capability and best quality imaging facilities we will improve Imaging Services for the patients of the North East and North Cumbria.”
The network aims to:
- Achieve Network Maturing status by 2024/25 as required by NHS England
- Achieve a system wide approach to network services through sharing best practice and expert knowledge
- Commit to reducing health inequality within Imaging services, ensuring equitable and timely access for patients across the network.
- Improve staff wellbeing and retention through high quality training and development opportunities for all staff.
- Utilise digital and AI innovation to improve services.
- Deliver best value for money through system resource management.
Since 2019, the NENC Imaging Network has brought together FTs and other partners to collaborate and support each other given the challenges of rising demand, shortages in the imaging workforce, and ageing imaging equipment. All these things put pressure on each individual FT but by working together we have been able to deliver some fantastic results and made great progress in how we work together.
Some of the Network’s key achievements in 2023/24 include:
- Securing capital funding for imaging equipment and services across the region. This includes:
- £2.3m for a second MRI scanner at the Queen Elizabeth Hospital in Gateshead
- £1.6m for a second CT scanner at West Cumberland Hospital in North Cumbria.
- £2m to implement a new Chest X-ray using AI technology across seven Trusts.
- Introducing new leadership roles – a Lead Radiographer and a Digital Lead – to provide expert advice and guidance across the region.
- Developing the Imaging Academy (funded by Health Education England) to develop the training and education landscape across Radiology. The academy will also aim to introduce new roles into the Radiology workforce to free up clinical time and improve processes.
- Supporting the development of a future sustainable service model for Interventional Radiology across the region
- Launch of Specialist Interest Groups (SIG) for Paediatrics, Gynaecology, ENT, Spinal, MSK and Chest Imaging
The network continues to develop transformational strategies within five key work areas to continually work towards the network vision:
- Workforce
- Digital
- Quality
- Clinical access and activity
- Capital planning and equipment
The NENC Endoscopy Network is a collaboration of the eight acute and community provider trusts, and the Northern Cancer Alliance. The development of Endoscopy Networks was a recommendation from the Richard’s review, and seen as being key to recovering and transforming endoscopy services.
Through collaborative working the network aims to improve population outcomes from digestive diseases, improve quality and productivity, reduce inequalities and improve the sustainability of services.
The network was formalised in Dec 21, building on an already successful collaboration that was in place.
Some of the achievements to date:
- Review of Endoscopy Services across the ICS
- Implementation and evaluation of combined GI referral pathway
- Attracting additional capital monies
- 22/23 - £2.2m (equipment and estates upgrades)
- 23/24 – £14.996m (New build four room unit – North Cumbria)
- North Tees and Hartlepool and Gateshead Health have been re-accredited by JAG
- Northern Endoscopy Training Academy well established
- Gastroscopy training time reduced from 2 years to 0.54yrs
- 6 Gastro ST5, 5 surgeons & 2 clinical endoscopists certified in Gastroscopy
- Colonoscopy – consolidation of training, 10 surgeons, 4 gastro trainees and 2 clinical endoscopists
- Completion of productivity audits to inform service improvement
The key priorities for the network in 24/25 are:
- ERCP Network development
- Supporting all units to achieve JAG accreditation
- Ensuring provision of out of hours upper GI bleeding services, to ensure that all patients have access to the full range of emergency therapeutic options
- Developing complex polyp pathway
- Supporting alternative diagnostic testing
- Developing a workforce strategy
The national pathology transformation programme of work was established following decades of recognition and publications demonstrating that “the current system was fit for the purpose for which it was designed, but it is not fit for the future”. (1) Largely informed by the review of Pathology Services led by Lord Carter of Coles in 2016, NHS England defined “managed pathology networks” that are underpinned by a “framework that delivers an integrated service… to meet the needs of all”. (2, 3) The NENC Pathology Alliance is the managed pathology network in our ICS. In 2023, NHS England updated formalised guidance to progress the maturity of managed pathology networks such as our alliance. (4) Our alliance aligns with the ambitions defined by this guidance by ongoing programme of work, enabled by our operating model that supports our journey towards excellence in quality through more integrated pathology services and clinical support functions across the NENC network.
