Neil Anderson, Clinical Director of Coventry and Warwickshire Pathology Services, highlighted how UK laboratory medicine is at a pivotal point. He is concerned that the ageing workforce profile could present a problem in the future. ‘Pathology,’ he explained, ‘has an age profile that is tending to show the greatest number of staff in the 40-60-year-old category with not enough staff coming in at the 20-30-year-old category.’
While work has been conducted around workforce patterns, he suggested predictions were often flawed in the way they looked at simply replacing numbers, rather than analysing what type of workforce will be needed in the future. It is about putting the right people with relevant skills in the posts available and in the right numbers, Anderson said. His concerns centre on a potential de-skilling of the pathology workforce with recruitment of more medical laboratory assistants in lower grade pay bands at the expense or experienced staff. ‘That is not just due to budget pressures and cost improvement targets, but also to the fact that to run complex machinery actually requires a range of staff who have different roles.
‘Loading and unloading machines are perhaps jobs more suited to lower staff grade and that could be perceived as a down-skilling, when we desperately need to up-skill staff, especially around the clinical interface, assays selection, interpretation and user engagement. We haven’t created the roles we need to respond to future challenges.’
Anderson believes a critical step in meeting those challenges lies with pathology becoming an ‘integrated medical service’ rather than being regarded as a support service, and establishing links with community and acute pathology sectors as it strives to provide ‘more appropriate test selection and usage’.
‘In addition, pathology in the United Kingdom needs to become a more coherent business function, needing to understand its costs and have a pricing strategy, articulate visions and, if required, work with the private sector.’ He also feels public sector pathology needs to be good in areas in which the private sector excels, e.g. managing transition and change, and negotiating discounts with diagnostic suppliers.
One significant development is the 100,000 Genomes Project, which will sequence 100,000 whole genomes from NHS patients by 2017, set up a genomic medicine service for the NHS, enable new scientific discovery and medical insights and kick start the development of a UK genomics industry. ‘The staff needed to support that are very different to those currently in place within most pathology laboratories,’ he pointed out.
‘It’s not just about working towards the 100,000 Genome Project, it’s what’s done with those data that emerge from the 100,000 genome project, identification of new companion diagnostic tests, whether in cancer services or endocrinology and about developing those assays and turning those data into information. The amount of data is rising exponentially and we’re going to work to assimilate that to create information of value to patient care.’
Coventry and Warwick, one of the largest pathology organisations within the UK, is leading the way as it invests in the adoption of digital histopathology and molecular diagnostics to support cellular technology and virology, and is part of an international trial looking at the verification of using digital histopathology in a routine setting.
‘We are aware of the implications of the 100,000 genome project, the implications around rapid diagnostics through point of care testing and its applicability and we are engaged in transforming the way we deliver pathology,’ he said. ‘However, with increased demands on future staffing, we may have to look at alternative models, so that we can adopt new technologies more rapidly.’
Anderson also stressed that, to create a laboratory medicine workforce fit for the future, pathology needs to develop new service models, integrate into clinical teams, embrace specialist working and ultimately ensure the appropriate use of pathology.
Neil Anderson is Clinical Director of Coventry and Warwickshire Pathology Services and a consultant clinical biochemist. He addressed the Frontiers in Laboratory Medicine conference earlier this year in the ‘Developing a laboratory medicine workforce fit for the future’ session, when he examined how, given new and emerging technologies, modernising science careers and an ageing workforce, the evolving laboratory workforce can be fit for purpose today and in future.