22 November 2021

We welcome the call for urgent action to ensure sickle cell patients receive care at a standard to which they are entitled.

The Royal College of Pathologists endorses the recommendations made in the All Party Parliamentary Group on Sickle Cell and Thalassaemia report ‘No One’s Listening following their inquiry into avoidable deaths and failures of care for sickle cell patients. We welcome the call for urgent action to ensure sickle cell patients receive care at a standard to which they are entitled. To ensure safe patient care, it is vital to have the right number of health staff, with the right knowledge and training, in the right places.

The under-funding of services and inadequate levels of staffing can be a mutually reinforcing problem. As a result of the significant underfunding of sickle cell services, there are far fewer specialised nurses, doctors, psychologists, and support staff that have chosen to work within this service than are needed. Individuals with sickle cell deserve care from a multidisciplinary team with specialist knowledge. Improvements to community services and support are equally important and keep patients well and out of hospital. 

With clinical pressures on haematology consultants increasing, consultants are finding it increasingly difficult to undertake vital diagnostic work in the laboratory.1 As demand and workloads increase, for haematology consultants to continue to provide diagnostic laboratory services, including laboratory diagnostics, interpretation of test results and liaison with other medical professionals, there needs to be a commitment by the NHS to support and expand these services. This has implications for the workforce.

Improving awareness of sickle cell among healthcare professionals, access to relevant educational resources, and ensuring comprehensive training in sickle cell is part of curriculums for trainee healthcare professionals is of paramount importance and RCPath will work with all key stakeholders to address these gaps. Funding to support these activities is vital. There is a particular need to address training and awareness of sickle cell and its complications amongst frontline clinical staff and it is essential that key Royal Colleges work together to this effect.

Several new open access resources have been developed to support safe transfusion in Haemoglobinopathy by NHS Blood and Transplant and Serious Hazards of Transfusion (listed below). These resources are intended for use within HCC and Specialist Hospital Teams to support the development of training programmes for their haemoglobinopathy networks. Additional resources are being developed and funding support to expand existing training programmes is essential. It is important that all available resources are promoted widely so that all those who are involved in the management of sickle patients are aware, access these resources and help improve safety.

Haemoglobinopathies coordinating centres (HCCs) established in England are responsible for coordinating, supporting, and promoting a system-wide regional networked approach to the delivery of haemoglobinopathy services including supporting hospitals in their area with less expertise in these conditions, ensuring all patients have access to specialist advice when needed. The College, with the National School of Healthcare Science, has been pivotal in developing the Consultant Clinical Scientist role to support specialist red cell immunology knowledge, and they play a vital role in supporting HCCs across England. There is a need to further expand the development of Consultant Clinical Scientists posts within Trusts and in partnership with UK Blood services. This will assist clinical care and educate others, which is essential for the safe management of sickle cell patients.

The RCPath Transfusion Special Advisory Committee would like to continue to work with the APPG to address concerns around gaps in sickle cell care, with the consensus being that the problem is currently on course to get worse. It is vital that NHS England & NHS Improvement take action to address the issues highlighted by the APPG to improve the care received by all individuals affected by sickle cell.

  1. The Royal College of Pathologists, The haematology laboratory workforce: challenges and solutions, 2019
  2. New videos produced for manual red cell exchange for sickle cell disease supported by Health Education England funding. Watch the video for patients less than 40kg   Watch the video for patients 40kg and above
  3. Haemolytic transfusion reactions in patients with haemoglobinopathies https://www.shotuk.org/resources/current-resources/videos/
  4. SHOT Bites: ‘Transfusion reactions and errors in patients with haemoglobinopathies’ and ‘Hyperhaemolysis’ (SHOT Bites 14 and 15) https://www.shotuk.org/resources/current-resources/shot-bites/