Pathology services need to become more transparent and be subjected to better safety checks, an NHS England commissioned review has recommended.
NHS England’s chair of the pathology quality assurance review board Ian Barnes, who led the review, said that while pathology services generally operated well, there was too little information about what constituted an acceptable standard. There was “little in the way of sanctions when laboratory performance falls below” what standards existed, Dr Barnes warned.
The review was prompted by Sherwood Forest Hospitals Foundation Trust recall of 79 female patients in October 2012 due to faulty test results relating to breast tissue biopsies.
Dr Barnes found there was also little evidence of commissioners across the country agreeing service specifications for pathology work and monitoring contracts against them.
The report recommends that NHS England sets up a new oversight group to monitor quality in pathology and to oversee the implementation of the recommendations. It has already agreed to do so.
Other recommendations include more transparency in sharing data with patients, regular training opportunities for staff, the creation of an open culture in which errors are admitted and learned from, and commissioner action to ensure high quality outcomes are obtained.
The report also recommends that an agreed list of key assurance indicators are developed which can be used in wider Care Quality Commission inspections of providers.
Dr Barnes writes that the UK has been “at the forefront of quality assurance in pathology for the past 50 years” but the current system “relies almost entirely on professionalism and goodwill”.
“It was set up to provide assurance to laboratories,” he adds. “It was not designed to provide public assurance to patients, nor to assist boards and commissioners in fulfilling their statutory duties.”
He added: “Nor does it provide much in the way of sanctions or support when laboratories do fall below an acceptable standard of performance.”
Dr Barnes described his recommendations as “modest and achievable” and said that “costs will be absorbed by the existing system because the recommendations are building on what’s already there in many cases”.
The Royal College of Pathologists, Institute of Biomedical Science and Association for Clinical Biochemistry and Laboratory Medicine issued a joint statement welcoming the review’s recommendations.
It read: “This will require strong professional leadership and a great deal of work from many individuals, including representatives of patients’ interests. We believe that our professions are equal to this task.”
HSJ asked Dr Barnes what the implications would be for pathology services seeking to merge. About 30 major laboratories who are currently exploring merger options. However, there is no mention in the review of the “hub and spoke” structure that Lord Carter recommended in his 2008 review – a model where complex pathology work would be centralised at a smaller number of centres.
Dr Barnes said that while he personally agreed with the “hub and spokes” model the focus of his review was on improving quality which would apply to all providers, whether undergoing a merger or not.
He said: “Whether you’re merging or staying as a single provider you should be ensuring that your quality of service is not affected. What we’ve written here are recommendations that should provide a template to ensure that quality is maintained. My view is the merger side is not relevant to this in the sense that they [providers] should never be doing anything that reduces the quality.”