Carter Report: Second report

Institute of Biomedical Science comment on the Report of the Second Phase of the Review of NHS Pathology Services in England and the accompanying response by the Department of Health.

The Institute welcomes the publication of the report and the accompanying response from the Department of Health. This report has been keenly anticipated as it represents a thorough and informed appraisal of pathology and the direction in which this key diagnostic service should develop to meet the requirement for high quality patient healthcare.

Quality is fundamental to patient care and safety and is embedded in the professional culture of laboratory medicine. The Institute welcomes the extension of this quality culture to cover the full 'end to end' aspects of the service, which will also be enhanced by the implementation of the IT connectivity recommendations. It is encouraging this is seen as a priority. It has been a long standing source of frustration to laboratory professionals that inefficiencies in the sample collection and result transmission/delivery systems reflect negatively upon the diagnostic and interpretive service and the recognition of this through the report is reassuring.

The Institute is pleased the Department of Health (DH) report recommends mandatory accreditation and that its response recognises the importance of External Quality Assurance and benchmarking schemes for pathology. However, it is disappointing that no acknowledgement is given to the long standing participation of laboratories and individual laboratory medicine practitioners in these schemes.

The extension of accreditation to cover diagnostic point of care testing services outside the laboratory is welcomed by the Institute. The UK has had a key role in the development of International Standards and recognises the evolutionary process that will lead to the integration of CPA (UK) Ltd with UKAS to provide an accreditation service that is independent and strengthened. However, the move for greater independence from the professions should not be at the expense of the fundamental quality principles on which CPA was established and supported by the pathology professions.

An appropriately educated, trained and developed workforce is one of the essential keys to a high quality service and the Institute naturally supports the recommendation that all staff involved in the delivery of pathology keep their knowledge and skills current through participation in relevant continuing professional development. The Institute has signed up to the joint position statement on CPD for Health and Social Care Practitioners which recognises that CPD is fundamental to staff development and to enhancing quality of patient care. The Institute has also long supported the need for professional awards and qualifications relevant to service needs and has developed qualifications for biomedical scientists at all professional levels, including for point of care testing. CPD is integral to this qualification framework and it is encouraging that the DH recognises the need for awards and qualifications as part of continuing staff and patient focused service development in pathology.

The reconfiguration and consolidation of services is a natural consequence of changing healthcare needs. The Institute is pleased that both the report and the DH response recognise the existence of highly specialised diagnostic services within pathology and the need to consolidate and reinforce them. As a key stakeholder in pathology, the Institute is well placed to provide expert input to inform the process. The potential of pathology networks to deliver a more cost effective service is indisputable but this should not compromise the quality proposals already identified, nor must it be allowed to destabilise key services through loss of existing skilled staff. Additional short term investment may be required to develop individuals to deliver the change process and to ensure against loss of existing specialist expertise. It is noted that consideration is being given to the creation of a workforce group focused on diagnostics. As the professional body representing the majority of the pathology workforce the Institute would be pleased to have formal input in to such a project.

The recognition that the innovation and adoption of new technologies requires a simpler pathway and the response to this from the Department of Health in the establishment of a new diagnostics evaluation programme is positive. This will help to ensure the most appropriate testing and technology breakthroughs are available rapidly to enhance and improve the patient care pathway. The initiation of a working group that is fostering the contribution of pathology services to research and the recognition of the premise of research in commissioning pathology services is most encouraging and welcome.

The Institute is encouraged that the aim is to align the many complex agendas across workforce, quality etc as this alignment of vision, planning and implementation has been challenging for the NHS in the past. The appointment of a national clinical lead for pathology is a most positive move towards achieving the vision of this report and is welcomed by the Institute.

In conclusion, we applaud the recognition that diagnostic pathology is a highly scientific service that contributes significantly to patient care and which is underpinned by scientific and diagnostic innovation. Again, the Institute would be pleased to contribute to the development of a new diagnostics development programme and is happy to work with the DH and all other pathology stakeholders in delivering a stronger, improved patient focused service.