The here and now of pathology reform

In the first of a two part series, we catch up with the recent Roche Diagnostics Managers’ Forum and get to grips with the ever changing landscape of modern pathology 

REFORMING pathology: now and in the future - The 2009 Roche Diagnostics Managers’ Forum - was held recently at Somerset House, London, gathering senior pathology managers and key decision makers from NHS Trusts throughout the UK to discuss the pathology laboratory’s response to NHS reform and modernisation.  Following on from the success of the 2008 Roche Pathology Forum (Pathology – The shape of things to come), when the pathology community was waiting with baited breath for the reports from Lord Darzi and Lord Carter (published in June 2008 and December 2008 respectively), the aim of this years’ meeting was to continue the debate, in the light of these reports, about how NHS pathology laboratories can evolve to meet the changing needs of a modern, patient-centred health service.

Roche put together an interesting and practical programme, with expert speakers from within the NHS, Department of Health and the private sector, to inform and help equip laboratories for the road ahead. This article will review the first half of the forum, chaired by Michael Sobanja, chief executive officer of the NHS Alliance. This session explored the bigger picture, in terms of policy, and the Department of Health’s responses to the Darzi and Carter reports, in addition to obtaining a clinical perspective of pathology reform.

Mr Sobanja opened by describing the current climate in the health service. “These are rapidly changing and challenging times in which we are also faced with political uncertainty and tightening budgets. 

“Pathology reform is about markets and competition and about the provision of a service that is ‘fit for purpose’. Quality will be driven from the top, which will mean tougher regulation in all parts of the health service moving forward. This will be Lord Darzi’s legacy – bringing the quality issue to the forefront. Income will be quality related, but how will this be sustained in a financially cold climate?”

Mr Sobanja described the shifts in power that are making the health service more patient-centred and locally driven. “Practice Based Commissioning will play an important role in changing the face of the health service,” he concluded, “making it increasingly more competitive.”

The first presentation of the day - The big picture: Healthcare policy in a pre-election year - was given by Corinne Pluchino, director and head of health policy and health public affairs at Hill and Knowlton.  

Ms Pluchino acknowledged the difficulties in predicting political events over the coming months. In spite of this, she did feel that the major parties were more or less agreed on the main challenges for the NHS. 

Like Mr Sobanja, she also observed the strong focus on quality resulting from Lord Darzi’s and Lord Carter’s recent reviews, in particular relating to patient safety, efficiency of care and patient experience, and that it is now a constantly repeated theme in all documents relating to the health service. “There are similarities in the policies that are being proposed by the two main parties,” she commented, “but there are also some subtle and important differences in areas such as GP commissioning, information provision and local autonomy.

“There is increasing diversity in the delivery of health care. There will be more choice for patients, which will be counterbalanced by the setting of standards and targets for providers.  The focus on delivering care closer to the patient, giving them greater responsibility for their own health, together with the clinical priorities set by the government, will have a significant impact on pathology services in the future.”

Following on from this review of government policy, Dr Ian Barnes provided an update on pathology modernisation from his perspective as national clinical lead for pathology in the Department of Health. Aligning the recommendations of the Darzi and Carter reports, he outlined the Department of Health’s response and support programme.

The quality theme continued as Dr Barnes also identified that the quality agenda is critical for the pathology service, in addition to issues of increasing demand and tightening budgets. “We have an increasingly informed population,” he said.  “Patients are going to have a raised expectation of access to quality diagnostic services and this is going to have an impact on where tests are performed in the future.”

Dr Barnes pointed out that there is a general lack of understanding and knowledge about diagnostics and pathology. This needs to be rectified, he stated, given that they have an essential role in health care, and this will put the pathology service under the spotlight. “Transparency around quality is critical. The Quality Framework, along with improved efficiency and productivity, will be key drivers for future change.” 

Professor Adrian Newland from Queen Mary’s School of Medicine, University of London, concluded the first session by offering a valuable clinical perspective on pathology reform. 

“The delivery of health care and pathology services is changing. We can’t avoid it,” he stated and went on to discuss some of the challenges facing the health service, including - changing population demographics, changing patterns of disease, changing lifestyles, public expectations, health inequalities, demand and access, and reduced resources.

“The service provided by pathology departments is much more than analytical. It incorporates making diagnoses, monitoring therapy, advising on appropriate management, providing clinical care, auditing health care, predicting trends, educating staff and public, driving research, translating technology and more.” 

“It is therefore highly clinically relevant, and a large proportion of the cost of a test is related to this additional expertise. Commissioners need to be educated about this if that cost is to be protected.”

Professor Newland went on to propose a model for how the pathology service could develop. He proposed a managed pathology network that aims to minimise fragmentation of the service, consisting of a core laboratory and rapid on site facilities that would serve local health centres. The role of the core laboratory would be to centralise high volume, non-urgent work and to offer ‘high tech’ services (such as molecular diagnostics and immunology) that require critical mass for a quality, cost-efficient service. Rapid local services would include 4 hour turnaround of standard haematology and biochemistry tests, the support of essential services (such as blood transfusion and infection control) and the provision of expertise.

“Point of care testing (POCT) will have a significant role to play,” he commented. “I will help to improve the management of chronic conditions and to reduce inappropriate referrals to secondary care.” He proposed that POCT services could be contracted out to general practice, and could include staff training, quality assurance and data capture.

Professor Newland concluded with a warning about the shortfall in clinical consultants throughout the various disciplines. “There is a continuing need to attract medical trainees, to improve training, to develop specialist training opportunities, and to foster the recruitment and retention of the non-medical workforce,” he stressed.  ”"This is essential for the future development of the pathology service and its workforce.”

With the morning session providing a valuable overview of some of the drivers that are shaping the development of pathology services in the UK, the delegates had an opportunity to continue discussions over lunch. The afternoon session explored the customer base and marketing of pathology service and will be discussed in next month’s issue of Laboratory News in The here and now of Pathology Reform: Part 2 – the pathology marketplace.