The publication of the Pathology Transformation Review, chaired by Lord Carter of Coles, has been a long time coming and is welcomed. It provides an opportunity to focus on and highlight a service under tremendous pressure, as demand grows against a capacity that cannot keep up.

The move towards more integrated services, better standardised interoperability, the rapid implementation of digital and AI implementation, improved workforce modelling and the drive to the level of efficiency and productivity needed, will not happen spontaneously. Considerable investment will be needed up front, with a strong mandate for change ensuring standardisation and alignment of services can progress at the pace needed.

Given the widening demand/capacity gap, unwarranted variation and workforce crisis, the concept of service delivery following an integrated service model would seem appropriate. We welcome the step away from more structural change/physical consolidation being recommended at this time. The fragility inherent of a workforce under pressure, struggling to meet clinical demand and with many pathologists believing that current staffing levels are inadequate to ensure the long-term sustainability of their service, signals a need for support for retention, rather than relocation. In addition, integration of IT, standards, equipment, protocols, management and even financial control can still be achieved, with the efficiency, productivity and clinical gains realised without the need to relocate everyone into pathology factories.

Artificial intelligence (AI) has the potential to improve diagnostic capability across all of pathology. It is, however, vital that underlying IT infrastructure is improved and that aspects of patient safety, liability, regulation and affordability are properly assessed to ensure that systems work and are feasible for implementation. Upfront support to ensure integration of IT, digital and AI is key.

Financial aspects are touched upon in the report, and the single tariff model is worth exploring, if only to look at alternatives to locally held and often siloed budgets. These can strangle services and disincentivise innovation. There is much that could be learned from the integrated services models that exist or are being developed in the devolved nations.

Caution is needed in reviewing examples of best practice, often defined by finances, productivity or patient safety, as a benchmark to forecast projected changes and savings if every service were to perform as well. It is unlikely that lower-performing services can achieve the productivity of the best-performing integrated networks. That assumption is rarely true in healthcare at scale and is unlikely to be realised. It needs to be made clear that the transferability of such high performer metrics should not be assumed to be the source of the necessary funding required to move integration and transformation of services in the short term – new upfront investment will be urgently required.

There will be a need for government, NHS and the profession to collaborate closely to ensure that the proposals in this review are realised.  In doing so, It is vital that the professional voice is represented by a wider range of participants, and the College is keen to help drive this forward.

Dr Bernie Croal
President