The NENC Pathology vision statement: “We are stronger together; our Alliance collaborates and innovates, bringing together clinical expertise to ensure equitable, quality and sustainable pathology services for the people of the NENC ICS” was agreed through engagement and recognition that we must ensure equitable service provisions to the population of the NENC ICS.
Our ongoing programme of work details our priority objective; such as progressing our workforce strategy and optimising our business intelligence processes to enable new and innovative ways of working and a high quality, effective and sustainable pathology service that meet the needs of our patients and users of the NENC ICS.
This programme of work reflects the national pathology transformation plans, which detail maturity requirements across seven domains:
- Governance
- Leadership
- Operational
- Quality
- IT & Digital
- Workforce
- Shared Supply Chain
The NENC Pathology Alliance workplan will inform requirements for these domains and aims to strengthen our pathology leadership, capability, capacity, resource management, workforce and deliver efficiencies for patients and carers.
Each year our diagnostic team leads are assessed and moderated by NHS England to determine the maturity of the NENC Pathology Alliance against the above domains. We are required to progress each of these domains to maturity by March 2025.
In May 2024, NHSE moderated the NENC Pathology Alliance as maturing for 5 of the 7 domains and maturing overall as a managed pathology network. This reflects an immense effort by ICS and Trust leaders and wider colleagues to establish a solid foundation to further improve pathology provisions for NENC.
Two of the 7 domains are currently moderated as developing (Digital & IT and Shared Supply Chain) and progression of these domains will inform our next steps. These include a comprehensive baseline of assets and contracts to inform a procurement strategy that aims to delivery the based value to our population and liaising & supporting digital and IT colleagues to progress laboratory information management system requirements that can facilitate an interoperable digital solution for patients and clinicians.
The moderated position of our pathology alliance is informed by progress such as:
- The formal establishment of the NENC Pathology Alliance and associated vision, values, organisation structure, defined lines of decision making and priority objectives.
- Securing a £1 million grant to establish the NENC Pathology Alliance Training Academy (PATA) to increase the number of registered Biomedical Scientists in NENC Trusts.
- Progression of the NENC Pathology Alliance Point of Care Testing (PoCT) reference group and development of the NENC PoCT strategy to support ICS clinicians in the development of PoCT and ensuring the most appropriate applications of these solutions.
- Building on established quality monitoring processes to begin developing an ICS wide pathology business intelligence dashboard that will provide all service providers with live data on activity. This will enable evidence-based decisions on demand optimisation and allow NENC to explore options to repatriate pathology testing, that is currently sent elsewhere, within NENC.
- Formalised business continuity processes and agreement that will inform further emergency, resilience, and preparedness of pathology services in NENC.
- NHSE recognition of a highly collaborative and transparent culture that facilitates continuous improvement.
- Dr Ian Barnes NHS England. Pathology Quality Assurance Review. 2014.
- Department of Health. Report of the Review of NHS Pathology Services in England. Chaired by Lord Carter of Coles. 2016.
- NHS Improvement. Proposed Pathology Consolidation Networks. 2021. Retrieved 25th June 2024.
- NHS England. Pathology Transformation – Progressing Network Maturity. 2023
Physiological science (PS) services describe a group of eight services (listed below) that predominantly
focus on assessing the function of major organ systems.
- Audiology
- Cardiac Physiology
- Gastrointestinal (GI) Physiology
- Neurophysiology
- Ophthalmic and Vision Science
- Respiratory Physiology (including Sleep Physiology)
- Urodynamics
- Vascular Technology
The development of PS Networks was recommended through the Richards review as a mechanism to drive the reform of the way services are organised and delivered at a regional and local level. Networks will enable greater connectivity between individual services, driving standardisation, improving quality, supporting training, and creating opportunities for shared learning between & across individual professional peer groups and services. They will provide greater leadership opportunities and support for physiological scientists. The programme will also work closely with the IQIPs programme to increase accreditation in across the 8 disciplines in Physiological Science.
The Richards review also recommended that clinical and managerial leadership should be put in place for all diagnostic disciplines at a national, regional and local/network level, to support implementation and to drive the change programme.
In NENC ICS, the focus has been on developing an Audiology network. The network provides a forum for sharing good practice and peer support. The network is working with the 7 provider trusts within the ICS that provide Audiology services as well as regional colleagues on a number of workstreams including workforce and quality.
