Senior medics working for the two trusts which run the Royal Preston and Chorley and South Ribble hospitals and Blackpool Victoria Hospital say they have been left with a “significant lack of confidence” in the management leading the region’s pathology collaboration project.
Under that programme, analysis of a range of non-urgent specimens requested by GPs and outpatient departments is set to be moved from eight individual hospital sites across the patch – including the Royal Lancaster Infirmary and the Royal Blackburn Hospital - to what would be a purpose-built facility in Samlesbury.
As the Local Democracy Reporting Service (LDRS) revealed back in April, the plans have been put on hold for what the NHS in the region says is an opportunity for further engagement with affected staff - and to ensure that ensure that all options have been explored for securing the £31m required for developing the proposed service.
However, in a letter seen by the LDRS, 26 consultants and a leading clinical scientist from Lancashire Teaching Hospitals (LTH) and Blackpool Teaching Hospitals (BTH) blast Mark Hindle – the managing director for the Lancashire and South Cumbria Pathology Collaboration - over remarks he made during a national NHS pathology conference webinar just a week after details of the pause in work emerged.
They highlight a suggestion he made that staff should be “segmented” during the consultation process “so that the voices of some of our more senior colleagues, or perceived senior colleagues - for example, consultants - do not intimidate the voices of the majority”.
The letter, dated 28th May and addressed to the Pathology Collaboration Board - including LTH chief executive Kevin McGee, as its senior responsible officer - goes on: “[Mr. Hindle] also denigrates the clinical leadership in the region as ‘clinical domination of the agenda’ and refers to senior staff as ‘vociferous’ who, in his view, ’intimidate the majority’. The session concludes with further disparaging comments about the ‘clinical culture’ in the region.
“Pathology consultants of all disciplines, as the clinical experts, have made significant efforts to work with the Collaboration management team to develop a high quality, efficient regional service for their patients.
“To have this effort deprecated on a national stage by such defamatory remarks is profoundly disappointing. This matter raises a significant lack of confidence and trust in the Pathology Collaboration senior management.”
Mr. Hindle has told the LDRS that it was not his intention to “cause any offence” and stressed that the contribution of the consultants to the pathology collaboration work is “extremely valued”.
The LDRS has obtained a copy of the full NHS pathology webinar at which he made the comments which have stirred the ire of senior staff.
They came during a question and answer session towards the end of the three-hour virtual event, where Mr. Hindle had earlier delivered a 20-minute presentation on the progress of the collaboration project in Lancashire and South Cumbria and his vision for the future.
During that address, he told delegates that “staff engagement” was one of several issues which the collaboration was “currently grappling with”.
Mr. Hindle said that the planned “hub and spoke” model - which would see non-urgent outpatient samples analysed at the proposed Samlesbury site and urgent and inpatient tests continue to be carried out at existing hospital facilities - had formed the basis of conversations with staff..
However, he acknowledged that the collaboration needed to secure the “hearts and minds” of the workforce about “what we [will] do in that building, what our staff and…clinicians are passionate about and how we deliver that service in a really fit-for-purpose, state-of-the art building”.
Mr. Hindle later fielded a question from one delegate about the biggest challenge that he had so far overcome in developing a revamped pathology service.
He responded: “I don't think I’ve actually overcome it yet. The biggest single issue that I am still encountering is having a meaningful and positive engagement with our staff. I don't think it's helped by some of our stakeholders who are talking...about things like privatisation and ulterior motives - and I haven’t yet been able to get to the place where we have a transparent, clear and open set of agreed priorities and set of values.
"To get round this, I plan to relaunch a new and completely revitalised engagement process in the next month or so that’s going to be targeted, I think, at the vast majority of staff whose voices are often drowned out by the people who are most vociferous and actually intimidate the majority of our workforce from speaking and expressing their opinion."
The collaboration boss was then asked by NHS England’s head of pathology, Jane Mills, how he was managing to engage with staff across an area as vast as Lancashire and South Cumbria, with the resultant risk “that people hear different messages at different times”.
Mr. Hindle quipped that the national leader must have “walked in my shoes” to have alighted upon that issue, before adding: “It is really difficult when you’ve got such a very disparate geography as Lancashire and South Cumbria. It takes you well over an hour to travel from one part of the county to another.
“I think we've got to be smart, we’ve got to use technology - and I don't think we’ve used things like voice over internet and that way of communicating the same message at the same time, and even simple things like Survey Monkey.
“And I think what I’m going to do differently this time is get some help from a specialist company who actually have done some of these things…and get them to come in and help us to undertake this work.
“I would also say, I think we need to segment our workforce, so that the voices of some of our more senior colleagues, or perceived senior colleagues - for example, consultants - do not intimidate the voices of the majority of our workforce from putting their opinions forward.
“I think that’s one of the most difficult challenges in pathology. After being out [of the sector] for 25 years and coming back in [two years ago], the culture is very similar to when I left in the very late 1990s - of hierarchy, of doing things in a certain way, of so-called clinical leadership - which… if I’m being very honest on this call - is not always clinical leadership, it’s clinical domination of the agenda, rather than allowing everybody to have a voice and everybody's voice to be heard and influence the priorities.
