on behalf of all DHBs
NATIONAL SERVICES PAEDIATRIC AND PERINATAL PATHOLOGY SERVICES
TIER LEVEL TWO
SERVICE SPECIFICATION
STATUS
MANDATORY 
Approved to be used for mandatory
nationwide description of services to be
provided.
Review History
Date
Approved
June 2011
Published on NSFL
June 2011
New service specification
May 2011
Consideration for next Service
Specification Review
Within three years
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: http://www.nsfl.health.govt.nz/.
NATIONAL SERVICES PAEDIATRIC AND PERINATAL PATHOLOGY SERVICES
TIER LEVEL TWO
SERVICE SPECIFICATION
NS10020, NS10021, NS10022, M00010
This tier two Paediatric and Perinatal Pathology service 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 decisions for this Service will be made at a
national level because the 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 and that the Service can 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 the Service 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.
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Note: Paediatric and Perinatal Forensic Services are provided under another contract with
another agency, however some 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 day patients.
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 elects not
to provide 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 the Service 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.
2.1 Māori 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.
Refer to Perinatal and Maternal Mortality Review Committee’s Second Report to the Minister of Health
(2009)
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3
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
4.1
General
This national Service will provide equity of access to all of New Zealand according to two
main pathways.
a.
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.
b.
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.
4.2
Entry Criteria
Entry to the Service is via a referral from a secondary or tertiary health service provider
that requires specialist pathology expertise.
4.3
Exit Criteria
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.
4.4
Time
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.
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
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Nationwide Service Framework
5.
Service Components
5.1 Processes
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.
5.2 Pacific 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.
5.3 Settings
The Service will be based in the regional centres subject to placement of clinical services.
All autopsies and testing and related activity will be undertaken in designated facilities.
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Appropriate mortuary facilities for paediatric autopsy and reconstruction work will need to
be accessed.
Provision will be made by the Service Provider for some off-site collection services, or
collection and testing through another agency, to reduce access and service barriers for
outpatients.
5.4 Support Services
The following support services are required to be provided as an integral part of the
Service and are funded under this service specification:

laboratory services

diagnostic imaging services

administrative services including managing data and reporting (support from
laboratory).
5.5 Key Inputs
The key inputs for the Service include:

a specialist workforce

laboratory facilities and services -includes laboratory services for specimens for tests
not performed in-house for technical, commercial or other reasons where 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 one Services 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 Liaise and work
allied staff and Lead Maternity with on referral
Carers
DHB and Community Laboratory
providers
Receive advice and expert opinion to aid
decision making
Bereavement counselling
Tissue return and disposal.
Primary health care providers
including General Practitioners,
Nurse Practitioners
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
Liaise and work
with
Shared facilities on some sites.
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Other Service Provider
Nature of
Linkage
services
collaboratively
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.
Accountabilities of other service
provider
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
8.1 General
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.
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8.2 Acceptability

Peer review mechanisms and professional development plans for Specialist
Paediatric Pathologists should be in place and implemented.

The Service participates in a recognised quality assurance programme and findings /
outcomes are the basis for quality improvements as required.

Providers of autopsy, 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
NonAdmitted
Patient
Collection
(NNPAC)
NS10021
National
Services
Perinatal and
Paediatric
Service - Noncoronial
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
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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).
9.3 Quality 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.
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