The mercy of quality?

Rather than accepting Lord Carter of Coles as an authority on pathology, we should recognise him as a Blair crony and one whose boardroom interests will probably not see him become financially worse off with the privatisation of the NHS.  Written in the days of fraudulent prosperity, his report setting pathology labs up for privatisation is nevertheless still being implemented.  Along with other professional organisations (some of which owned CPA before they sold it to UKAS) The Royal College of Pathologists has accepted, not demanded evidence for, the recommendations of the Carter Report.  In particular, for objective standards by which pathology services can be subjected to accreditation – lust for the credibility of false measures.  Read about their thinking here:


The mercy of quality

Key performance indicators are here to stay and rapidly becoming universal and obligatory benchmarks for all pathology service providers and to help commissioners.

Dr Rachael Liebmann
Question: ‘What is best practice?’ Answer: ‘It’s what I do of course!’ Some time ago, I reported in this Bulletin the reason the Key Performance Indicators, developed by the College in 2011, were needed and were needed now – in the midst of a financial challenge. In Lord Carter of Coles’ report, the first two recommendations were:

  1. Objective and measurable quality standards should be developed for pathology services, from sample request to delivery of interpreted result.
  2. The accreditation process should be reviewed so that it inspects against the quality standards (once developed) referred to in Recommendation 1.While the report was written at the request, and for the benefit, of the last Government, the College has responded to the challenge of Recommendation 1 and – in partnership with Association for Clinical Biochemistry (ACB), The United Kingdom Accreditation Service (UKAS) and The Institute of Biomedical Science (IBMS) – is addressing the challenge of Recommendation 2.

The importance of the ‘end to end’ pathology service is crucial to maintaining and demonstrating the relevance of our clinical services. This is why the Key Performance Indicators steadfastly address the whole sample pathway and interpretation. The same ‘end to end’ focus that was seen in the College indicators was also seen in the ACB’s quality indica- tors, developed separately and at the same time. These ACB indicators have been added to those from the College and a consultation process was led by Professor Peter Furness. As well as email discussions, there was an internet-based consultation during which pathologists, service users, patients, managers and commissioners were invited to comment. A total of 275 responses were received, with a large majority of contributions coming from pathologists. In 2012 a steering group was set up, under the chairmanship of Dr Archie Prentice, to move forward the enhancement of the accreditation process to take into account the performance indicators. A multi- specialty working group has recently met to plan the implementation process and this will report back to the steering group later this year. Fellows will be kept informed of the outcome of this work, which will be widely published through Clinical Pathology Accreditation and College publications. Pathologists who were initially concerned about their services being judged on areas of this pathway that were not under the control of the pathology laboratory have gradually been won over. However, a new set of requests for clarification have started to come through to the College:

  • ‘Aren’t these indicators just for the big teaching hospitals?’
  • ‘I’m being told it doesn’t count for the private work. That can’t be right ……can it?’
  • ‘Does this apply to our Department?’
  • ‘We’re different because…….’The College, ACB, UKAS and IBMS are clear in their approach to all standards and guidelines and there are no ‘no-go areas’ for quality. All pathology providers, regardless of size and status, are expect- ed to be measuring the quality of the services they provide for patients. If your service is providing pa- thology clinical and diagnostic services on which clinical decision-making may depend, then your service should be registered for Clinical Pathology Accreditation and will come into the realm of Key Performance Indicators.Some of the indicators may prove difficult for all services, while other KPIs may be easily achieved. There may be local issues that need to be taken into account in the reporting of performance indicators. Nevertheless, these represent specific provider problems and are of limited or no interest to clinical users of the service or commissioners. Patients – the ultimate users of our services – have even less interest and have the right to expect a basic standard of care, no matter where they are being screened, investigated or treated.Just as Shakespeare rightly pointed out: “The quality of mercy is not strain’d, It droppeth as the gentle rain from heaven Upon the place beneath: it is twice blest; It blesseth him that gives and him that takes…”. As a direct consequence of measuring end-to-end performance and striving to improve the clinical utility of our pathology services, we become more aware of our own importance and relevance to our patients. We have always known that we have a vital role to play, but struggled to demonstrate this, due to the cross-cutting nature of our services and the lack of patient-outcome measures for pathology. Within each service we have always believed that we provide the best and highest standard possible in our local circumstances. That is, we have believed that we achieve the best outputs, given the limitations of the inputs we receive. Now it is time for the provider organisations that employ us to demonstrate pathology quality standards with a degree of granularity, which commissioners can use to help determine where best to site services in the future. The additional information will allow comparison of services and patients and clinical staff to reassure themselves that we are right in our strongly held beliefs about the quality of our services. Then the plaudits for our hard work will surely “droppeth as the gentle rain”….


For details of this work, which is ongoing, please contact Dr Rachael Liebmann at registrar@ Dr Rachael Liebmann, Registrar. 

The Bulletin of The Royal College of Pathologists October 2012 Number 160; 242.

The labs that remain will become busier yet more moribund.  But the indicators will show otherwise.  Do systems thinkers believe this is going to work well?  Who is going to warn these organisations?  Here comes the real pathology…

foot washing

Accreditation will prevent this happening in the NHS

This entry was posted in Bureaucracy, Laboratory medicine, Management, Medicine, NHS, Politics and tagged , , , , , , , . Bookmark the permalink.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s