Bulletin April 2017 Number 178

The focus this issue is very much on the consolidation of pathology services, as well as political engagement and upcoming College elections.

The majority of my editorial this issue focuses on consolidation, something that taxes me in my roles as both President and head of a cellular pathology department. However, there are other important articles in this issue, including reports of some imaginative public engagement events and several examples of trainees undertaking research and encouraging others to do the same.

Consolidation – background

Pressure on pathology services to consolidate, reconfigure or modernise, whatever you prefer to call it, is nothing new. Lord Carter’s first reports, Independent Review of NHS Pathology Services in England, published in 2006 and 2008, recommended consolidation of services “to improve quality, patient safety and efficiency.” A key recommendation was the reinvestment of savings in the service. Despite significant savings having been made over the last decade, there has been limited evidence of reinvestment.  

Lord Carter’s most recent report, Operational Productivity and Performance in English NHS Acute Hospitals: Unwarranted Variations, reiterated the call for consolidation, and NHS Improvement (NHSI) has called on trusts to draw up business plans, irrespective of whether services have already undergone consolidation or their host trusts already spend below the national average on pathology.

Following recent discussions with NHSI and members, I started to pull together accounts of consolidation, both successful and unsuccessful, with the aim of developing a ‘toolkit’ of examples of what has worked well and what hasn’t, to help those undergoing the process themselves. Unfortunately, but perhaps not surprisingly, few of the organisations where consolidation has been unsuccessful were prepared to share information about their experience. I therefore changed tack and invited members to write about their experience for The Bulletin. The first three of these are in this issue, along with an account from Chris Fourie of LTS Consulting about NHSI’s vision for the future of pathology services.

Consolidation – common themes

Not surprisingly there are some common themes emerging from the accounts received so far, most of which were highlighted in the College’s response to Lord Carter’s most recent report. To be fair, the 2008 Carter Report does say that investment in infrastructure, including IT and transport, is essential for successful consolidation. Unfortunately, this investment has not always been forthcoming, which may explain why several attempts at consolidation have failed recently.

Several members of the Pathology Alliance, which represents all pathology specialties and professional groups, recently attended the first meeting of the NHSI Pathology Optimisation Delivery Group, tasked with implementing Lord Carter’s recent recommendations on consolidation. Interestingly, the main presentation by NHSI highlighted the factors needed for this to succeed – and they were remarkably similar to the investment called for in the College response to the report and the common themes that have emerged from the pathology services that have undergone successful consolidation. It is heartening to learn that NHSI recognises the significant investment that will be required to deliver the desired efficiencies. The Pathology Alliance commits to working with NHSI to achieve the best outcome for patients.

Consolidation – reliable data

One of the concerns the College raised about enforced consolidation was the lack of reliable data on which to base decisions. This is highlighted in the 2nd Atlas of Variation in NHS Diagnostic Services in England, published in January, which contains no pathology or genetics because “the data could not be accessed”.

Unlike the first Atlas, it contains only imaging, endoscopy and physiological diagnostics. It is reassuring to read that one of the first things NHSI has done is to collect data from all pathology services. This is very much needed, both in terms of workforce and workload.

The College conducts its own workforce census and is in the process of carrying out specialty-specific data collection, but response rates are too low to be reliable. Please take a few minutes to update your information on the College website and complete the survey if you receive one. Without reliable data it is very difficult to address current challenges or make any meaningful plans for the future.

Although reliable data is essential, it is important that staff work rates are not measured purely in terms of the volume and complexity of samples processed. This does not recognise much of the vitally important work done by staff such as teaching, training, research, quality assurance, quality improvement, management, leadership, and regional and national work for the wider NHS.

NHS Digital’s standardised test list will aid comparison of workload. It will not, however, replace the currently stalled National Laboratory Medicine Catalogue (NLMC), in which the College and NHS England have invested considerable time, expertise and money. It is somewhat comforting to read about the National Pathology Handbook that has been introduced in Wales (p87), drawing heavily on the work done in England on the NLMC. Ireland has also based its new national pathology IT system, MedLIS, on the catalogue. Dr Miriam Griffin will be writing about the Ireland experience in the July issue of The Bulletin.

Consolidation – information technology

Recognition by NHSI of the importance of joined-up IT systems is welcome but not particularly reassuring. New laboratory information management systems (LIMS), and the professionals to support them, are expensive and few labs can afford to update what they’ve got, let alone start from scratch with a completely new system. Unless central funding is identified to resource shared LIMS across networks, consolidation plans are doomed to fail. Several recent high profile examples of problems with LIMS have highlighted the importance of having reliable pathology IT provision, but that costs money and won’t be introduced overnight.

Consolidation – key messages

Consolidation doesn’t always save money, at least not in the short term. All the featured successful reconfigurations have required significant investment, often in new buildings. As Dr Gareth Bryson says of his experience in Glasgow (p83), “merging for financial reasons alone is unlikely to result in long-term stability and success”.

