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Underfunding of UK labs threatens cancer treatment, top doctor warns

Years of underfunding of UK laboratory services is threatening to delay cancer diagnoses and treatment as the NHS struggles to clear a massive backlog of cases, a leading doctor has warned.

In an interview with the Financial Times, Professor Michael Osborn, president of the Royal College of Pathologists, also highlighted “a workforce crisis”, with a quarter of histopathologists, who diagnose disease, aged at least 55 and an urgent need for more trainees.

A failure to invest sufficiently in digital technology, which can allow tissue samples to be read remotely, had left the NHS poorly resourced to deal with a huge increase in workload as the health service struggled to deliver treatment delayed by Covid-19, he suggested.

“Without additional investment in pathology you will not be able to get rid of the backlog, however much money you put into other areas of healthcare,” Osborn said. “Poor pathology provision has the capacity to stymie absolutely everything the government wants to do in healthcare.”

In September the government gave the NHS an extra £5.4bn for the second half of this financial year to defray the costs of Covid, including £500m of additional capital. Separately, under a new health and social care levy, a further £15.8bn has been earmarked to pay for running costs and reduce waiting lists over the next three years.

However, Osborn said the debate over the treatment backlog, and the allocation of this funding, tended to focus on a lack of frontline staff such as nurses and surgeons or a shortage of beds.

“The laboratory and diagnostic services are often very much forgotten. So you are in danger, if this is not addressed by policymakers and those who hold the purse strings, of only investing into the upfront, easily visible things — surgery, endoscopy, nurses, all vitally important of course — but forgetting then to support them with the pathology,” he added.

All areas of pathology, which covers 17 different specialities, were affected. “Every aspect of it is stressed, and every aspect of it is involved in overcoming the backlog,” as well as dealing with new cases, Osborn said.

The most worrying pinch point was in cellular pathology, the branch of the discipline which diagnoses cancers and provides the information on which to decide the best treatment course. Cellular pathology is also used to assess the genetic make-up of a tumour to allow clinicians to prescribe drugs tailored to each patient.

Even before the pandemic, Osborn said, insufficient staffing and outdated IT systems were causing “significant issues”, affecting the speed and efficiency with which specimens were booked in and tracked. “A result is pretty pointless if it doesn’t end up in the patient’s notes.” 

However, until Covid struck most laboratories had been “just about hitting targets for turnround times”. These were now deteriorating, he warned. Pathology departments were used to working with limited resources but were now “having to prioritise the urgent cases in preference to the less urgent cases”.

There was a real danger that cancers would be picked up only when they had reached a more advanced stage when treatment “is more significant, harder and more expensive and survival is less likely”, he said.

The Department of Health and Social Care said: “Cancer diagnosis and treatment remains a top priority, and most cancer services are operating at or above pre-pandemic levels.”

The government had provided “record investment to tackle the backlog”, it added, and was also deploying “more efficient ways to deliver additional appointments and treatments”, including 40 new community diagnostic centres.

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