The meeting was chaired by Iain Banks, Laboratory Manager in the Department of Histopathology and Molecular Pathology at Leeds Teaching Hospitals who agreed that feedback from delegates had been "very positive and enthusiastic". "The meeting covered a range of management topics which are current in Pathology, addressing issues relating directly to Agenda for Change and the creation of Managed Pathology Networks", he said. "Several of the presentations were particularly topical in terms of overcoming 'tribalism' within the profession, while others focused on new quality management standards and developments in Molecular Pathology." A summary of all the presentations appears below.
The keynote speaker was Professor Sir John Lilleyman (former President of the Royal College of Pathologists) who predicted that radical changes in Pathology will inevitably take place, but that they are likely to be evolutionary rather than revolutionary. Sir John said that there will have to be some reconfiguration of the laboratory service in terms of its organisation and skillmix. No single organisation structure will suit all parts of the NHS, but it will undoubtedly become much more difficult to maintain standalone laboratory organisations over the next decade.
Sir John stressed the impact on Pathology services of the imminent European Working Time Directive which will make it illegal for anybody in paid employment to work more than 48 hours a week, stating that formal shift working is likely to become the norm once this Directive comes into effect. Legislation such as this will place a great deal of pressure on the Health Service as a whole, while Pathology continues to struggle with the difficulties of poor capital investment, a major recruitment and retention problem plus a change in public attitudes to the NHS in general. Trying to persuade the public that zero error rates are not achievable is a huge challenge. Although medical influence has driven change so far, Sir John suggested that it is likely to be senior scientists who will dictate how best to organise things for the future.
Gearing up for change
Sir John's presentation was followed by a progress report on the newly-formed Federation of Healthcare Scientists (FHCS) by Dr Peter Griffiths of Lincoln County Hospital. Delegates learned that agreement has been reached on the structure and role of the FHCS, whose primary aim is to provide advice to the Department of Health, Ministers and national bodies on workforce issues, whilst also contributing to the formulation of policy related to Healthcare Scientists. It also aims to provide an effective forum for exchange of information and good practice amongst its constituent professions.
Activities of the Federation to date including the issuing of a Consultation Document, organisation of roadshows to raise awareness of Healthcare Science and meetings with Government officials. Its first National Meeting focused on key roles for Healthcare Scientists, arrangements for the Federation's professional sections and FHCS priorities. Dr Griffiths concluded that the FHCS has an essential role to play in meeting the objectives of 'Making the Change', although the multiplicity of professional groups within it makes this a formidable and difficult task.
Neil Willis (University of Wales) then outlined the role of the new Health Professions Council (HPC) which has been formed to replace the Council for Professions Supplementary to Medicine (CPSM). He explained that the HPC is going to be a smaller Council than the CPSM, but with greater patient and public representation. Its aims are to reform ways of working by treating the welfare of patients as paramount, collaborating and consulting with key stakeholders and being open and pro-active in accounting to the public and professions for its work. The HPC also aims to achieve reform by linking registration with evidence of CPD, protecting professional titles and enabling the extension of regulation to new groups. In its 'first transitional period' (April 2002 - 2003), the newly-formed HPC had to consult as widely as possible and formulate HPC rules whilst continuing carrying out the business of the CPSM. Having completed the consultation process, the HPC is now entering its 'second transitional period' in which it will operate under its own new rules and operational arrangements.
Sarah May, Executive Head of Strategy with the IBMS, outlined the proposed new qualification structure for Advanced Biomedical Scientist Practitioners, declaring the creation of consultant-equivalent roles to be a unique opportunity for those in the Pathology profession. She said that clear evidence of specialist professional skills and competencies will be essential in order for an individual to progress to these new roles. State registration is the obvious starting point, complemented by educational and professional qualifications plus proof of higher specialist skills. The IBMS has recently announced a new professional examination that will enable Biomedical Scientists to meet the requirements of Agenda for Change. Graduation and State Registration will be followed by gaining discipline-specific experience with the possibility of studying for a Masters degree, progressing through to the Higher Specialist Examination and, ultimately, Advanced Specialist Certificates.
Dr Fraser Lewis, Chief Biomedical Scientist in Molecular Pathology at Leeds Teaching Hospitals NHS Trust then outlined the effect of the Human Genome Project on delivery of diagnostic services. He explained that genome research has generated the ability to identify sequence changes and specific expression events with implications that are diagnostic, prognostic and predictive. Pharmaceutical companies will soon be introducing new drugs targeted to specific disease and individuals, while chromosomes are currently being mapped in order to indicate exactly where disease genes reside. In Histopathology, large data sets will in future be collected for every specimen, involving protein and mRNA expression studies using tissue and liquid-based assays. This will not only require high throughput tissue-based assays, but also highly specialised Bioinformatics. One way to increase throughput is the construction of tissue microarrays, which will need to be viewed using virtual microscopy. This technology has automated the scanning, positioning and archiving of images and provides a permanent record of stained cores.
