The Royal College of Pathologists Pathology: the science behind the cure 2016 elections
2016 elections The College and pathology In May people in Northern Ireland will elect their representatives to the legislative assembly. A new executive will take responsibility for a range of devolved areas including health services. As the population gets older and long-term conditions increase, it is more important than ever to support good health, effective disease prevention and treatment. Pathology is the key to delivering those objectives. To that end The Royal College of Pathologists has developed four policies that, if delivered, would improve the health of people in Northern Ireland and save money. The College The Royal College of Pathologists is a charity with over 10,000 members worldwide, most of whom work in hospitals and universities in the UK. In every devolved nation of the UK, the College has a council of local clinicians and scientists directing activity in their area. The chairs of the Northern Ireland, Scotland and Wales councils represent their nations on the College s main Council and Trustee Board. The College is committed to improving patient care by promoting excellence and maintaining the highest standards through training, assessments, examinations and professional development. Pathology College President Dr Suzy Lishman (centre) with Northern Ireland s Chief Medical Officer Dr Michael McBride (on her left), Chair of the College s Northern Ireland Regional Council Dr Peter Sharpe (right) with other members of the council last summer. Involved in 70% of all diagnoses made in the NHS, pathology is the medical specialty at the heart of modern healthcare. Pathology is vital for the diagnosis of cancer, infections and organ damage, key to screening for congenital diseases, and essential for monitoring the progress of disease and its response to treatment, including chronic illnesses, such as diabetes. From prenatal testing and childhood vaccinations to cancer screening, diagnosis and monitoring, pathology is vital at every stage of life. Anyone who has a blood test, cervical smear or tissue biopsy has a pathologist involved in their care. With the right support pathology can play a central role in the delivery of a more effective health system in Northern Ireland improving the prevention, diagnosis and treatment of disease. 1 2
Policies that build on excellence Policy 1 prioritise investment in pathology information technology (IT) systems Many pathology services in Northern Ireland already have an international reputation for high quality. Northern Ireland s pathologists are at the forefront of molecular diagnostics, genetics and virology services, for example, and are engaged in innovation and collaborative research with universities and other partners. Last year, a Northern Ireland consortium, which included both Queen s University Belfast and Ulster University was named as one of six UK centres of excellence that will act as a hub for research and development in personalised medicine. By using diagnostic tests and data, personalised medicine enables treatment to be targeted on an individual patient s tumour resulting in more predictable, safer and cost-effective outcomes. Northern Ireland will also be contributing to the 100,000 Genomes Project with the opening of a new Genomic Medicine Centre. Based at the Belfast Health and Social Care Trust, this will provide patients with more accurate cancer and rare disease diagnosis and contribute to valuable research. By adopting the following four policies Northern Ireland s leaders can build on these exciting developments to benefit patients and attract investment and expertise. Northern Ireland s health and social care services must replace old IT infrastructure with a modern system that can support the future delivery of pathology services. By modernising electronic records and effective means of sharing data digitally, including images of pathology slides, testing could be speeded up resulting in quicker and better diagnosis and treatment. Pathology services should be a priority for the implementation of the ehealth and Care Strategy for Northern Ireland and the development of the electronic health record. Policy 2 train, recruit and retain the right workforce Ulster University, which along with Queen s University Belfast, was part of the successful Northern Ireland consortium named as one of six UK centres of excellence that will act as a hub for research and development in personalised medicine. In order to operate a high quality, efficient service pathology laboratories need the right mix and number of qualified staff. At the moment Northern Ireland does not have enough, or the right proportion, of medically qualified pathologists, clinical scientists and biomedical scientists. In order to correct this the Department of Health, Social Services and Public Safety needs to work with the College to identify and correct current and emerging gaps. As training pathologists and scientists takes five to ten years it is vital that a commitment to a sustained investment in creating a modern workforce is made now. 3 4
Policy 3 Implement pathology service modernisation A decade ago Dame Ingrid Allen s Review of Pathology Services in Northern Ireland found that laboratories were unequally distributed. Although some progress has been made, much more work is needed to ensure the right facilities are in the right places. By doing so it is easier to recruit staff and improve efficiency and quality across the country. Policy 4 Ensure the right test at the right time In line with the Allen Review and Sir Liam Donaldson s Right Time Right Place, the College supports changes to ensure that hospitals and laboratories are in locations that promote the highest quality and efficiency with well-motivated, laboratory staff working within multidisciplinary teams and networks. Dr Peter Sharpe, Chair of the Northern Ireland Regional Council, and specialist familial hypercholesterolaemia (FH) nurse, Julie McCullough, at the launch of the FH cascade family screening service in Southern Health & Social Care Trust. 5 Each person in Northern Ireland has an average of 24 pathology tests every year. Duplication and a lack of training for doctors in how to order tests appropriately means that many of these tests are unnecessary. Reducing tests that are not needed would free up resources to better serve those in real need and enable savings to be made. Northern Ireland should adopt approaches such as active requesting where doctors have to request a test in writing rather than just ticking a box. This has been shown to significantly reduce demand, with no noticeable effect on quality of care. There are also specific issues relating to the overuse of testing by doctors in training who ask for tests just in case. The reduction of basic science and pathology teaching in medical education needs to be addressed and reversed to ensure that doctors have the scientific knowledge to request and interpret tests appropriately. Minimum test intervals should be introduced, as is happening across the rest of the UK. Excellent educational resources for patients in use of and interpretation of results, like labtestsonline.org. uk, should be promoted along with point of care testing in the home, pharmacy and GP surgery. By adopting these measures, patients and doctors will be given more control and unnecessary laboratory testing will be cut. A Queen s University Belfast student working in the labs in the Medical Biology Centre. 6
info@rcpath.org 020 7451 6700 2016 The Royal College of Pathologists 4th Floor, 21 Prescot Street, London E1 8BB www.rcpath.org March 2016