Modernising
Pathology
The following
letter is the response by the college to the request from Lord
Warner for Pathology Services to be reviewed by Lord Carter.
President's
Office
Telephone:
020 7451 6710
Fax:
020 7451 6702
e-mail:
james.underwood@rcpath.org
Lord
Warner of Brockley
Minister
of State for NHS Delivery
Department
of Health
Richmond
House
79
Whitehall
London
SW1A 2NS
21
September 2005
Modernising
Pathology: Building a Service Responsive to Patients
I
am writing to affirm the Royal College of Pathologists' eagerness
to assist the independent review of pathology services in England
to be conducted by Lord Carter of Coles and the Pathology Service
Review Panel. The review is one element of Modernising Pathology:
Building a Service Responsive to Patients , published by
the Department of Health on 9 September and discussed by the College's
Council at its meeting on 15 September.
The
College's Pathology Modernisation Reference Panel will be the
principal interface between the College and the independent review.
It comprises representatives of the major pathology specialties
together with the directors of training and of professional standards
and, of course, a lay member to represent patients' interests.
Before the independent review was announced, I had already instigated
a survey of the scale and scope of pathology modernisation within
each of College's eight regions in England. The results of this
survey will be available in October; I am sure that the findings
will be of interest to Lord Carter and the Pathology Service Review
Panel. Indeed, I hope that the College's Pathology Modernisation
Reference Panel will be able to meet Lord Carter in the near future.
In addition to copying this letter to him, I will be writing separately
to offer the College's input to the review and to invite him to
meet with the Pathology Modernisation Reference Panel.
Although
we realise that it is not a consultation document, I thought it
might be helpful at this stage to set out the College's initial
comments on Modernising Pathology: Building a Service Responsive
to Patients . We hope that the following points will be explored
further by Lord Carter and his independent review panel:
•
The College welcomes
the patient focus of the government's vision for pathology service.
Indeed, this accords fully with the delivery of pathology as a
clinical service. The clinical aspects includes not only
clinical accountability for the reliability of individual pathology
investigations (the Department of Health estimates that 70% of
diagnoses in the NHS rely on pathology tests), but also the consultative
clinical involvement in the pre-analytical and post-analytical
phases. While the extent of clinical involvement varies with the
indications for and complexity of the investigation, this vitally
important dimension is a remarkable omission from “The Pathology
Patient Pathway” (Annex B, Figure 1, page 23).
•
In the interests of patient welfare
and safety, the College emphasises the imperatives of laboratory
accreditation and quality assurance. The College applauded John
Hutton's ministerial statement (June 2003) that pathology services
to NHS patients should be registered with an accreditation scheme
and, on behalf of patients, we hope that the government will reaffirm
this. It is notable that the lay representatives on College Council
give primacy to the quality of pathology investigations
rather than, within reason, to issues of timeliness and convenience.
This is pertinent particularly to the involvement of “innovative
new providers … in non-traditional settings” (paragraph 2.7).
•
We note that mortuary services are
mentioned in paragraph 2.9. The College will be apprising the
Pathology Service Review Panel of the other wider integral functions
of pathology services such as hospital infection control, multidisciplinary
involvement in cancer diagnosis and treatment, population screening,
direct clinical care, etc.
•
Pathology services are reliant on
devices and technologies for much of their analytical, interpretive
and consultative work. Therefore, the Health Industries Task Force
report Better health through partnership: a programme for
action (cited in paragraph 3.3) is of considerable relevance.
The College supports strongly an evidence-based approach to the
introduction of new technologies, with patient outcomes as the
ultimate test of their effectiveness. The involvement of pathology
specialists is vital. Even with existing technologies, we believe
there is significant inappropriate use and, with point-of-care
testing, a risk of misinterpretation and of fragmentation of patient
data which could be detrimental.
•
We hope that the government's commitment
to increasing the independent sector's involvement in NHS pathology
services will be complemented by a commitment to expanding our
capacity to train the next generation of the skilled pathology
workforce — biomedical scientists, clinical scientists and medical
pathologists. The College recommends that consideration of “capacity”
in the terms of reference of the Pathology Service Review Panel
(paragraph 4.3) should take training and future workforce supply
into account.
•
The College supports and exerts,
within its remit, national leadership in pathology modernisation,
but recognises that the configuration of local services involves
local leadership, local decisions and local implementation. To
safeguard patient welfare and to ensure continuous improvement
through audit and remedial actions, we recommend that independent
and NHS providers of local pathology services for NHS patients
should have management and operational relationships that permit
seamless clinical governance.
•
Developments in primary care, notably
the new GMS contract, have led to substantial increases in clinical
biochemistry workloads. This, and a number of other issues at
the interface between primary care and pathology services, were
discussed last year with Dr David Colin-Thomé (National
Director for Primary Care). The College welcomes the commitment
(paragraph 2.10) to work with the National Primary Care Development
Team; the College would be pleased to be a partner in this.
In
conclusion, I emphasise the College's wish to be engaged fully
in the independent review with a view to achieving high quality
pathology services for current and future patients.
Professor
Sir James Underwood
President.
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