Junior health minister Lord Darzi's interim report promotes a radical patient-centred view most would endorse. The concept of local treatment centres where most examinations can be carried out is an attractive one. But such services must not be offered in isolation, remote from high-quality diagnostic services.
Under the proposals, primary and community care groups in each strategic health authority will consider the practicalities and the desirability of setting up such centres. However, judging by the membership of the proposed national group, we are not certain they are equipped to understand just how important the integrity of the diagnostic pathway is.
Diagnostics encompasses a spectrum of investigational modes of varying complexity. If the results are normal, they can be straightforward to interpret. However, when abnormalities occur, access to a trained healthcare scientist is crucial.
The healthcare scientist's role includes carrying out diagnostic testing, interpreting the results, indicating the diagnosis or change in pathology, and advising on further investigations and, in some cases, additional interventions and treatment. The 50,000 scientists and technicians in this workforce make a major contribution to patient care.
Due to the complexity of diagnostics equipment and to ensure effective resource management, healthcare scientists have largely been confined to hospitals. The departments they work in must meet high standards; for example, all laboratories in the UK have to belong to a rigorous accreditation scheme. Clinical Pathology Accreditation UK bases its inspection regulations on an international quality standard, which ensures the very best care for patients.
If these services were moved to local treatment centres, patients would rightly expect them to be of an equally high standard - otherwise, what would be the benefit to patients? Convenience at the potential expense of safety and quality?
We believe that healthcare scientists should be incorporated into such centres, where they would be responsible for providing diagnostic services as well as a link to hospital laboratories, maintaining the integrity of the diagnostic pathway from hospital to community.
No more than one or two scientists would be required for any one facility and some scientists could work in multiple centres. They would be employees of the local trust, where they would be members of an appropriate department.
We recommend that they should be part of a rotational pool with their peers in a local network of healthcare scientists. Such an arrangement would help to assure the quality of diagnostic testing.
Are "traditionally" trained healthcare scientists suitable for this role? Probably not as things stand - they would need additional skills. To address this, we might need to create a new breed of healthcare scientist who could perform their core specialty as well as phlebotomy and other laboratory, physical or physiological measurements. New roles would need to be defined, their training and qualifications agreed, and the quality agenda to support them put in place.
Healthcare scientists have cross-cutting responsibilities for almost every patient pathway. In our view, the patient pathway review groups being established in each SHA to consider Lord Darzi's recommendations should ensure that a healthcare scientist and appropriate pathology advice is part of each and every one.