Memorandum by The President of the Royal
College of Pathologists (PS48)
TOPIC: PUBLIC: PRIVATE PARTNERSHIPS IN NHS
PATHOLOGY
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
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