Laboratory medicine: service consolidation is not the answer

The massed voices of sensible commentators on healthcare in the UK (and across Europe) now seem to agree that systemic change is needed. With various factors inexorably driving up healthcare consumption, radical reform is needed to make our healthcare system sustainable in the 21st century. The NHS Constitution notes that we as individuals must bear some responsibility for our own, and our family’s, health. This notion is now being extended to an idea of creating more healthy societies through better information, public education, diagnosis, early intervention, accurate treatment and, ultimately, prevention.

Healthier societies require less treatment – attacking the problem of swelling healthcare demand at its root cause. Reaching this noble nirvana is, of course, a massive challenge. Nevertheless, most would agree that pathology services – which provide that all-important diagnostic input – will become strategically more, not less, important as we move into a world of preventative medicine. Surely, therefore, more important means more investment. Apparently, this is not the case.

Lord Carter’s report on pathology, published in February 2016,1 categorises pathology as a ‘back office’ function, not a strategic building block for the health service of the future. NHS Improvement issued a letter2 to all acute NHS trusts indicating that pathology services should reach standard performance targets or face consolidation on a regional basis – with the deadline of early 2017. We can all agree that stringent demands for efficiency should continue. Nevertheless, this ‘guillotine’ approach to pathology services seems puzzling.