Hospital chief executives are being urged by NHS Improvement to consolidate back room services and pathology on a regional basis, regardless of the serious risks to patient care.
“Consolidation” is a term used in pathology to describe the effects of infection on the lungs, whereby the normal spongy structure of the lung becomes solid, grey and – if sufficiently severe – unable to support life. This cannot be what the NHS intends for pathology services and there must be an alternative.
The Nuffield Trust’s report, The future of pathology services, suggests that there is a future for pathology. But will we recognise it?
The 19 various and varied specialties that form pathology are front-line clinical services that support emergency and urgent care services and which are essential for effective inpatient and community care, for cancer diagnostics and personalised medicine. As such, pathology services need to continue to be fully integrated into patient care, with pathologists providing testing and advice for patients and clinical colleagues in all settings. The increasing complexity of modern medicine demands effective team working with colleagues who are able to trust each others’ judgement in dealing with the uncertainties implicit in medical practice. Disrupting team working with reconfigurations that do not reflect clinical pathways at best create inefficiencies and, at worst, place patients at risk.
Meanwhile, standardisation of the nomenclature of pathology testing is essential to make effective use of pathology resources and to improved efficiency by joining up information systems. NHS Digital has a major piece of work to bring the National Laboratory Medicine Catalogue to fruition. The need for this standard terminology is more evident now than ever.
The report also explores how changes in genomic technology may impact on pathology. Genomics and molecular medicine in general rely on information technology. The informatics resources underpin the analysis and interpretation of the genomics data, and laboratory IT systems need to integrate molecular data with the more traditional (but not inferior) pathology information that will continue to be the foundation for diagnosis and clinical practice.
The Royal College of Pathologists is uniquely well placed to support the education and training of the health care professionals in this area as it has already developed the genomics curricula and examinations for scientists and medical pathologists. We will be working closely with the providers of laboratory information systems to ensure that these data are presented to patients, physicians and oncologists in way that supports effective clinical practice.
Taken as a whole, the Nuffield Trust’s report provides a snapshot of some of the demands on pathology services but there is, of course, a risk that it will be quoted selectively to support particular points of view. The Royal College is not a trade union and does not negotiate terms and conditions of service; its role is to work to maintain the quality of services through education, assessment and supporting the continuing development of the professionals who deliver the services for the benefit of patients. As the report acknowledges, the strength of pathology lies in the staff, their training and their ability to adapt and cope with constantly changing clinical demands. The Royal College and other organisations in the Pathology Alliance are integral to this adaptability and the future sustainability of clinical services.
The tensions implicit in the report on the future of pathology services lie between beliefs that there are better and arguably more cost-effective ways of doing things, and the evidence from The King’s Fund report by Candace Imison that networking and consolidation are very unlikely to lead to the major savings (or opportunities for reinvestment) of 10-20 per cent that are suggested in the headlines.
Most, if not all, pathology services have made efficiencies and savings, while preserving clinical services, over the last 10 years. It seems unlikely that further major savings will be easily achieved. The report outlines how some areas are forming provider networks, either between NHS trusts or in combination with private providers, with the aspiration to improve productivity. However, while commercial sensitivities may preclude some joint ventures with the private sector from publishing detailed results, something more robust than anecdote is surely required before placing whole systems at risk of collapse.
The Royal College of Pathologists strongly endorses the view in the Nuffield report that the NHS should be able to support a range of patterns of service configuration based on what works locally. Rational and intelligent redesign, led by clinicians and scientists and based on evidence, should be the way forward. This is will undoubtedly take time and effort and is perhaps too neatly summarised as: collaborate where possible, centralise where necessary and maintain the flexibility to respond to changes in the scientific basis of medical practice.
Please note all views expressed in guest blogs on our website are the authors' own and do not necessarily reflect the views of the Trust.
Helliwell T (2016) ‘Pathology: collaborate where possible, centralise where necessary’. Nuffield Trust comment, 10 August 2016. https://www.nuffieldtrust.org.uk/news-item/pathology-collaborate-where-possible-centralise-where-necessary