Select Committee on Health Minutes of Evidence


Examination of Witnesses (Questions 552 - 559)

THURSDAY 22 NOVEMBER 2001

KAREN WARD, PROFESSOR JOHN LILLEYMAN, MR ROGER SPILLER, DR RAY PRUDO-CHLEBOSZ AND GAIL WANNELL

Chairman

  552. May I welcome you to this morning's session of the Committee and particularly welcome our witnesses? May I thank you on behalf of the Committee for your very helpful written evidence which is useful to us in framing our questions? May I begin by asking you each to introduce yourself briefly to the Committee, starting with you, Mr Spiller?

  (Mr Spiller) I am Roger Spiller. I am Head of Health in the union MSF which represents both public and private sector. With me I have our Head of Research and Policy for the health sector and also one of our lay members, a senior biomedical scientist.
  (Ms Ward) I am Karen Ward. I am Business Development Director for Quest Diagnostics. My responsibilities are to develop partnerships with the NHS and I have a colleague with me who is our Operations Manager.
  (Professor Lilleyman) I am John Lilleyman. I am President of the Royal College of Pathologists and I am here entirely on my own.
  (Ms Wannell) I am Gail Wannell. I am the Chief Executive of West Middlesex University Hospital NHS Trust and I have brought some colleagues with me.
  (Dr Prudo-Chlebosz) I am Ray Prudo. I am Chief Executive of The Doctors' Healthcare Company and The Doctors' Laboratory which is a pathology organisation and a pathology IT company. We have been working in partnership with the NHS for about ten years.

  553. May I begin by asking Professor Lilleyman about his views and his organisation's views on the current state of pathology services and the general direction in which we are going at the present time?
  (Professor Lilleyman) It is fair to say that the standard and quality of pathology services across the country is variable. This was very amply demonstrated in the early 1990s by the Audit Commission in its first survey and further study has only served to underline that. Whilst at its best NHS pathology is probably better than anything else in the world, at its worst, it is not. Overall, if we look at the totality of English NHS and Welsh NHS pathology, what you are seeing are some pockets of unsatisfactory service due to chronic under-investment, due to workforce shortages of both medical and scientific staff. That is the background we are sitting with at the present time. My institution strongly endorses the need to mend pathology where it is broken and to modernise, if that is the word you prefer to use—we should like to say "develop and improve". We are quite open minded about the best way to achieve this.

  554. Presumably when you say mend it where it is broken, what you are suggesting is that there is something of a patchwork, that there are certain areas where it is working well, presumably within the NHS.
  (Professor Lilleyman) Yes indeed. There are some parts of the country where the initiative has been seized and where improvements are being made and visionary plans are developing in other areas. It is by no means a total picture of gloom and despondency. There is a need for capital investment which is pretty well universal, but some people are picking this ball up and running with it more effectively than others.

  555. You wrote in the Bulletin of your Royal College in October about the modernisation programme running into some difficulties. You make the point that the notion that capital might be more readily available from the private sector has not been greeted with universal enthusiasm. Could you say a bit more about what you meant by that?
  (Professor Lilleyman) What I meant by that was that there is plenty of enthusiasm within the professional groups in pathology for developing and improving their own service. There is—again patchily—a level of frustration that they cannot engage strategic management in the NHS. That is because in turn strategic management in the NHS is itself rather patchy; on the whole, it has a rather indifferent track record. That is against the background of yet another upheaval in the strategic level of Health Service management, which is paralysing progress to some extent at a time when that is the last thing we need.

  556. Where do you feel the real steer in terms of policy in your area should be within the NHS?
  (Professor Lilleyman) We fully support the modernisation programme the Department of Health is running and we are very anxious to see that proceed in the direction in which it is generally going. We do not have any serious discomfort with that. All we would welcome is whatever it takes to make that happen as fast as possible.

  557. Clearly we have a Bill going through Parliament this very week which as you appreciate is looking at the new strategic health authorities. Where do you see the location of the strategy in respect of pathology? Where would it be most appropriately placed?
  (Professor Lilleyman) I would say certainly at a level above individual trusts. One of the problems in pathology is that it has been embedded in individual trusts on an historical basis because it is in some senses a support service, though we would obviously fiercely argue that it is a pivotal clinical service. It has been regarded as a support service and therefore as an overhead and it has not been in the clear strategic vision of trust chief executives; at least not generally; there are many exceptions. That has disadvantaged it over the last ten years since trusts became part of the NHS. What we should like to see is it taken out of trusts and put one stratum higher at a strategic level, probably of the new health authorities, so we can develop services on a bigger population base. We would strongly welcome that. We cannot engage new health authorities yet because they do not exist.

  558. Are you confident that your area of work will be one of the key objectives of these new bodies?
  (Professor Lilleyman) I should like to be confident; I should like to think so. I have not had complete reassurance on that yet, but it would be very logical, so I should be very disappointed if it were not so.

Mr Burns

  559. I come from a home counties constituency and I have been acutely aware of the problems in path services. One of the problems which you said partly contributed to the variation in the quality throughout the country was the workforce shortages. It seems to me, particularly if you are living in the home counties and London, that the salary or pay scale of these staff is so chronic that you just cannot live in that part of the country at any decent level. Is that still a problem? Is that one of the main contributory factors to the workforce shortages which is contributing to standards being variable, or is it more sophisticated than that?
  (Professor Lilleyman) In some parts of the country it is a very major problem; it is patchy. There are two aspects. Pay is of course a major one and I fully agree with you that the initial pay structure to attract people into this profession is bordering on the derisory. It has improved and that has had an effect, but it needs to improve more. There is the pay aspect. Then there is the career development aspect. Many of these people who come into this profession are highly able intellectually and find it very frustrating that they cannot progress beyond the very basic level. We would be very keen to explore any way that can enhance career development for these people. That is one aspect of the workforce. The other aspect of the workforce is in the medical workforce, particularly in one branch of pathology, which is histopathology. This is pivotal to the development of the cancer plan, which is why it has suddenly become quite a high profile problem. We have about a ten per cent vacancy factor in consultant histopathologists throughout the country. This is not the result of derisory pay scales, it is in fact the result of disastrous workforce planning about five years ago. It is water under the bridge but we are now reaping what we sowed in those days.


 
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