Select Committee on Health Minutes of Evidence

Memorandum by The President of the Royal College of Pathologists (PS48)


  The NHS Plan mentions pathology services only once, in chapter 11 on changes in the relationship between the NHS and the private sector. It says "We also propose to develop some partnership arrangements at a regional level for modernising pathology services".

  There is an undoubted need to have a rethink about the configuration and management of pathology services in the NHS as a whole. In several areas serious problems have developed due to a compound effect of workforce shortages, rising demand and lack of capital investment. There is also considerable disparity in service provision throughout the UK, both in terms of repertoire and levels of resource. The Audit Commission showed this very clearly a decade ago in its first report on medical laboratories.

  "Pathology" consumes around 6 per cent of the NHS acute services budget, and covers the whole spectrum of laboratory-based medicine. Specialties are grouped into the four main disciplines of medical microbiology, clinical biochemistry, haematology and histopathology/cytopathology. There are other smaller disciplines such as immunology, virology, genetics, transfusion medicine and histocompatibility (tissue typing). Very few hospital patients are treated without any laboratory investigation, and pathology, a key clinical facility, is pivotal to diagnosis and disease management.

  Laboratories are mostly based in NHS hospitals. They are mostly managed at the level of individual Trusts, and many Chief Executives see them as an overhead, giving rise to continual efforts to reduce activity and costs. Despite this there is an inexorable and universal rise in demand running at between 5 and 10 per cent per year. Technical staff are difficult to recruit and retain due to poor career prospects and remuneration. There is a 10 per cent vacancy factor in consultants in histopathology due to poor workforce planning in the mid 1990s, which is hampering the ambitions of the Cancer Plan. Lack of capital planning has led to automated machinery being used long past its normal life span with consequent reliability problems and high maintenance costs. Much of the fabric of laboratories has been ignored in the competition for capital developments, with many buildings being inadequate, dilapidated or both.

  For all these reasons the College is therefore very keen to see the service "modernised". We support the idea that managed networks covering a larger population base than the average District hospital are potentially a better model of service delivery than the present Trust-based system. They offer the potential for more flexible working with common purchasing policies, avoiding unnecessary duplication, common standard operating procedures and equipment, co-ordinated staff training and linked IT systems. They also offer the potential for work sensitive funding with primary, secondary and tertiary care organisations entering into proper clinical contracts.

  We do not see that the private sector necessarily needs to be involved to achieve such change, and some NHS schemes based on this model are showing promise. We have no prejudice on the matter, however, and accept that the possibility of partnerships is worth exploring, particularly where local NHS services are failing or where major capital investment is needed.

6 November 2001

previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2002
Prepared 15 May 2002