National Pathology Programme

This is an exciting programme looking at the way that new technologies can be used to change the way that cellular pathology services are delivered.

Technological advances have made it possible to efficiently digitalise (scan) glass microscope slide preparations to a high level of quality, so that cellular pathology slides can be viewed and reported using digital images.

A digital service would eliminate many of the physical and time consuming steps involved in transporting microscope slides to consultant cellular pathologists and multi-disciplinary team review. 

In addition, case review and external expert opinion could be undertaken electronically in real-time, which would provide additional diagnostic expertise and precision, supporting the potential for greater sub-specialisation and shared working across NHS Wales.

The Programme has been split into the following 3 phases:

• Phase 1 - A rapid evaluation and national verification of the quality of digital pathology. Results of the verification showed above 95% concordance between reporting from glass slides and reporting from digital images.

• Phase 2 - Procuring and implementing limited digital scanning capability in each health board in Wales; configuring scanners in a hub and spoke formation to enable national image sharing, as a proof of concept, to support remote reporting and shared specialisms.

• Phase 3 - The intention is for this phase of work to be the national scale-up of end-to-end digital enablement.

The Pathology Workforce and Education Group was established recognising the importance of investment in training and education in pathology services, including provision for new trainees, post qualification, registration and continued professional development. 

The group take opportunities to innovate, evaluate roles, skills, responsibilities and learning from current exemplars, in order to develop the scope of practice of healthcare scientists across all specialities within pathology.

The scope of the group is determined by the National Pathology Network and focuses on the following workforce actions outlined in the Pathology Statement of Intent:

• NHS Wales will support the adoption of prudent, cross discipline and flexible skill-mix approaches to future workforce models, overcoming professional/speciality boundaries by strengthening skills and expertise, increasing attraction and retention of professions within pathology.

• Health Education and Improvement Wales (HEIW) will support the development of targeted strategies, in conjunction with the ‘HealthCare Science – Looking Forward' framework, to facilitate the development of a modern workforce for pathology services in Wales.

• HEIW and NHS Wales will support the development of information to provide clarity regarding services and workforce to assist with robust future workforce planning and analysis and outline plans to build and consolidate the clinical and scientific base in NHS pathology services.

The main objectives of the National Pathology Operational Managers Group are to:

• consider how best, in the context of limited funding, pathology in NHS Wales can help achieve its vision for:

  • better health for everyone

  • better access and experience for the patient

  • improved health outcomes by better service safety and quality

• support health boards and trusts in the planning and delivery of efficient  and effective pathology services that fit with the priority areas outlined in the Pathology Statement of Intent;

• provide an environment which supports clinicians and managers in collaborating together to deliver the Pathology Statement of Intent ;

• maintain a general overview of pathology services across Wales; and

• champion and promote the role and value of pathology services.

Pathology services in Wales continue to focus on improving quality and safety, and to develop a health and care system that is always learning. 

Staff and patient safety will be prioritised through the reduction of risk and incidents by using appropriate procedures, the latest technologies (e.g. automation, robotics) and by undertaking monitoring, investigating, audit and shared learning.  

Robust clinical governance systems and compliance with evidence-based clinical quality standards and requirements will ensure that accurate, precise, reliable, clinically appropriate and timely reports are essential for a safe, effective pathology service.

The All Wales Pathology Quality and Regulatory Compliance Group is building on the foundations and mechanisms that are currently in place to ensure: 

• a fully accredited pathology service for NHS Wales, which meets quality and regulatory requirements;

• patient safety and delivery of timely, accurate and informative results that reduce the risk of harm and contribute to direct patient care;

• evidence-based, standardised practices and approaches throughout NHS Wales;

• any unwarranted variation is evidenced and acted on

• feedback mechanisms on services (patients and referrer facing) are developed further; and

• any errors, specimen losses, waste and incidents are minimized. 

The programme aims to make information available and actively support the current ‘learning culture’ within the pathology community.  It will support the use of an electronic quality management system (eQMS), which will be maintained at a national level to work towards standard practices.

Recognising that emerging trends and technologies provide exciting opportunities for the pathology community to rethink approaches to the development and delivery of services in the future, the National Point of Care Testing Strategy Group is working to identify and establish a formal structured arrangement to deliver Point of Care Testing services in NHS Wales.

Point of Care Testing (POCT) relates to any medical diagnostic testing at the time and place of patient care.  

It is an area of healthcare that is developing rapidly, with increased and improved connectivity and technological innovation. These advancements make ‘near patient’ results possible, with the potential to improve assessment and care management for the patient. 

Having diagnosis closer to the patient can help manage life-threatening conditions, such as sepsis and infection control.  It also helps patients to self-monitor chronic conditions, such as diabetes, without having to visit hospitals and GP surgeries.

Working with health board point of care testing services, the POCT Strategy Group will also oversee other areas of work, such as:

• improvements in the infrastructure to support national POCT systems;

• the development of POCT training and competencies for both laboratory and non-laboratory based staff; and 

• promoting and championing the role and value of POCT, which will improve the consistency of the service throughout Wales, and help share best practice and the benefits of research.