Does healthcare really need a 24/7 pathology service?
Tony Dedman
Training Coordinator and Method Development Scientist
Homerton University Hospital NHS Foundation Trust
The simple response to this becomes “horses for courses” in that providing a 24/7 service will depend upon the discipline, workload, staffing complement and the degree of clinical cover provided.
Recent NHS Improvement documents suggest that once laboratory collaboration widens, the increase in workloads – in particular from primary care – will inevitably lead to a requirement for working extended
hours at the hub laboratories.
It is, therefore, a relatively minor step to move from extended hours to a 24/7 service. However, this would not be true for all disciplines, but just those required to support the critical care areas of the parent organisation.
The ever-expanding repertoire of assays that is available as point-of-care and the options of the “electronic cross match” suggest that spoke sites would not be required to operate a 24/7 on-site pathology service if properly supported by the hub laboratory.
In the current political climate, pathology spending is seen as an essential but expensive service that compromises trust finances. The move to reduce the number of experienced qualified staff will result in a threshold being reached, below which it no longer becomes safe to run a 24/7 service. An unsafe service should equate to no service.
Ian Cocking
Pathology Service Manager
Leeds Teaching Hospitals NHS Trust
The short answer is “yes” and to some extent many pathology departments have provided such
a service for many years.
In the 20 years I have been a biomedical scientist in microbiology, I have seen considerable change in laboratory service needs, alongside which patient needs and expectations have changed tremendously. They expect to have access to healthcare 24/7 – this includes diagnostic pathology. Can we justify not providing such a service when we ourselves would demand the same when accessing NHS services?
Whilst staff do not always favour late or overnight shifts to provide a 24/7 pathology service, we all feel obliged to provide such a service despite our own personal commitments. Whilst the majority of biochemistry, haematology and blood transfusion departments have well established 24-hour working patterns, microbiology has always been variable in the level of service provided out of hours. But the demands for appropriate antimicrobial stewardship and antimicrobial resistance have seen increasing dependency on rapid and timely testing and reporting of microbiology tests at all times of the day.
We are constantly introducing new rapid diagnostic tests to improve turnaround times to ensure the patient pathway through our services is fit for purpose and effective. Pathology must not be seen as the service that holds up or delays this process. We must all play our part in ensuring NHS services are fit for the patient and fit for the future.
Bamidele Farinre
Specialist Biomedical Scientist
Great Ormond Street Hospital
Emphatically, “yes”. It is clear that our dear NHS has entered a new era of change, which has been accelerated by the healthcare reforms, increased burden of rising care costs due to a surge in chronic disease prevalence and the expansion of care for the ageing population. It is inevitable that pathology will move towards 24/7 routine services and providers should commit to meeting patient and public expectations.
"Plan to move towards 24/7 service provision must be linked to broader strategic plans"