/
on behalf of all DHBs
NATIONAL SERVICES -
PAEDIATRIC AND PERINATALPATHOLOGY SERVICES
TIER LEVEL TWO
SERVICE SPECIFICATION
STATUS
Approved to be used for mandatory nationwide description of services to be provided. / MANDATORY 
Review History / Date
Approved / June 2011
Published on NSFL / June 2011
New service specification / May 2011
Consideration for next Service Specification Review / Within threeyears

Note: Contact the Service Specification Programme Manager, National Health Board Business Unit, Ministry of Health to discuss the process and guidance available in developing new or updating and revising existing service specifications. Web site address of the Nationwide Service Framework Library:

NATIONAL SERVICES -

PAEDIATRIC AND PERINATAL PATHOLOGY SERVICES

TIER LEVEL TWO

SERVICE SPECIFICATION

NS10020, NS10021, NS10022, M00010

This tier two Paediatric and Perinatal Pathologyservice specification (the Service) must be used in conjunction with the overarching tier one Services for Children and Young People and is linked (where appropriate) to the tier one Specialist Medical and Surgical Services service specification.

Refer to the overarching tier one service specifications for generic details on:

  • Service Objectives
  • Service Users
  • Access
  • Service Components
  • Service Linkages
  • Exclusions
  • Quality Requirements

The above heading sections are applicable to all service delivery.

Background

From 1 July 2011, planning and funding decisionsfor this Service will be made at a national level becausethe Service requires a highly specialised workforce and has a low volume patient group, thereby benefiting from a national approach.

The desired outcome of this national approach is for this Service to be sustainable,delivered consistently andthatthe Servicecan be accessed equitably. This service specification will be fully implemented over a three year period by 1 July 2014.

A District Health Board (DHB) will be selected to deliver theService and a single contract with provider specific information will detail the management of any transition arrangements.

The investigation, diagnosis and management of diseases affecting infants, children and adolescents often requires different laboratory techniques, expertise and knowledge than diseases seen in adults. In addition the diseases affecting the unborn infant and causing stillbirth or early neonatal death have no relation to adult pathology and require a very specialised pathology service to aid investigation and diagnosis.

Within the Service, there are two sub speciality areas:

a.Paediatric pathology services incorporating paediatric autopsy and surgical pathology(including oncology). Surgical pathology involves the examination of surgically removed biopsies, tissues and organs, and supports a broad range of paediatric sub specialties, by providing accurate diagnosis and predicting disease progression.

b.Perinatal pathology services providing autopsy services that include developmental and genetic cases (involving confirmation, diagnosis specialised testing for the national Genetics Services) high risk pregnancies, terminations of pregnancy, unexpected intrauterine deaths from approximately 14 weeks gestation to term, stillbirth, neonatal deaths and placental pathology.

Note: Paediatric and Perinatal Forensic Services are provided under another contract with another agency, howeversome of the same staff may be involved in the delivery of both services. The roles, definitions and responsibilities of the different Pathology divisions will be well defined and support quality and consistency of care.[1]

1.Service Definition

The Service is a national tertiary specialist service that provides urgent, routine and specialised paediatric and perinatal medical laboratory services for inpatients, outpatients, and daypatients.

The Service includes anatomic pathology and the following sub-specialties:

  • paediatric surgical pathology
  • perinatal pathology including examination of placentas
  • post- neonatal autopsies (non-coronial).

Information is provided to family and whānau as part of consent procedure.

Laboratory services are an input to other operational services purchased from the organisation. Each separately specified operational service will include in its service the share of the laboratory components which are required to support it. If the DHB electsnot toprovide the necessary range of services, it must purchase them as needed from another service provider.

Clinical pathology laboratory services are considered within the service definitions of other paediatric services such as Metabolic Services, Oncology and Haematology Services and Clinical Genetic Services.

2.Service Objectives

The objective of theService is to:

  • provide diagnostic information communicated in specific reports as a result of laboratory testing and examination
  • identify problems and inform decision making about further investigations, interventions and treatments that may be required.

2.1Māori Health

An overarching aim of the health and disability sector is the improvement of health outcomes and reduction of health inequalities for Māori. Health providers are expected to provide health services that will contribute to realising this aim. This may be achieved through mechanisms that facilitate Māori access to services, provision of appropriate pathways of care which might include, but are not limited to:

  • matters such as referrals and discharge planning
  • ensuring that the services are culturally competent and
  • that services are provided that meet the health needs of Māori.

It is expected that, where appropriate, there will be Māori participation in the decision making around, and delivery of, the Service.

Service processes will consider the needs of Māori and include engagement with Māori utilising specific cultural protocols, to improve service access and service outcome for Māori.

3.Service Users

The Service user group comprises:

  • unborn infants, infants, and children and youth under 18 years of age and their parents and families
  • women receiving perinatal care within the organisation for whom tests are directly requested by a DHB employed professional
  • Health Care Professionals (HCP)[2]

4.Access

4.1General

This national Service will provide equity of access to all of New Zealand according to two main pathways.

