The Carter Report
 

There have been successive reviews of the Pathology Service in England, most notably the Carter Review of Pathology Services in 2008.  The Carter Report made 20 discrete recommendations covering the following eight broad topics:

• Quality
• Communication
• User responsiveness and information transparency
• Consolidation
• Workforce reform
• Tariffs / benchmarking
• Commissioning guidance
• Innovation

Carter noted that the principle mechanism for performance improvement lies in the consolidation of acute trust pathology services into Managed Pathology Networks.

All of the hospitals within a Network would have a rapid response laboratory on site to perform the limited range of pathology tests that are required in under four hours. The bulk of the testing for all of the hospitals and associated GP practices (some 80% by volume) that requires a response in a timeframe of over four hours and under 24 hours would be performed at a single high throughput laboratory.

Following QIPP* principles, the rationalisation of pathology services into Networks offers maximum flexibility, operational and financial efficiency through significant economies of scale, and improvements in quality.

The recommendations of the Carter Report are in alignment with the recent review of the NHS by Lord Darzi, ‘High quality care for all’, which emphasised the importance of the principle of ‘localise where possible, centralise where necessary’. The principle of expanded healthcare delivery in the community, and of greater centralisations of complex services, infers that the standard ‘District General Hospital’ style of hospital Trust, delivering a full range of services, will be increasingly unsustainable. There will be an increasing demand for blood tests to be carried out in primary care or even at patients’ homes, avoiding needless travel to and from hospital and with results made available more quickly.  Specialist pathology will be required in centres of excellence.

The Carter review also recommended that, with the support of the Department of Health, each Strategic Health Authority should require the Primary Care Trusts in its area to take the lead with providers (existing and potential) in drawing up cost effective plans for implementation of the report's proposals.

*‘QIPP’ is the acronym used by the NHS to describe the approach to successfully deliver national and local service and quality objectives within the anticipated constraints in future funding. Made up of four interlinked elements: Quality, Innovation, Productivity and Prevention, together they will enable the NHS to deliver on its vision for change and improvement whist maintaining the quality and range of services people want and need.