Examination of Witnesses (Questions 552
THURSDAY 22 NOVEMBER 2001
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
(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
(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
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 usewe 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
isagain patchilya 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
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
(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.
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
(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.