  1. For autopsies: these will be undertaken at the regional centres (to be designated) and the deceased infant may need to be transported to their nearest regional centre. The Pathologist may if required, travel to the regional centre to undertake the autopsy. Parental consent is required for all non-forensic autopsies.
  2. For surgical pathology and placentas: patients may have specimens collected locally and referred to the highly specialised laboratory at one of the regional centres before or after examination by a local non specialist anatomic pathologist. Where necessary the patient may be referred for specimen collection where this in itself requires highly specialised techniques by the Paediatric Pathologist.

4.2Entry Criteria

Entry to the Service is via a referral from a secondary or tertiary health service provider that requires specialist pathology expertise.

4.3ExitCriteria

Once an examination has been undertaken, and a report with findings has been completed and sent to the referrer,the Service specialist involvement is complete and the specimens will be returned to the referring laboratory for management. Following completion of the autopsy the deceased is returned to the parent or next of kin for burial or cremation.

4.4Time

The Service will aim to perform 95% of autopsies within two working days of receipt of the deceased at the regional centres. 90% of surgical pathology specimens will be processed within 10 working days.

5.Service Components

5.1Processes

Service Component / Description
Testing/analysis of specimens
Performance of autopsies / Performance testing and autopsies are the responsibility of the Service. This includes the provision of all materials, equipment and substances required for the provision of the tests.
Reporting of results / The Service will provide a written or electronic report, preceded by telephone report if required when an urgent response has been sought. The report must include description of findings highlighting and/or describing any abnormalities and providing a diagnosis where appropriate is the responsibility of the Service.
Forwarding of laboratory specimens / It will be the responsibility of the Service to transport to another laboratory specimens for tests:
  • not performed in-house for technical, commercial or other reasons
  • where the tests have been identified as ‘regional specialised tests’ and DHB is purchasing such tests from a restricted number of approved sites.

Clinical advice / The Service will provide advice to clinical staff as appropriate on interpretation of results and other clinical issues. This includes pre-test and post-test advice to clinicians about choice of tests and further investigations.
Communication / The patients’ family, whānau, General Practitioner and other referrers will receive clear information and support for the period the Service. is provided.
Registrar training, scientists and specialist training / The Service will provide training including where appropriate overseas fellowships and attachments) to: Registrars, scientists and Senior Medical Officers, and non- clinical staff / technicians.

The Service Provider will be familiar with:

  • other DHBs care pathways of outlining local care after the death of an unborn infant, a child or young person, including planning for access to appropriate post mortem examinations where indicated and
  • access processes to other DHB services.

5.2Pacific Health

Services will work with Pacific people to ensure communications about processes and consent to procedures are undertaken in a culturally acceptable way that support access to the Service.

5.3Settings

The Service will bebased in the regional centressubject to placement of clinical services. All autopsies and testing and related activity will be undertaken in designated facilities.

Appropriate mortuary facilities for paediatric autopsy and reconstruction work will need to be accessed.

Provision willbe made by the Service Provider for some off-site collection services, or collection and testing through another agency, to reduce access andservice barriers for outpatients.

5.4Support Services

The following support services are required to be provided as an integral part of the Serviceand are funded under this service specification:

  • laboratory services
  • diagnostic imaging services
  • administrativeservices including managing data and reporting(support from laboratory).

5.5Key Inputs

The key inputs for the Service include:

  • a specialist workforce
  • laboratory facilities and services-includes laboratory servicesfor specimens for tests not performed in-house for technical, commercial or other reasonswhere the tests have been identified as ‘regional specialised tests’
  • administrative support
  • clinical photography
  • paediatric and obstetric consultation and liaison.

6.Service Linkages

Generic service linkages are described in the tier oneServices for Children and Young People service specification.

The Service specific linkages include, but are not limited to the following:

Other Service Provider / Nature of Linkage / Accountabilities of other service provider
DHB medical and nursing and allied staff and Lead Maternity Carers
DHB and Community Laboratory providers / Liaise and work with on referral / Receive advice and expert opinion to aid decision making
Bereavement counselling
Tissue return and disposal.
Primary health care providers including General Practitioners, NursePractitioners / Liaise and work with on referral / Receive advice and expert opinion to aid decision making (usually from a secondary provider)
Provide education and support to service user.
Private specialists
Tertiary fertility service providers
Genetic disorder services / Liaise and work with on referral / Receive advice and expert opinion to aid decision making.
Mortuary and forensic pathology services / Liaise and work with collaboratively / Shared facilities on some sites.
Clinical and Diagnostic Genetic services / Liaison and consultation / Receive advice and expert opinion to aid decision making.
National Coronial Service (Ministry of Justice) / Interface with shared workforce
Routine post mortem / Communicate regarding activity and service interfaces.
Funeral director services / Liaison and work with / Assist with preparation of the deceased and transportation.
Cancer Society
The Paediatric Society
Perinatal Society of Australia and New Zealand
Stillborn and Newborn Death Support
Royal College of Pathologists of Australasia / Liaison / Engage in communications and consultation about service delivery
Provide education and support.
Child and Youth Mortality Review Committee (CYMRC)
Perinatal and Maternal Mortality Review Committee (PMMRC) / Liaise and work with / Liaise with service provider regarding findings of reviews and recommendations.
Māori, iwi and Māori communities and health Service providers / Facilitate access and participation / Liaise with local iwi and communities to ensure cultural appropriateness and accessibility of services.
Pacific Peoples community leaders, health Service providers church leaders / Facilitate access and participation / Liaise with communities to ensure cultural appropriateness and accessibility of services.
Medical Council of New Zealand / Liaison / Engage in communications and consultation.

