Focus Conference in Glasgow puts spotlight on how medical laboratories must deliver more testing with less reimbursement
Clinical pathology laboratory services might be considered “under siege” in the United Kingdom. That’s because clinical laboratories are facing significant reductions to their annual budgets, even as health trusts throughout the country push for regional integration and further consolidation of laboratory testing services.
This week in Glasgow, Scotland, the Association for Clinical Biochemistry is conducting Focus, its annual meeting. This large gathering for the laboratory medicine profession in the United Kingdom offers attendees a wide spectrum of topics and speakers relating to laboratory testing. Your Dark Daily Editor is here to chair a session, learn from the many interesting presentations, and visit some hospital laboratories in Glasgow.
In response to intensifying pressures to squeeze costs from laboratory testing, Focus organized two extended sessions. Each session deals with the management and operation of clinical pathology laboratories in the United Kingdom.
The first extended session took place on Tuesday, May 11. It delivered a national perspective on how medical laboratories in the United Kingdom are changing to meet specific objectives of the parent health system. Most Americans know that the U.K. has a universal health system, run by the National Health Service (NSH). Within the U.K., each of the four countries—England, Northern Ireland, Scotland, and Wales—administers healthcare within its country.
During the extended session on Tuesday, a laboratory professional from each country discussed specific developments affecting the management, organization, and delivery of clinical pathology laboratories within that country.
- Scotland (population of 5.1 million): First came a briefing on the state of health in Scotland as measured by life expectancy. Included were comments about such major issues in that country as binge drinking and increased use of illegal drugs. For example, 30% of Scottish males from the age of 16 through 64 regularly drink in excess of recommended levels. Health problems associated with such a high intake of alcohol are visible across the health system. Integration of laboratory testing services has been ongoing in recent years. There is also a program to standardize test methodologies and lab test reporting in the country. One method to achieve this is to contract with a small number of in vitro diagnostics (IVD) suppliers. One consequence is that each pathology network might eventually end up with just one or two primary IVD vendors as the source of laboratory equipment, test kits, reagents, and other consumables.
- Northern Ireland (population of 1.8 million): Currently the emphasis is on integrating existing laboratories to create five managed pathology networks which will serve the five newly-defined health trusts in the country. This will necessitate some consolidation of laboratory testing and more regional integration of pathology laboratories performing lab tests within each community or region.
- Wales (population of 3 million): To revamp clinical pathology testing services within this country, a series of study groups were undertaken, starting in 2005. Among other things, the resulting recommendations stressed the value of more lab automation, expanded use of Lean and Six Sigma methods, and appropriate development of point-of-care testing. Accreditation of laboratories within the country is another goal.
- England (population of 51.4 million): Because it serves the biggest population among the constituent U.K. countries, England has the largest number of pathology testing laboratories. During the past 10 years, more than £100 million has been invested in pathology modernization, but true progress as measured in budget impact across the pathology cost center has been limited. There were approximately 380 laboratories in England a decade ago, and about 280 laboratories are operational today. This illustrates some of the progress that has been made in rationalizing lab testing services. The Carter Review, with its evidence-based assessment, calls for clinical pathology labs in England to achieve measurable improvement in service—achieved by a combination of laboratory consolidation, innovation that includes new diagnostic tests which add value, and more engagement in clinical programs.
It is important to recognize that Northern Ireland, Scotland, and Wales are quite compact health systems, both in geography and number of people served. This made it easier to implement useful changes in the structure and operations of clinical laboratories within their respective countries. England, with 51 million people, has a much bigger challenge when it tackles the restructuring of pathology testing laboratories.
There was at least one unmistakable message that emerged from the presentations by the speakers from Northern Ireland, Scotland, Wales, and England during this extended session. Pathology laboratories will need to perform higher volumes of laboratory tests even as operating budgets are squeezed down because of reduced budgets for laboratory testing.
From Glasgow, your Dark Daily Editor,
Robert L. Michel
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