On June 28^th 2016 a letter was sent to the Chairs and CEOs of Foundation Trusts and NHS Trusts from Jim Mackey and Ed Smith, CEO and Chairman of NHS Improvement. The letter set out NHS Improvement’s progress on eradicating the deficit in the provider sector and what further actions will be required over the next few weeks.

The letter identified three such areas:

• Elimination of pay cost growth
• Back office and pathology consolidation
• Unsustainable service consolidation

All three of these have an impact on pathology services, which are an integral part of almost all patient pathways. Chronic understaffing, insufficient investment in training and increasing workload have resulted in many services struggling to recruit or retain staff. In addition to staffing problems being exacerbated by agency rate caps, the uncertain position of non-UK EU citizens is also making it difficult to retain trained staff. All this at a time when there is increased pressure to meet targets such as the early diagnosis of cancer, the roll out of bowel scope screening and more care being delivered outside hospitals.

Falsely categorising pathology as a ‘back office service’ displays a fundamental misunderstanding of the vital role that pathology and pathologists play in the NHS. Pathology is not a results service; it is the delivery of clinically relevant scientific information and opinion to positively influence patient outcome. This complex group of diverse medical and scientific disciplines underpins the delivery of healthcare, both in the laboratory and at the patient’s bedside. Although pathology has embraced automation where applicable, the clinical interpretation of patients’ specimens is done by highly skilled professionals.

As the College pointed out in its response to Lord Carter’s report on operational productivity earlier this year, consolidation has not always provided the predicted benefits and has been detrimental to services in several instances. Only this week, Cambridge University Hospitals (CUH) gave notice that they intend to leave the Pathology Partnership (tPP), a network of six NHS hospitals, of which they were host. In withdrawing from tPP, CUH said; “The Partnership was created in 2014 as an innovative model for the management of pathology services. This model now needs to evolve. In CUH’s view, the current model is not proving to be the most cost effective way of providing pathology services for CUH.”

Enforcing consolidation with no evidence of benefit to patients or cost savings at a time when organisations involved in earlier consolidations are withdrawing due to large deficits is unlikely to help the current financial position. Demanding outline plans within four weeks is unrealistic and likely to lead to errors of judgment. There is no reason to believe that consolidation on a regional basis will be any more successful than the schemes that have already failed.

All trusts have been exploring networked services and potential consolidation for several years. Significant savings have been made in pathology services already. Derailing existing plans with a one-size-fits-all instruction to consolidate irrespective of local arrangements or patient needs is unlikely to save money and is likely to cost more in the long term, put the lives and well-being of patients at risk and increase litigation.

I strongly advise NHS Improvement to reconsider this approach. The College and other pathology organisations would be only too happy to support implementation of alternative solutions, several of which we proposed in our response to the Carter report.