Pathological service cuts?

Whenever ministers think a public service needs an overhaul, they bring in ‘the experts’.

Ironically in many cases ‘the experts’ have limited expertise.

And the very last thing ‘the experts’ do to make up for a lack of practical knowledge is to take much notice of people who actually work in the service in question. They charge huge sums of money and so they must be good – or that’s what ministers believe.

Take pathology services – a critical arm of the NHS which is responsible, among other things, for detecting disease in bodily samples taken from patients.

The government’s Big Idea, following input from ‘the experts’, is that pathology services should be centralised. To the outsider it might seem like a reasonable plan; in practice it could be disastrous, according to biomedical scientist and Unite activist Ian Evans.

The blueprint was originally proposed by privatisation enthusiast Lord Carter of Coles, who holds a number of directorships in healthcare companies. He currently chairs the review body on the future of NHS pathology.

Ian, chair of Unite’s healthcare scientists’ committee and a member of the union’s health sector committee, believes the Blairite peer has got it spectacularly wrong. Ian says the centralisation strategy would lead to delays in analysing samples and in some cases incorrect analysis leading to misdiagnosis. And we are talking here of killer diseases like cancer.

Ian argues the blueprint is not aimed at making the service more efficient – as ministers argue – but solely to make it cheaper and primed for privatisation. And when that is achieved the 60,000 staff employed by the service will inevitably end up with worse terms and conditions.

Currently there are 105 laboratories in England which the government intends to cut to 29 with the rest acting as satellites. It is a reintroduction of the ‘hub and spoke’ model, which has already been tried in some areas and which has failed to produce results or save money.

In 2008 the government claimed the reorganisation would save £500m, although that figure has now been trimmed back to £200m. There is, by the way, no indication of where the major investment required to establish these new ‘super labs’ would come from.

And throughout the rest of the UK, similar models are either already going ahead or under consideration. A resolution passed at Unite’s last health sector conference commits the union to a UK-wide campaign against the proposals.

Vacuous mantra

Meanwhile, according to Ian, private sector consultants have trousered hundreds of millions of taxpayers’ money, repeating their vacuous mantra about ‘innovation’.

Presumably their fees are mounting as health secretary Jeremy Hunt and his ministers continue to talk to the consultants – although little has changed during years of expensive analysis.

“The idea is totally impractical,” says Ian. “A lot of pathology is quite ‘manual’ and time-consuming and requires a great deal of care and attention. Inevitably centralisation means that staff will have to drive long distances to get to work.”

There is an expectation that settled, highly trained and experienced staff can easily relocate, but many would rather leave the service and find alternative employment than go through the ordeal of moving. Some of them are already making 120 mile round trips. That would only get worse, according to the health sector conference’s resolution.

Staff who have homes near their workplace would be forced to work elsewhere which would only have a negative effect on them, their families and the service users.

“They haven’t looked at the logistics of this,” Ian comments. “Samples could be travelling more than 100 miles to the lab. Blood samples in particular don’t travel well. They can change quite significantly and that can lead to erroneous results.

“And sometimes patients need to attend the haematology lab to give samples. Centralisation will inevitably mean they will have to travel much longer distances.”

Currently some hospitals are unable to read sample results electronically because they have installed different software – ironically a function of decentralisation and the introduction of private contractors. Such hospitals have to receive results by post.

Ian, managing pathology support services and working in the labs at the Royal Sussex Hospital in Brighton, argues that centralisation of the system will make that worse.

Concern

He has two other areas of concern. At the moment there are 97 cytology labs, which among other things, deal with smear test samples. On the advice of the ‘experts’, minsters want to cut them back to 13 labs – or ‘centres of excellence’ as the consultants prefer to call them. That might benefit patients in the large metropolitan areas, but not the rest of the country, Ian believes.

A lot of those who screen samples at the cytology labs are working mothers who value short shifts because they fit in with their family responsibilities. Ian points out that because of the concentration required by screeners staring into microscopes, short shifts are also considered to be the safest and most effective way of doing the job. Such employees will not be able to travel long distances to get to these new centralised hubs. There’s a danger the service will lose much of its experienced workforce.

The policy Institute of Biomedical Science and the British Association for Cytopathology has raised similar concerns to Unite, but along with the union, they are being ‘fobbed off’.

The government also plans to cut the number of genetics laboratories from 13 to six. The problem is that they specialise in different aspects of the subject and Ian suspects that some specialisms might simply cease to exist.

As ministers sit back and contemplate the brave new world of pathology services, Ian is worried. “What really concerns me is their complete failure to engage with those who will be truly affected,” he says.