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Health: Genomic Medicine

Volume 715: debated on Monday 30 November 2009


Asked By

To ask Her Majesty’s Government, in the light of the two reports on NHS Pathology Services by Lord Carter of Coles and the report on Genomic Medicine by the Science and Technology Committee (2nd Report, Session 2008-09, HL Paper 107), what progress they have made on the consolidation of pathology services; and what savings they expect to achieve by April 2011.

My Lords, we have asked all 10 strategic health authorities to lead work regionally across the NHS to deliver pathology modernisation in the light of the report of my noble friend Lord Carter and to advise us on the transition costs and timescales involved. The report on genomic medicine contained a large number of recommendations. However, we expect to respond before the end of the year.

My Lords, I thank my noble friend for that Answer. Is she aware that it is now nearly four years since my noble friend Lord Carter of Coles was asked to investigate this area? Is she further aware that the noble Lord, Lord Darzi, promised me in a Written Answer in July that we would have a full report on implementation of this service area “later this year”?

My Lords, my noble friend will be aware that change on this scale does not happen across the whole country overnight. All 10 strategic health authorities are now working together to formulate local responses to the consolidation agenda as set out in the Carter report. However, they need time to identify what the transition will look like in terms of time and cost as they decide the future of pathology services in their local areas. My noble friend will be pleased to know that, following the work of my noble friend Lord Darzi, we have warned the NHS that an assumption about improved efficiency in pathology services is likely at some stage to be built into the tariff payments used to calculate all secondary care income.

My Lords, I am pleased to hear from the Minister that the Government will respond to the report on genomic medicine of the Science and Technology Committee, which I had the privilege to chair. Does she agree that, unless pathology services are properly organised for modern diagnostics and molecular and genetic tests, the postcode lottery that currently exists will continue, with more deaths occurring because of late diagnosis, inappropriate treatment and inappropriate monitoring?

The noble Lord is quite right: it is important that we pursue this reform agenda. We support the noble Lord’s report on centralising the genetic labs into the molecular pathology labs. He can anticipate that when we publish our response later this year we will make clear our continuing support for the bringing together of molecular pathology and genetic labs. We agree that this has great potential to benefit patients through better use of the laboratory workforce and more effective uptake.

My Lords, does the Minister agree that, no matter how well you bring the services together, pathology is still a science that depends very much on the individual pathologist diagnosing, as opposed to biochemical tests, all of which can now be done more or less automatically? What improvements will be made in ways of monitoring standards after this is done?

We anticipate not a reduction but a bringing together of laboratories and scientists to create a more effective and efficient service.

Could consolidation lead to job losses? Is there not a danger that we might be going down a privatisation route?

The reform recommended by the review was to match the skills of the workforce to the job done, to maximise the contribution of staff and not to save money. In fact, there are job shortages in this area. The reprofiling will bring with it better career opportunities for junior staff, with senior staff freed up to use their expertise to more effect. This is not about reducing numbers but about being more effective. Nor is it about privatisation. The private sector already provides limited pathology services, but the job of the commissioners of services is to find the best and most appropriate sources of services and the best expertise available to them.

How can IT connectivity be brought up to a standard sufficient to enable the reforms to take place when the rest of the NHS IT system has been such an expensive disaster?

I do not agree with the noble Baroness’s contention on the lack of effectiveness of the IT. We expect that built into the reform and the centralising of services will be the need for effective communication. IT services play a large part in getting results back to patients and their clinicians as quickly as possible.

Has any view been reached about the relative costs of proliferating high-tech services in each trust versus consolidation, as recommended in the Carter report and in the Select Committee’s report on genomic medicine?

We already know that consolidation and centralisation of pathology services in Kent and in the north-east have not only enhanced the services there but also saved millions of pounds.

My Lords, the report of the noble Lord, Lord Carter, recommended improved training of the pathology workforce. Can the Minister outline what improvements in pathology training for existing and new staff are either in train or have been implemented so far?

This is work in progress. I shall write to the noble Earl with the detail. However, training and recruitment of staff—as I said, we are short of technicians in this area—are important and integral parts of the implementation of the report.

My Lords, on two occasions we have heard in a reply—from the noble Lord, Lord Darzi, and from the Minister herself—that there will be a report by the end of the year. Could I ask which year? Do the Government have a precise timetable?