Cheshire and Merseyside Pathology Network Programme Management and Full Business Case Support

The NHS Transformation Unit (TU) were commissioned to provide support to the Cheshire and Merseyside Pathology Network (CMPN) between May 2023 and September 2024 to oversee and lead the CMPN Digital workstream. The workstream comprised of two major programmes:  Laboratory Information Management System (LIMS) and Primary Care Order Communications (Order Comms). The TU provided leadership to the LIMs programme, and were responsible for the authorship and delivery of an Outline Business Case (OBC), and subsequent Full Business Case (FBC) to justify the implementation of a single LIMS across five providers in Cheshire and Merseyside.

The Challenge

In 2021, the Network agreed a capital plan to progress their development towards ‘mature’ or ‘thriving’ status. The plan covered three major programmes: Digital Pathology, LIMS, and Primary Care Order Comms. In 2023, following a reset of the overall Pathology Network, the TU were commissioned to lead the digital team on behalf of the network. The TU were asked to progress two programmes, LIMs and Order Comms.

In order to access the allocated capital, the network needed to rapidly agree the preferred single solution for LIMS across the whole of CMPN. This was a significant challenge – although the network had been in existence for 20 years, it had not previously reached agreement on a single LIMS solution. The introduction of a single LIMS solution would enable the transfer of tests and reports between hospitals within the network, creating a strong foundation for greater collaboration and network working,

Our Approach

We worked in partnership with CMPN to agree a structured and transparent approach to managing the programme, including:

• Performing a financial deep-dive to understand the spend to date and projected spend. 
• Reviewing progress to date.
• Developing a thorough plan to successfully implement a single LIMS solution across CMPN.
• Developing a comprehensive engagement plan working with existing diagnostic governance
• Using programme management tools including programme plans, risks logs and action logs across LIMS and Order Comms.
• Engaging with stakeholders in NHS England and through wider Integrated Care Board (ICB) governance.

We followed the HM Treasury Better Business Case’s five-case methodology in the development of the Business Cases. This gave a robust framework and process by which to build the case and guide appropriate development of content, governance and transparency.

The Outcome

LIMS:

• We completed a system wide options appraisal to identify a preferred option for a single LIMS. This approach ensured system wide buy in and agreement on the way forward for the programme.
• We secured the award of additional capital to support delivery of the overall programme.
• We co-ordinated and inputted into a system-wide technical specification, working with clinical and technical colleagues to outline the vision for the service. This allowed C&M to purchase the best solution to suit the needs of Pathology services.
• We developed and authored an Outline Business Case. This enabled procurement to begin on behalf of 5 Trusts.
• We organised and facilitated system wide procurement activity across 5 Trusts. This delivered a compliant and transparent procurement process resulting in the successful identification of a preferred supplier.
• We completed full NHSE economic modelling, including costs, benefits and risks.  
• We implemented a new governance framework, to support system buy in.
• We engaged thoroughly with stakeholders, including through weekly executive meetings, weekly finance meetings and ongoing meetings with clinical and technical colleagues.
• We developed and authored the Full Business Case. This led to the approval of the programme by all 5 Trusts, which resulted in the successful contract signature of the solution.
• We navigated the business case through formal assurances, including developing Board papers and presenting to multiple Trust Boards and ICB governance meetings.
• We developed a system wide Memorandum of Understanding (MoU) outlining the principles of risk and gain across benefits and costs in the programme. This provided a process for Trusts to ensure a system wide approach, whilst recognising the financial constraints which are not uncommon in most ICBs.
• We planned for implementation, providing leadership to the programme to begin programme initiation activities with clinical and technical colleagues.
• We helped the network to recruit a full technical team, including developing job descriptions.

The successful approval of the FBC secured a strategic investment of £9.2m capital funding, and £11.5m revenue funding for a single LIMS system across 5 acute Trusts. The TU lead the navigation of the formal assurance process, effectively communicating the business case to all stakeholders. This included presentation at Cheshire and Merseyside Acute and Specialist Trusts Provider Collaborative (CMAST) which secured the executive support for the programme. We secured the approval of the business case from the boards of all 5 Trusts by delivering key presentations at multiple Trust Board meetings to gain consensus and agreement.