Irish health service plans to downsize and shut some pathology laboratories while building two or three new stand-alone clinical laboratories
DUBLIN, IRELAND—Pathology testing and clinical laboratories in Ireland will soon be involved in a major project to overhaul the entire system of laboratory medicine in this country of 4.5 million people. Today, your Dark Daily editor wraps up a week-long visit to medical laboratories in Dublin and the pending reorganization of clinical laboratories is a major topic among pathologists and clinical laboratory scientists.
Last year, Ireland’s Health Service Executive (HSE) issued a press release announcing the program to modernize the nation’s clinical laboratory service. The plan specifies that some pathology laboratories will be downsized or closed as regional laboratory testing networks are developed. Another major element in the plan is the creation of two or three “cold” laboratories—what North American laboratory professionals would recognize as a stand-alone clinical laboratory facility providing routine testing to general practice clinics—to serve this segment of the Irish healthcare system.
During my time in Dublin, I visited five hospital laboratories and participated in a seminar session organized by the Academy of Medical Laboratory Science (AMLS). The clinical laboratory site visits included a range of larger and mid-sized hospitals in Dublin, as follows:
- Beaumont Hospital, with 820 beds.
- St. James’s Hospital, with 901 beds. It was 1667 when the earliest care facility was constructed at St. James’s location.
- National Maternity Hospital, with 171 beds. This specialty hospital delivered 9,142 babies during 2008.
- Mater Misericordiae University Hospital, with 600 beds. This hospital was founded 150 years ago.
- Mater Private Hospital, with 184 inpatient beds. This is a private hospital affiliated with Mater Misericordiae. It opened in 1986 at its current site.
As is true with clinical labs in most countries, each hospital laboratory in Ireland offers the basic testing menu, along with a different mix of competencies. The Republic of Ireland is a compact country, with a population of 4.5 million people. There are 46 hospital laboratories which serve the nation. Reference testing flows to several of the larger hospital laboratories in the country. For example, St. James’s provides reference testing in this fashion. Also, on the St. James’s campus is the National Centre for Hereditary Coagulation Disorders. This center has a pathology laboratory capable of advanced coagulation testing, including state-of-the-art molecular diagnostics.
In Ireland, there is one private laboratory company with activities throughout the nation. It is Claymon Biomnis Laboratories. Founded it 1991, it offers a menu of 2,500 laboratory tests. It serves the private health market and also provides reference laboratory testing services for a number of hospitals throughout Ireland.
Of course, in common with clinical laboratories in other developed countries, many pathology laboratories in Ireland struggle to maintain adequate numbers of skilled staff. For example, because of budget requirements, a multi-year hiring freeze has been in place for many laboratories. This makes it difficult to replace key positions when skilled personnel leave the employ of the laboratory. Another factor is the tight labor situation. Due to the economic recession in Ireland, some experienced laboratory professionals migrated out of the country to pursue other laboratory opportunities.
Ireland has a single-payer, universal health system. This is funded by tax revenue. Individuals may be required to pay a subsidized fee for selected procedures. Wikipedia.com reports that, in 2005, 47.6% of the Irish population had private health insurance. Also, in that same year, Ireland spent 8.2% of GDP on health care. This worked out to be per capita health spending of US $3,996. Of the total money spent on healthcare in Ireland, during 2005, about 79% was funded by the government.
The one topic ever-present during every laboratory site visit in Dublin is the pending reorganization and restructuring of clinical laboratory testing in the nation. Since, in the case of cervical cancer testing, the government health service has already demonstrated its willingness to steer large volumes of laboratory testing to a laboratory outside Ireland, pathologists and laboratory scientists are uncertain about how the coming laboratory restructuring will affect their clinical laboratory and personal career.
The Dark Report has prepared a more detailed analysis of the Irish national laboratory restructuring program in the current issue, now at the printer. This exclusive analysis is filed under the title: “Ireland Is Restructuring Its National Laboratory Test System.” This is “must reading” for any pathologist or laboratory executive who is interested in how and why a national health service is motivated to implement a top-to-bottom makeover of its existing laboratory medicine establishment.
Later today, your Dark Daily editor flies to Birmingham, England to attend the Ninth Annual Frontiers in Laboratory Medicine (FiLM) conference. This is co-produced annually by the Association for Clinical Biochemistry and The Dark Report.
FiLM is now an important resource for presenting best practices and innovation in pathology laboratory management and operations in the United Kingdom and Europe. Stay tuned to your Dark Daily e-briefings this week to learn what the most interesting developments that emerge as this year’s group of lab leaders lead sessions at FiLM.
Your Dark Daily Editor, Robert L. Michel