Testing Times to Come? Cancer Research UK’s Evaluation of Pathology Capacity Across the UK
Whilst cancer survival is at its highest ever level, health services are under considerable pressure. Increasing cancer incidence, an ageing population and efforts to improve outcomes means that the demand for cancer diagnostics has never been higher. Cancer Research UK, the world’s leading cancer charity, commissioned research to understand the pressures facing pathology services across the UK and to identify solutions to address these issues.
The evaluation was conducted by 2020 Delivery and involved interviews with 25 different pathology providers, a survey of 11 laboratories and use of centrally collected data. Cancer Research UK gave a special thanks to the Northern Ireland Pathology network and David Wells from Viapath for making considerable time to support the research. The research focussed on the pathology disciplines most relevant to cancer: cellular pathology (which encompassed both histopathology and cytopathology); blood sciences; and molecular pathology.
The comprehensive report outlines the current landscape within these pathology disciplines and comments that, based on the number of pathologists currently in training and the age profile of the current workforce, there is likely to be a severe crisis in pathology capacity within the next five to ten years and immediate action is needed to avert a crisis in pathology capacity and ensure the service is fit for the future.
The report makes the following recommendations:
ENSURE PATHOLOGY SERVICES ARE MAXIMISING EFFICIENCY
RECOMMENDATION 1: NHS England and NHS Improvement should continue to support Sustainability and Transformation Plan Footprints areas (STPs) and Trusts to consolidate pathology services, in order to facilitate testing taking place at the appropriate level.
OPTIMISE THE PATHOLOGY WORKFORCE
RECOMMENDATION 2: Trusts and their pathology departments, supported through guidance from professional bodies and NHS England, should:
1. Ensure biomedical scientists (BMS) are being utilised to cut up specimens where possible, in accordance with ‘Principles of Good Practice for Biomedical Scientists Involved in Histopathological Dissection.’
2. Explore the role of clinical scientists to support complex diagnostics and research. Clinical Scientists input should be recognised in their job plans with backfill provided for existing duties.
3. Develop graduated increase in trainee responsibility. The Royal College of Pathologists should update and promote their guidance document.
4. Ensure widespread use of BMS reporting following their completion of the Biomedical Scientist reporting programme.
RECOMMENDATION 3: Health Education England should include either cellular and molecular pathology within their review of the cancer and related workforce, to enable longer-term workforce planning. The Royal College of Pathologists should continue to run programmes aiming to attract more staff to cellular pathology.
RECOMMENDATION 4: In considering the new consultant contract, the Department of Health and NHS England should consider the impact on near-retirement consultants.
FUTURE-PROOF PATHOLOGY
RECOMMENDATION 5: There should be continuous support from the NHS, researchers, funders and professional bodies for the CM-Path initiative and delivery of the four work streams within its strategy. Workforce initiatives should allow pathologists to spend time on research. The recommendations from ‘Every Patient a Research Patient’ should also be implemented to encourage a more positive research environment in the NHS, including investment in academic pathology training posts and chairs.
RECOMMENDATION 6: Departments and Trusts should invest in infrastructure to support digital pathology and businesses/researchers should look at how to make this worthwhile. Sharing results and on-screen examination of histological slides should both be utilised in the short term to enable more efficient, networked services. Electronic requests should also be used.
RECOMMENDATION 7: Molecular pathology should be more involved with the whole diagnostic process for solid tumours (including how molecular pathology results are reported), in a similar way to blood cancer. This should be facilitated through better IT connectivity and closer working between relevant staff.
IMPROVE UNDERSTANDING OF PATHOLOGY PROVISION
RECOMMENDATION 8: NHS Trusts should invest in technology so departments can comply with requirements to supply pathology data to the Cancer Outcomes and Services Dataset (COSD). The Royal College of Pathologists should pro-actively collect comprehensive workforce information from departments across the UK.
RECOMMENDATION 9: The impact on pathology should be factored into NHS workforce and resourcing plans to ensure that pathologists and clinical scientists are involved in the dialogue.
