The Royal College of Pathologists welcomes the publication of the NHS Wales Performance and Productivity Independent Review and its recognition of the vital role of pathology and diagnostics in addressing healthcare pressures.
The report makes it clear that pathology services in Wales are under acute and growing pressure. For example, the proporton of histopathology requests relating to suspected cancer has increased from just over 10% in 2018 to more than 30% today. One team reported that urgent suspected cancer (USC) pathology demand had risen from 28% to 62% of their total workload in just 6 years. This sharp increase in urgent demand is compounded by the rising complexity of diagnostic information, which increasingly requires input from multidisciplinary teams (MDTs).
The review also highlights critical system constraints:
- Median turnaround times for pathology have doubled since the pandemic, from 6 to 12 days.
- Pathology estate is often unfit for purpose, with some labs lacking the physical space for modern equipment like digital pathology systems.
- There is a significant national shortage of pathologists, and in some areas, services are described as ''critically fragile''.
- Despite these pressures, the report found no clear national strategy to develop sustainable diagnostic capacity across Wales-leaving individual health boards to act in isolation.
We strongly support the recommendations that pathology, in addition to endoscopy be designated as priority fragile services that require urgent national and regional solutions and welcome the Government's acceptance of this recommendation.
Furthermore, we note that capital constraints, workforce gaps, and poor data availability are holding back progress. The successful rollout of digital pathology – a key enabler for diagnostic resilience and workforce flexibility is being hindered by these systemic issues.
Pathology underpins nearly all medical diagnosis. This review presents a timely opportunity to transform how diagnostic services are delivered in Wales. RCPath stands ready to work with NHS Wales, the Welsh Government, and other partners to ensure pathology is equipped to meet future challenges.
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