A sector in transition
In the UK, pathology is a large, typically in-house service, which for reasons of cost increases, capital availability and perceived inefficiency is now being viewed by the NHS as suitable for outsourcing. The total value is estimated to be £2.5bn to £3bn, a figure comparable with other European countries, as a percentage of healthcare expenditure.
The pathology workforce is not being renewed and there are staff shortages for skilled grades, making the increased use of automated testing a priority. However, there has been a lack of investment in process and equipment for several years, leaving many trusts without enough staff and with not enough money to automate. Costs have also increased by about 13% over five years.
Plans to introduce managed pathology networks have in general not been successful, despite the massive scale benefits associated with forming service hubs.
All NHS Acute hospitals in the UK have their own pathology laboratories. Some trusts use Managed Equipment Services (MES) to attract investment in equipment. Primary Care Trusts usually source pathology services from their local acute Trust, which constitutes about 40% of all testing. Outside of the NHS, most private hospitals have limited pathology services since they focus on elective procedures, but again each of the five large private hospital groups has a dedicated pathology infrastructure.
Against this background the option of outsourcing pathology services presents opportunities for the NHS and independent hospitals in the UK.