The Institute of Biomedical Science

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Carter Report: IBMS comments and statements

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 IBMS comment on the publication of the first review in November 2006 is given below.

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.

The Independent Review of NHS Pathology Services

Carter Report links and information

December 2008

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

Tags: Professional & workforce