Next, Jim Ramsay described the experience he has gained as Quality Manager in the Department of Histopathology at Ninewells Hospital, Dundee, highlighting the requirements and practical implications of the new CPA Standards. He explained that Ninewells appointed a Quality Manager within each Pathology discipline, but experience has shown that it may be better to have one overall Quality Manager with a Quality Team representative in each of the disciplines. It is necessary to 'sell' the Quality Management concept to laboratory staff, so that they can appreciate the value of activities such as minor error logging in a 'no-blame' culture.
Three grades of error/incident have been introduced at Ninewells, while databases have also been established of cases reviewed at CPC and those reported by consensus. Mr Ramsay said that quality has definitely improved, as it is now possible to highlight where problems are arising and try to resolve them. One of the problems with sub-specialised reporting, however, is that turn around times have increased due to more detailed reporting and the national shortage of Pathologists.
The second day of the meeting began with Lee Outhwaite, Management Accountant at Frimley Park Hospital NHS Trust, sharing some valuable insights into the role of financial appraisal in Pathology modernisation. He said that such appraisals can be an excellent vehicle for achieving modernisation goals, provided laboratory managers fully understand the 'rules of engagement' with their finance colleagues.
The feasibility of creating a stress-free workplace was explored by Tim Waterhouse, Head of Bayer Healthcare's Human Resources Department, who concluded that managers must take steps to know their people, recognise stress and address it in a reasonable way by implementing a stress management policy, he said. Establishing a framework for such a policy might encompass carrying out risk assessments, training people to recognise and deal with the causes of stress, providing procedures to deal with complaints and improving the quality of the work environment.
Norman Burrows (who recently retired from Bayer to become a consultant) highlighted the differences between mentoring and coaching, outlining the benefits of coaching as a motivational tool. He explained that mentoring is basically about teaching, but coaching is concerned with helping people address the gap between performance and potential. Coaching helps people increase their self-awareness, and is also concerned with self-development and the discovery of additional personal resources. The achievement of goals should be regarded as a by-product of coaching which ultimately is about helping people gain the confidence to deal with almost any future situation.
Kath Hinchliff, Director of Education Commissioning for the West Yorkshire Workforce Development Confederation, explained the role and function of Confederations such as hers in service modernisation. She told delegates that 28 Workforce Development Confederations have been set up under the Shifting the Balance of Power initiative. Membership of these organisations is open to anyone with a stake in the employment of health professionals in the NHS. The Confederations' job is to 'vision' the future workforce, i.e. determine what social healthcare is going to look like in years to come and what the impact of new technologies will be on the type of skills that will be needed. They must also find practical ways of meeting labour market challenges in terms of education, training and workforce development. Ms Hinchliff stressed that the Confederations exist to provide a service to their members, and anyone who is not happy with this service should be prepared to 'knock on the door' and discuss their specific needs.
Finally, Dr Dennis Wright, Clinical Director of Pathology at North West London Hospitals Trust, looked at progress towards the creation of Managed Pathology Networks, stating that IT is one of the bedrocks for their success. The vision for the future is that electronic patient records will work in conjunction with a PCT-based 'cradle to grave' electronic health record (EHR) for each patient, making the need for standardisation paramount.
Dr Wright said that there is a groundswell of support for change in NHS Pathology through a process of phased development, but that steps must be taken to support staff and reduce uncertainty. Support for change and leadership from professional and other bodies is also vital. The DoH is now focusing more closely on outcomes and less on structural/management issues, recognising the need to integrate more closely with key national strategies. If Pathology is to continue to receive DoH support, it is essential to demonstrate how central it is to the achievement of key NHS targets such as trolley waits and speed of cancer treatment. The Department has repeatedly emphasised the fact that 70% of diagnoses depend to some extent on Pathology; now the onus is on laboratories to prove it, documenting exactly where that contribution is made, and why.
The meeting concluded with a general forum in which questions raised by the audience were discussed by a panel of speakers. "It proved to be a very successful and through-provoking meeting", concluded Iain Banks.
A booklet containing abstracts from all the presentations and a CD containing copies of the speakers' slides are available on request from Sue Mead, Telephone: 01635 566243; Email: firstname.lastname@example.org or by clicking on the link below.