“So I think we need to do it differently, we need to be, as much as possible, much more inclusive. I think we need some tools and techniques that probably aren’t in our armoury at this moment in time,” Mr. Hindle added.
The letter complaining about some aspects of Mr. Hindle’s comments was signed by consultants in disciplines including histopathology, microbiology and immunology. Nineteen of the signatories were from Lancashire Teaching Hospitals and eight from Blackpool Teaching Hospitals.
The pathology collaboration also incorporates the University Hospitals of Morecambe Bay and East Lancashire Hospitals NHS trusts
Mr. Hindle has said that the issues raised in the correspondence will get a direct response.
‘I MEANT NO OFFENCE’
Responding to the controversy surrounding his comments about senior pathology staff, Mark Hindle told the Local Democracy Reporting Service that he wanted to ensure that the consultation process reflected the full range of opinion about the collaboration plans amongst the pathology workforce in Lancashire and South Cumbria.
In a statement, he said: “There are approximately 800 employees working in pathology and the main point that I was making was that I want all voices to be heard as we move forward with the transformative work that we are progressing.
“In some cases, employees do not feel able to voice their opinion and this can be for many reasons, position and hierarchy being one of them. It is important to me that in the next phase of engagement everyone has the chance to give their view and that we capture all perspectives both clinical and operational, which can differ.
“Clinical colleagues are pivotal in the diagnosis and delivery of the high-quality pathology services that we see in Lancashire and South Cumbria. Notwithstanding that, the majority of employees working in pathology are biomedical scientists and support staff, who are also pivotal, so it is critical that they have a say, too, in designing the future delivery of our service.
“We are pleased to now also have the additional input of a partnership officer who will help to facilitate dialogue at every level and between union members.
“There has been a concerted effort over a number of years to engage with clinical colleagues and the clinical director continues to engage with the leads from across all disciplines to design the future delivery framework and clinical model.
“The continued input of the consultant body into this programme of work is extremely valued and it was not my intention to cause any offence. The concerns that have been raised in the letter will be responded to directly.”
'IT MAKES NO SENSE'
A union official says that he does not recognise the claim that the voices of rank and file pathology staff in Lancashire and South Cumbria are being “drowned out” by senior consultants in discussions about plans to centralise some aspects of the service.
Keith Hutson, regional officer for Unite, told the Local Democracy Reporting Service that the suggestion seemed to be an attempt by the leaders of the pathology collaboration project in the region to “talk to people who are going to say what [they] want to hear”.
Unite has long opposed the proposed model of creating a single base for the analysis of routine tests, which was first mooted more than five years ago for a site in Lancaster and, later, Leyland.
The union represents the biomedical scientists and scientific support staff whom pathology collaboration boss Mark Hindle has suggested might struggle to be heard during the ongoing consultation process.
However, Mr. Hutson has rubbished that idea, saying that his members’ views have been put across loud and clear by the union.
“[The collaboration leaders] say, ‘Well, what about people who aren't in the union?’
“We’re open and honest about this - they’ve made their decision, that’s not our problem. We represent the majority here.
“What [they are] basically saying is [that they are] trying to talk to people who are going to say what [they] want to hear," Mr. Hutson said.
He claimed that clinicians had been “completely excluded” from the process and said that it was little wonder that they have now “got themselves annoyed about it”.
Meanwhile, the union officer said that Unite members could still see “no rhyme nor reason” for the proposed single-site plan - unless it was to privatise the service further down the line.
“We’ve never had a problem with the collaboration, it's just the path they want to take it down.
“We want to see a model that is based on the existing four hospitals in the collaboration and on the needs of the communities. Sending all your GP work to Samlesbury - when your GP is in Colne or Fleetwood or Lancaster - is nonsensical.
“A single-managed service is fine - things like the purchasing of equipment, which, if it was done so that everybody bought the same stuff, would save fortune.”
Mr Hindle told the national NHS pathology conference webinar back in April that the aim of the collaboration was not privatisation - something that the board "never intend[s] to do" - but rather standardisation.
“Today, if you are a Lancashire and South Cumbria patient, you will get a different service level from pathology depending on where you live.
“Providing a high-quality, resilient, rapid and appropriate diagnostic service is quite variable on the patch - and that’s not acceptable to me, it's not acceptable to patients, it’s not supportive of cancer [service] restoration, it’s not supportive of elective restoration - and all the [other] things that hospitals are now beginning to become focussed on in terms of this post-Covid world, which we know isn't really a post-Covid world.” Mr Hindle added.
He also said that being one of 29 pathology collaboratives nationwide has helped the region “immeasurably” during the pandemic.
WHAT’S THE BIG IDEA?
The Lancashire and South Cumbria pathology collaboration claims that £11m a year could be saved by the proposed overhaul of how routine tests ordered by GPs and out-of-hospital services are analsysed.
That non-urgent work accounts for around half of the 40 million samples processed across the region annually.
It is claimed that the centralisation plan would generate an £8.32 return for every £1 of investment – both in efficiencies and by not having to spend money on the existing estate.
The collaboration stresses that patients themselves will not have to travel any further or be affected adversely in any other way.
It also says that a “larger, more sustainable service will be able to develop services to adopt the new technology that the current system would be unable to do, such as technological advances using personal genomic profiles to make cancer treatments more effective”.