The Institute of Biomedical Science

Carter Report: First report

IBMS Council statement: November 2006

In common with other professional and industry organisations, the Institute of Biomedical Science welcomes the publication of Lord Carter of Cole’s independent review of NHS pathology services in England.

It is good to see the importance and quality of pathology services recognised, and the Institute is pleased to see this is attributed in the main to the commitment and professionalism of the staff. Such recognition of pathology has not always been forthcoming, as is further acknowledged in the report by the comments about the fragmented and inconsistent approach to the support of pathology services through transport, capital expenditure and information technology.

The Institute also welcomes the patient focus identified in the report and the opportunities this may provide for an innovative approach to the provision of pathology services, and for the development of new roles hitherto closed to healthcare scientists. The establishment of pilot sites to test the report’s proposals is a positive step at a time of other significant changes in the NHS, but the Institute remains cautious and believes that the pilot sites must be given the correct level of support and time to reach their conclusions.

The Institute agrees that there is sufficient capacity in pathology currently and would also agree that this capacity may be used to greater effect in the management of demand and the turnaround of results. This may involve working with different or new partners and, as the report suggests, would also require the development of an informative tariff to be able to measure and compare the costs and effectiveness between pathology service providers.

The Institute is confident that its members are well placed to meet these challenges and it welcomes the opportunities to engage with the Department of Health and the government to help in the design of pathology services that remain of the highest standard and meet the needs of patients and clinicians alike.

Statement on Lord Carter Pathology Review report: August 2006

The Institute was pleased to see the publication of the Lord Carter Pathology Review report. This is a substantial report which the Institute is able to support in terms of its openness and general direction. Indeed there is much within the report with which the Institute would positively agree.

Managed networks remain as the corner stone seen as the future for the delivery of pathology services: it is most encouraging to see pathology formally recognised as a clinical service, with the observation that the service has been '... too focused on cost rather than on benefit when making investment decisions'.

The existing barriers to change have been accurately recognised and incorporate many of the 'truisms' that are perceived currently by pathology staff.

President Gordon Sutehall commented: "I am pleased to see that the report has not focused on readily available dogma, and is calling for objective evidence in order to make progress. The work proposed for the pilot sites will be crucial in this respect."

12 sites have been selected to carry out pilot projects to further inform the Review.

Lord Carter will continue to be significantly involved  and will chair a project board that will oversee the pilot site activities. This phase will begin in January 2007.

As would be anticipated issues relating to IT, management ability, logistics and demand have received attention.

Specifically it is interesting to note that it is recommended that the laboratory component of the 'Payment by Results' initiative should be unbundled to provide a more meaningful basis for the proposed pathology tariffs.

Chief Executive, Alan Potter, commented: "It is encouraging to see that the Review Team has clearly listened and listened well to the much advice it has received. The result is that in addition to a description of strategic direction, many of the underpinning complications have been recognised, for example the perennial problem with transport logistics".

The Review Team were also able to make useful comparisons between the UK service delivery models and those used in Sweden, Australia and USA, and the extension of pathology testing beyond the physical confines of pathology is also recognised and discussed.

The report clearly recognises the need for end to end management, IT and responsibility within pathology services. Independent sector involvement features also, and it is particularly encouraging that it is not the dogmatic pressure that many had feared.

As has previously been suggested, this is not a document of revolution, although it is neither simply evolution – perhaps genetically engineered evolution would be a more apt description.

The Institute will of course look to digest fully the implications of this important document over the coming weeks and will be keen to play its part positively in the consolidation of an effective and efficient pathology service that is fit for purpose.

Carter Report links and information

August 2006