As chronic disease and aging populations strain the UK’s medical systems, staffing shortages at pathology laboratories contribute to lengthening delays of critical diagnostic services

In the United Kingdom (UK), pathologists and other physicians are going public with their concerns that a growing shortage of pathologists and medical laboratory scientists will soon contribute to delays in performing the lab tests needed to diagnose patients—particularly those with cancer—and identify which therapies will work best for them.

Thanks to vast improvements to both medical laboratory capabilities and treatment options, the cancer survival rate in the UK doubled over the past four decades. However, early diagnosis is a critical component to a successful outcome. As further strain is placed on medical laboratories and diagnostic providers, wait times continue to increase beyond the thresholds created by the UK’s National Health Service (NHS).

Worsening an already dire situation, a November 2016 report from Cancer Research UK, “Testing Times to Come? An Evaluation of Pathology Capacity Across the UK,” predicts a critical shortage in laboratory staffing within the next decade. Data on Provider-based Cancer Waiting Times for August 2016 from National Health Service England shows that 17.2% of patients with an urgent referral for suspected cancer fail to start treatment within two months of the referral.

UK Medical Institutions Warn of the Need for Additional Funding

Both the Royal College of Pathologists and the Royal College of Physicians have petitioned UK government leaders to infuse funding for medical training programs to help slow the speed at which their current diagnostic facilities and medical infrastructure are being overwhelmed.

In a letter to Theresa May, Minister of the UK, Dr. Jane Dacre, President of the Royal College of Physicians, said, “… investment levels are not sufficient to meet current or future patient needs. As a result, in spite of rapid advances in clinical care, services are often too paralyzed by spiraling demand to transform and modernize.”

Dr. Suzy Lishman (above center), Histopathologist and President, Royal College of Pathologists (RCPath) believes that “The health service is facing a perfect storm—with staff shortages, increasing use of Emergency Departments, social care pressures resulting in delayed discharge, and under-investment in equipment and infrastructure.” (Photo copyright: The Pathologist.)

Dr. Suzy Lishman (above center), Histopathologist and President, Royal College of Pathologists (RCPath) believes that “The health service is facing a perfect storm—with staff shortages, increasing use of Emergency Departments, social care pressures resulting in delayed discharge, and under-investment in equipment and infrastructure.” (Photo copyright: The Pathologist.)

In a response to Dacre’s letter, Dr. Suzy Lishman, President of the Royal College of Pathologists (RCPath), highlights how staffing shortages and shifting regulations in other specialties are further increasing the impact of shortages on medical laboratories and histopathology labs.

“Pathologists, for example, are busy supporting their frontline colleagues, ensuring that diagnostic tests are performed quickly and accurately so that patients receive the right diagnosis and can be treated without delay,” she said, “They are deeply concerned about the pressures on frontline emergency staff, but also about the longer-term effects that will be seen in delays to appointments and cancelled operations.”

Medical Laboratories in US, Canada, Other Developed Nations, Face Similar Challenges

These challenges are not new to laboratories. For example:

• In 2011, Dark Daily highlighted staffing difficulties facing anatomic pathology laboratories in Manitoba and Saskatchewan, Canada, that led to a backlog of tests in the thousands.

• In 2012, Dark Daily reported on multiple presentations at the 10th Annual Frontiers in Laboratory Medicine (FiLM) addressing the difficulties in recruiting millennials.

• In 2014, Dark Daily covered discussions at The 11th Annual Frontiers in Laboratory Medicine regarding how to navigate increasingly complex quality requirements while also working with shrinking funding.

Rapid Advancement in Technology and Testing Affecting Training Programs

As baby boomers continue to near retirement, staffing problems might reach a critical level. In a 2016 Cancer Research UK press release, Professor Manuel Salto-Tellez, MD-LMS, stated, “The number of cancer cases diagnosed each year is set to rise, and the already stretched pathology services won’t cope unless we ensure more people are trained and employed in pathology. We must also make sure that existing staff have the support they need to do their job.”

However, funding is but one aspect of the challenge in recruiting and training a new generation of pathologists and medical laboratory professionals. Significant, rapid advances in laboratory testing and diagnostic technologies also creates challenges within the training programs themselves.

As precision medicine continues to mature, demand for the latest lab tests and diagnostic technologies will only increase. This leads to a multi-faceted challenge—funding both staffing and the technology required to implement these new tests and diagnostic procedures. Even if funding for training is bolstered, it will remain important to ensure that trainees in laboratory medicine are skilled using the technologies. This is particularly true in some of the most in-demand specialties, such as molecular diagnostics, genetic testing, and next-generation gene sequencing.

Cancer Research UK predicts that incidence rates for cancer will increase by 2% between 2014 and 2035. The Centers for Disease Control and Prevention (CDC) expects incidence rates for cancer in the US to remain roughly the same between 2010 and 2020.

Paired with an aging population and increased life expectancy, these trends will only continue to increase in severity until a resolution is found. It remains essential for medical laboratories and anatomic pathology groups in nations around the world to continue pushing for increased funding, while communicating the important role diagnostic testing plays in modern healthcare.

—Jon Stone

Related Information:

UK’s Pathology Services at Tipping Point

Testing Times to Come? An Evaluation of Pathology Capacity Across the UK

Cancer Incidence Statistics

Cancer Waiting Times: What’s Causing the Delays?

NHS ‘Struggling to Cope’ With Increase in People Undergoing Cancer Tests

College Response to Royal College of Physicians Letter About NHS Capacity

‘Quality of Patient Care Threatened’ Physicians Tell PM

NHS Cancer Testing Service ‘At Breaking Point

Expected New Cancer Cases and Deaths in 2020

Cancer Waiting Times

When Recruiting and Training Generation Y to Work in Medical Laboratories, USA and UK Face Same Challenges

Medical Laboratory Leaders Gather in the United Kingdom to Address Challenges of Shrinking Lab Budgets and Need to Upgrade Quality Assurance Performance

Pathologist Shortage and Delays in Lab Test Reports Get Publicity in Saskatchewan