Select Committee on Health Minutes of Evidence


Examination of Witnesses (Questions 640 - 659)

THURSDAY 22 NOVEMBER 2001

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

  640. Where do the haematologists actually sit with their microscopes?
  (Ms Ward) At the District General.

  641. Really. Right. So there is very little need for the consultant pathologists to go to the major central laboratory.
  (Ms Ward) Yes.

  642. Really; that is encouraging.
  (Ms Wannell) May I confirm that the pathologists are mainly on the site? One of the biggest issues, starting with the on-site/off-site aspect of the tests was access to the relevant pathologist the surgeons would like. We have a lot of ad hoc meetings where the surgeons pop up to the laboratory on site and in terms of quality, with the cancer standards now, the pathologists are all sub-speciality orientated, they link in with multi-disciplinary meetings. There is a lot of commitment to clinical governance, there is a lot of commitment to clinical audit. They are a major part of our hospital. They are our consultants but there is a lot of liaison between the consultants on site and pathologists and surgeons and the physicians as well.

  643. Blood transfusion presumably has not changed, because that has always been done off site. Are you involved with that?
  (Ms Ward) Yes.
  (Ms Wannell) Yes.

  644. One of the good things is that pathologists are less involved with the management. I heartily welcome that. Rate of return. I understand you obviously get emergencies back very quickly. When would a GP expect purely routine biochemical results back?
  (Ms Ward) The vast majority of testing we do is performed on the day it is received and we have electronic links with many of the GPs.

  645. So he or she would get it back the same day.
  (Ms Ward) It would depend what time it arrived. If they take the specimen late in the afternoon —

  646. Before two o'clock.
  (Ms Ward) The vast majority is done on the same day.

  647. Would the same go for routine stuff from the wards.
  (Ms Ward) Yes, because the majority of that is done on site. All of the sites are linked via the IT system.

  648. What is the turnaround time for a blood count if you are going up to a chemotherapy clinic? Prior to treatment.
  (Ms Ward) If that is required so that the doctor can make a decision, then that would be available then.

  649. How quickly?
  (Ms Ward) I do not know off hand, but I can certainly provide that information.

  650. With NHS laboratories you can get that down to seven minutes. Is there a method for alerting GPs particularly to a surprisingly unexpected result?
  (Ms Ward) Yes.

  651. How do you do that?
  (Ms Ward) Very shortly after starting the partnership we established a client response centre, which is a single number which the doctors or anyone who uses the service can ring into and find out the results. It works the other way round. The client response centre also deals with contacting GPs and other medical staff with abnormal results. That is flagged up straightaway on the system, goes through automatically and is telephoned through to the GP. We have dedicated people there, who can focus on contacting that GP and who can chase around after that particular person. Rather than having someone in the lab who is trying to make sure that piece of kit is still operating and that the QC is all right, we have these people at the client response centre whose sole function is to deal with inquiries and to forward information of that nature.

  652. You have already mentioned one of the good things: the ability to limit tests. I certainly remember working in teaching hospitals where you got patients in from DGHs and nobody trusted the results which came from that laboratory, so they were duplicated. If you really do have large centres serving large groups of hospitals that will not happen, because the results will all come from the same tests. That is potentially a tremendous advantage. One of the advantages particularly of having biochemists on site is their connection with junior doctors and with limiting what junior doctors order. Does that still exist?
  (Ms Ward) Yes. All of the pathologists are keen to ensure that the service is used correctly. That is achieved through a variety of mechanisms and we are actively working on developing protocols which will enable all of the medical staff to be very confident that their requesting patterns are being followed. It is a question of getting best practice in and making sure that when the junior doctors arrive, they are given the right information, the right induction; we have regular meetings with the junior doctors, not just to impart information but to get feedback from them as to how easy or otherwise it is for them to use the service and what we could do to improve that.

  653. They can walk into the local laboratory and find the staff very easily.
  (Ms Ward) Yes. They also visit the off-site laboratory.

  654. Do they?
  (Ms Ward) Yes.

  655. Geographically how far away is it?
  (Ms Ward) Five miles away.

  656. Specialist endocrine assays, hormonal assays. Do you do those as well?
  (Ms Ward) Yes.

  657. Does the same go for you?
  (Dr Prudo-Chlebosz) Yes.

Andy Burnham

  658. Earlier I ask Ms Wannell to provide more evidence to us on this issue of costs, efficiency and quality and how they may have changed over the course of the contract. May I ask Ms Ward and Dr Prudo to do the same and provide further evidence to the Committee on each of these points: costs, efficiency and quality? You mentioned you were using your buying power to drive down costs and it would be interesting to have some firm evidence of that, so we could form our views and how you may have improved quality over the course of the contract.
  (Ms Ward) Yes.

Sandra Gidley

  659. Professor Lilleyman, what we are trying to pursue here is the issue of quality but as you have members who work in both sectors have you had any evidence as to difference between the public and private sector with respect to quality? It may be early days, but do you have any initial impressions?
  (Professor Lilleyman) If you look at pathology services in the private sector in the UK overall, there is not that much. The ratio would be something like 95 per cent public to five per cent independent or that sort of order. As we have already said in the public sector there is some considerable variation in quality and that is also true in the independent sector, although I have to say in all fairness that in the independent sector, what you might call the legitimate pathology services are very conscious of the quality issue and most of them have gained accreditation with some national or internationally recognised scheme. The quick answer to your question is that there is no big difference. There is one point I should like to make while I have your attention. Due to a quirk in legislation there is no regulation on human pathology services. Anyone can set up a laboratory in any high street if they want to and it is increasingly tempting to do this since you can buy off-the-shelf tests in Tesco's and Sainsbury's. We have had one or two bad experiences with rogue entrepreneurs setting up independent testing stations. That aside and the regulation question aside, I would say no, there is not a huge difference in quality.


 
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