Pathology, the branch of medicine involving the examination of organs, tissues and whole bodies, is involved in 70 to 80 per cent of diagnosis and treatment decisions. It also faces some of the fastest and most radical technological changes in health care. The Nuffield Trust has looked at the important opportunities to deliver better care and save money in this field, what could hold them back, and how they can be realised.
The future of pathology services finds well-established opportunities for pathology to make substantial improvements in care for patients, and deliver savings estimated at £200m. Yet despite major reviews identifying these possibilities in 2006 and 2008, progress has been patchy.
Several areas have embraced change by forming provider networks, either between NHS trusts or in combination with private providers. Although these networks have not been problem free, they are starting to demonstrate productivity gains.
Access to better information and use of common standards are critical to realising the potential to improve standards and efficiency. There is a need to accelerate the work that is underway. The Royal College of Pathologists has endorsed the ‘Choosing Wisely’ campaign, which is designed to ensure only the most appropriate and effective investigations are used. Achieving full benefits will require locally tailored approaches and pathologists working closely with other clinicians.
But there are real barriers to expanding and accelerating these changes, which must be overcome. Pathology could be overlooked by commissioners and boards focusing on service areas seen to be more central to the narrative of “integrated care”. Money will be needed up front for some changes to deliver savings later. There is a risk that we will not have enough pathology professionals, with the right skills, to sustain and improve services. There are growing signs of pressure on the workforce, driven by increasing demand and retirement, and it is not clear that there are robust plans in place to deal with this.
The report also looks at the changes digital and genomic technology is bringing in pathology, and what they mean for services, and how we can get the most benefit out of them. The development of the Genomic Medicine Centre network offers ground-breaking potential but care is needed to ensure local systems apply the right approaches to fully integrate with the national programme. Point of Care Testing, where laboratory tests on patients’ tissues are carried out where they are being treated, is gathering pace. Decisions on using it and contracts to fund it must consider and reward the full benefits it can deliver by reducing the need for patients to go to other services.
Biomedical sciences are a key growth area for the UK and the NHS should play its part in supporting early adoption and spread of new technology.