HEALTHCARE DELIVERY
and pathology should be one of the main focuses for additional spending, hand in hand with demands for efficiency. “Spend twice as much, but gain quadruple the benefit. Some visionary NHS Trusts have found this logic to be so obvious that they are unilaterally investing in pathology services to produce better patient outcomes, help minimise the lifetime ‘amount of treatment’ each patient consumes, and help strategically contain and reduce costs in the long-term. To quote one Trust, “Getting faster, more accurate microbiology results saves lives, as it means we can provide the best treatment sooner.”5
Further recognition
of the impact and return on investment from improved laboratory services is witnessed by the emergence of spin-off joint ventures between Trusts and commercial partners.6 The overly rapid, and possibly ineffective, demands by NHS Improvement to deliver cost and performance improvements or face the threat of consolidation, do not yet seem to be based on data. A Freedom of Information (FOI) enquiry was recently put to NHS Improvement7
asking which NHS
Trusts do not currently meet the 1.6% cost of service to Trust operating expenditure target as set out by the Carter report. The answer, interestingly, stated that NHS Improvement did not hold the information requested, but that it was planned to collect this information in the future. On a positive note, though, the Pathology Modernisation Programme and the Carter Review8
both recognise the need for a
change of scale for pathology services – albeit with reform of internal efficiency levels within the test production process. This does recognise the changing nature of the NHS towards better prevention; demand for pathology services is rising with overall
In order to shed light on just one aspect of the future of pathology services, MindMetre reviewed test turnaround times (TAT).
increasing demand for healthcare, and improvements are needed simply to manage current requirements.9
Improving performance
Quite apart from the strategic issue of whether more funds should be put into pathology services, it is the contention of this article that far more effort should first be put into improving laboratory performance, before crude guillotine measures of enforced consolidation are imposed.
In order to shed light on just one aspect of the future of pathology services, MindMetre – an independent research organisation – reviewed test turnaround times (TAT). Although one of several factors, TAT is a fundamental enabler – providing more test results, more quickly, back into clinicians’ hands. As part of our research, we questioned laboratory and chemistry managers on the role played by turnaround time improvement in the overall improvement in pathology service performance. Results from the study show that out of a list of 15 key aspects of laboratory services, ‘inpatient stat TAT’ is viewed as the most important service to clinicians. ‘Routine test TAT’ was also in the top five aspects of laboratory service considered by laboratory managers to be most important to clinicians, along with ‘critical value notification’, ‘quality/reliability of results’ and ‘accessibility of pathologists’.
Not only did the research ask respondents to rate different aspects of laboratory services, it also captured qualitative input from interviewees. The overwhelming majority of laboratory managers interviewed strongly emphasised the importance of test TAT to them, and the positive impact on the patient pathway of being able to reduce TAT. Therefore, one of the main arguments emerging from the MindMetre study is that there is room for TAT improvement, without any loss of test result quality, through procedural and technological improvements in the laboratory network as it currently stands. Laboratory mergers and consolidation should not be considered before stand-alone TAT improvement initiatives have been exhausted. To this extent, the authors of this study agree with the response to Lord Carter by the Royal College of Pathologists.10
Carrot or stick?
If we look historically, we find (rather astonishingly) evidence from a previous phase of the Government review programme saying: “a small investment in pathology services can disproportionately improve the quality and lower the total cost of a healthcare encounter.” It remains unclear why this good sense has now given way to ‘guillotine’ measures. If standard improvements have not been delivered, then simply consolidating two or more supposedly inefficient laboratories is not the answer. It is clear that investment is required in order to significantly reduce test TAT, and hospital laboratories should be looking to the range of innovative new technologies now available to help them achieve the key performance indicators set by The Royal College of Pathologists. Confusingly, the importance of embracing innovation is a key message of this earlier phase of government review, which makes it clear that “providing services which are swift to adopt innovative technology and practices, where effectiveness is proven” is a key aspect of the authors’ vision for NHS pathology putting patients first. The authors also “recommend that the Department of Health identifies ways to facilitate the adoption of innovation in pathology.” Of course, turnaround time improvements require more than just the introduction of technological innovation. Laboratories need to review the full test process – from sample collection and transport, to pre-analytical preparation, to testing, to result delivery – in order to ensure that any new technologies or measures adopted are of maximum benefit. As one laboratory manager commented: “I agree with the notion that improved test turnaround times would have a big impact on
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