7.Exclusions

Services excluded from this service specification are all other paediatric and perinatal pathology services purchased by the Ministry of Justice, including, but not limited to, Community Laboratory Services, Forensic Post-mortem Service, Metabolic Service, Oncology and Haematology Service, Microbiology or services that are required pursuant to a Coronial Inquiry.

8.Quality Requirements

8.1General

The Service must comply with the Provider Quality Standards described in the Operational Policy Framework or, as applicable, Crown Funding Agreement Variations, contracts or service level agreements.

8.2Acceptability

  • Peer review mechanisms and professional development plans for Specialist Paediatric Pathologists should bein place and implemented.
  • The Service participates in a recognised quality assurance programme and findings/outcomes are the basis for quality improvements as required.
  • Providers ofautopsy, cytology and histology services must be registered with an accreditation programme.
  • Any transport of specimens is undertaken in controlled conditions in accordance with current legislation and guidelines set out by the transportation authorities.

9.Purchase Units and Reporting Requirements

Purchase Units are defined in the joint DHB and Ministry’s Nationwide Service Framework Data Dictionary. The following Purchase Units apply to this Service.

PU Code / PU Description / PU Definition / PU Unit of Measure / PU Unit of Measure Definition / National Collections or Payment Systems
NS10020 / National Services Perinatal and Paediatric Pathology Funding / This Purchase Unit is used to distribute the funding for Perinatal and Paediatric Pathology National Services until a National Price has been agreed. / Test / Number of separate tests purchased. (eg, one person receiving an ECG and a stress test equates to two tests). For laboratory a group test such as liver function is counted as 1 test not each individual component. For test sets refer Laboratory contract schedule. / National Non-Admitted Patient Collection (NNPAC)
NS10021 / National Services Perinatal and Paediatric Service - Non-coronial Autopsy / Non Coronial Autopsies conducted by Pathology Laboratories. This service includes the examination of surgically removed biopsies, tissues and organs. For Counting Only. / Test / Number of separate tests purchased. (eg, one person receiving an ECG and a stress test equates to two tests). For laboratory a group test such as liver function is counted as 1 test not each individual component. For test sets refer Laboratory contract schedule. / NNPAC
NS10022 / National Services Perinatal and Paediatric Service - Surgical Tests / Perinatal and Paediatric pathology tests that include developmental and genetic cases (involving confirmation, diagnosis specialised testing for the National Genetics Services). For Counting Only. / Test / Number of separate tests purchased. (eg one person receiving an ECG and a stress test equates to two tests). For laboratory a group test such as Liver function is counted as 1 test not each individual component. For test sets refer Laboratory contract schedule. / NNPAC

The Service must comply with the requirements of national data collections where available.

9.2.Additional reporting requirements

You are required to report monthly to the Ministry of Health (as requested) on the information units given in the table below, for the Services provided in the period.

Frequency / Reporting Units
By month /
  • By ethnicity (NZ Māori, Pacific Island, European, Asian)
  • By DHB of domicile
  • The total number of:
-paediatric autopsies undertaken in the period
-perinatal pathology autopsy services undertaken in the period (includes developmental and genetic cases (involving confirmation, diagnosis specialised testing for the National Genetics Services) high risk pregnancies, terminations of pregnancy, unexpected intrauterine deaths from approximately 14 weeks gestation to term, stillbirth, neonatal deaths and placental pathology.
-surgical pathology examinations of surgically removed biopsies, tissues and organs(including oncology).

9.3Quality Reporting

The Service will:

  • develop and implement a quality improvement programme that is able to measure the Service’s performance
  • report quarterly on the development and implementation of the quality improvement plan, compliance with standards, and performance measures and targets.

1

National Services - Paediatric and Perinatal Pathology Services tier two service specification May 2011

Nationwide Service Framework

[1]Refer to Perinatal and Maternal Mortality Review Committee’s Second Report to the Minister of Health (2009)

[2]Health Care Professional is defined as a person who is or is deemed to be registered with an authority as a practitioner of a particular health profession, NZ Health Professional Competence Assurance Act 2003