The College has always argued that there is no single solution for all pathology disciplines and geographical locations. Dr Esther Youd says in her description of the Wales experience (p85), “Consolidation success looks different in different specialties. There is no one model which fits all.” Professor Jo Martin highlights the emotional link that many members of staff have to their workplace and comments that “the ultimate outcome of short-term cost savings can be long-term losses in terms of recruitment and morale”. While there are economies of scale in large departments, the workforce remains key to the provision of a high quality service and should not be forgotten or taken for granted. Staff buy-in is clearly essential.

Despite the challenges, consolidation has been a positive experience for our authors. I hope that you will find these accounts informative and helpful. I also hope that they will stimulate discussion and encourage others to share their experience. The topic of consolidation will be continued in the July issue of The Bulletin so please do let us know of your experience. A dedicated consolidation area has been set up on the College website, with links to all the relevant reports, College responses and Bulletin articles. A link will be included in the next e-newsletter.

Getting it Right First Time

NHSI is in the process of appointing Getting it Right First Time (GIRFT) leads in many specialties, including pathology. These onerous roles, which require a commitment of around 88 days per year, will involve collating data and ensuring clinical and professional engagement. I will be involved in the appointment of the Pathology GIRFT Lead, who will take up their post over the summer.

Political engagement

In other news, the College’s political engagement activities have continued. I recently met David Mowat MP, Parliamentary Under Secretary of State at the Department of Health, to discuss the role of pathology in patient safety. I also met Jo Churchill MP, a member of the All Party Parliamentary Group on Cancer, to discuss our response to CRUK’s Testing Times to Come report about pathology capacity. More recently I updated Jon Ashworth MP, Shadow Health Secretary, on a range of pathology-related issues including consolidation, workforce, medical examiners and the impact of Brexit. All the parliamentarians I spoke to understand the importance of pathology and are keen to be kept up to date with current challenges and to help support the discipline where they can.

Upcoming elections

It was a pleasure to welcome several new Specialty Advisory Committee chairs to their first Council meeting in February. I am grateful to members for continuing to take on these important roles, particularly given the workload pressures we all face. Many of the current College officers, Council members and committee chairs demit in November, so we will be advertising all posts in the next few weeks. Election of officers (Vice-Presidents, Registrar and Assistant Registrar) and England Council members will be run by Electoral Reform Services (ERS), as with the recent presidential election. Members are encouraged to consider standing for election or nominate a colleague. While there is no quota, and members from all pathology disciplines are invited to stand, ideally the specialties of the officers and elected Council members should reflect the range of pathology specialties represented by the College. Those in the smaller disciplines are particularly encouraged to put themselves forward. Any specialty gaps will be filled by co-option, so all will continue to be represented. Once the elections begin you will receive an email from the ERS; please use your votes to elect those you think will best represent your interests and those of our patients.

And finally…

It is always a pleasure to see members’ hard work being recognised, whether it’s exam success, a trainee research project or an award for a lifetime of achievement.

The other officers and I were delighted to welcome 90 new fellows to the College at a ceremony at Haberdashers’ Hall last month. It is always a joy to meet the College’s new members and talk to them and their families about their success and their hopes for the future. I was also pleased to award this year’s trainee research medals at the ceremony, and heartened to see the high quality research being undertaken by our younger colleagues. We also awarded the College medal to Dr Jo Sheldon, well known to many for her high profile public engagement work, particularly at the Chelsea Flower Show, but also recognised for her long-standing commitment to training the next generation of pathologists and scientists.

On page 122 you can read about the Lifetime Achievement Award presented to histopathologist Professor John Gosney by the British Thoracic Oncology Group. Professor Barbara Bain is also to be congratulated on her Lifetime Achievement Award from the British Society for Haematology for exceptional commitment and leadership. Professor Barry Cookson, consultant microbiologist and visiting professor at University College London, received a Lifetime Achievement Award at the Royal College of Physicians’ Excellence in Patient Care awards for his work, which includes infection prevention and control and antimicrobial stewardship. Professor Ian Frayling was honoured by the Royal College of Physicians of Ireland recently when he was awarded an honorary fellowship in recognition of his contribution to genetics. Many congratulations to them all.

I was pleased to be invited to the Chief Scientific Officer’s healthcare science awards ceremony last month. These annual awards highlight the important contribution that healthcare scientists make to the NHS and recognise excellence at all career stages. Congratulations to all those nominated and the winners, particularly those working in pathology.

We were also delighted that our very own Director of Publications and Engagement, Dr Lorna Williamson, received an OBE in the New Year’s Honours, awarded last month by HRH The Prince of Wales.

The RCPath Striders have done it again! You may remember that last year a team of College staff raised hundreds of pounds for charity by running up a 42-storey building. They did the same this year but beat their time and raised even more money. Many congratulations (and thanks for not taking me up on my offer to join you!)

I would like to add my thanks and best wishes to Edward Hulme and Annabel Ries, Managing Editor and Associate Editor, who are both leaving the College, and with whom I have worked for many years. Both have made a great contribution to the College and I have personally appreciated their support, dedication and professionalism.

I hope you enjoy this issue and it encourages you to contribute to the conversation about consolidation, whether that’s in the form of a Bulletin article, a letter to the editor or a comment for the website.

Dr Suzy Lishman