Speakers at Frontiers in Laboratory Medicine See Increased Role for Pathology

DATELINE: BIRMINGHAM, ENGLAND—As our North American readers of Dark Daily arrive for work this morning, it will be late afternoon here in the United Kingdom and the last presentations on the second day of the 10th annual Frontiers in Laboratory Medicine (FiLM) will be wrapping up.

It was a packed auditorium this year at FiLM, as clinical biochemists, pathologists, and medical laboratory scientists gathered to learn about achieving best practices in pathology management and clinical laboratory operations. One reason for this heightened interest is the major reforms already cascading throughout the United Kingdom’s National Health Service (NHS).

Reform goals were articulated in an NHS White Paper, titled “Equity and Excellence: Liberating the NHS,” and published last summer. Providers in the UK healthcare system will be focused on improving patient outcomes and patient satisfaction, while absorbing significant cuts in their base budgets.

Reduced Budgets for Pathology Laboratories in the United Kingdom

To understand the direct impact of the UK’s goal of cutting the healthcare budget by a measurable percentage, think about the commotion that would result if the President and the United States Congress told the American public that, in the next fiscal year, funding for Medicare would be reduced by, say, 5% from the previous year’s funding! That is the case in the United Kingdom, where the coalition government has told the public that significant budget reductions in the entire national budget must be achieved to slash a budget deficit that was 11% of GDP in the 2009/10 fiscal year. In percentage terms, this deficit was the largest of the G20 group of developed nations. Significant spending reductions are needed to avoid more severe financial and economic consequences.

This graph shows why there is a crisis in the government budget of the United Kingdom. The left axis is % of Gross Domestic Product (GDP). Between 2007 and 2009, there was a drop in tax revenues and a simultaneous rise in spending. As can be seen, in budget year 2008 and budget year 2009, the UK’s public deficit rose by more than the total spending on the National Health Service. Under current projections, it is not until budget year 2017-18 before public finances return to balance.

This graph shows why there is a crisis in the government budget of the United Kingdom. The left axis is % of Gross Domestic Product (GDP). Between 2007 and 2009, there was a drop in tax revenues and a simultaneous rise in spending. As can be seen, in budget year 2008 and budget year 2009, the UK’s public deficit rose by more than the total spending on the National Health Service. Under current projections, it is not until budget year 2017-18 before public finances return to balance.

Yesterday’s first keynote speaker at FiLM was Ian Cumming, OBE. He is Chief Executive of the West Midlands Strategic Health Authority. Cumming explained to the FiLM delegates which specific financial and clinical opportunities are expected to be primary drivers in the ongoing reform of the NHS.

One primary objective is to shift the emphasis by UK providers away from reactive and acute care, and toward proactive care. He described how the reformed health budget process will evolve to emphasize proactive care by general practice clinics. In this regard, the UK is moving on a parallel course with the United States, and its unfolding efforts to use medical homes and accountable care organizations (ACOs) to achieve a similar emphasis by physicians in the United States are unmistakable.

Using Medical Laboratory Testing to Support Clinical “Best Practices”

For emphasis, Cumming declared that “Admission to a hospital is not best practice!” His point was that, as any healthcare system drives to achieve best practices in proactive medicine, success will be measured by keeping patients out of the hospital.

Essential to cancer diagnosis and treatment is clinical pathology laboratory testing. Addressing the NHS goals in this clinical area was Professor Sir Mike Richards, CBE, who is the UK’s National Cancer Director. When it comes to nationwide cancer screening, compared to the United States, the NHS has a much easier time implementing effective programs.

Sir Richards provided an example. For colon cancer screening, a nationwide program that targets people aged 60 to 69 years old has been implemented. This is now being extended to include individuals who are 75 to 80 years old. The fecal occult blood tests (FOBT) are performed in five hub pathology laboratories.

Sir Richards reported that about 2% of the individuals screened by the program are positive and undergo colonoscopy. Of that number, 40% are determined to have a significant abnormality, such as a polyp or cancer. These patients require a biopsy and surgical pathology evaluation. This cervical cancer screening program is triggering a significant increase in workload for those laboratories receiving these specimens. On the other hand, improved colon cancer screening is estimated to eventually save as many as 3,000 lives per year in the United Kingdom.

Today’s sessions at FiLM drilled down on ways that clinical laboratories and anatomic pathologists can deliver added value to patients and physicians. They also went one step further, introducing ways that medical laboratories could provide payers—including government health plans and private health insurers—with objective documentation of how medical laboratory tests can improve patient outcomes while reducing the overall cost per healthcare encounter.

Frontiers in Laboratory Medicine attracted pathology and clinical pathology leaders from eight different countries this year. It is co-produced by the Association for Clinical Biochemistry (ACB) and The Dark Report.

Related Information:

Equity and Excellence: Liberating the NHS

Frontiers in Laboratory Medicine (FiLM): Speakers, Sessions, Agenda

United Kingdom’s Government Should Delay Some Public Spending Cuts – NIESR

What is THE DARK REPORT laboratory intelligence?