Letter: Pathology is part of patient care

Sir: In her perceptive article 'Pressure that causes clinical errors' (15 June), Judy Jones rightly draws attention to wider issues affecting NHS pathology beyond the unfortunate misdiagnosis currently under discussion.

As she points out, millions (in fact, hundreds of millions) of pathology tests are performed each year, the vast majority to a very high standard. It is a tribute to the efforts of all NHS laboratory staff that the quality of pathology in our hospitals is taken for granted. All the mechanisms put in place to maintain this quality (regular external quality assessment, regional and national clinical audit meetings) have evolved from initiatives taken by staff in NHS hospitals and associated medical schools. A more nebulous but equally important contribution to the development of a 'quality ethos' has come from the free exchange of information and ideas between colleagues sharing a common goal.

Unfortunately, pathology is perceived by managers to be an area where savings can be made. This was highlighted in the recent Audit Commission report (Critical Path: an Analysis of Pathology Services), in which they state 'general managers often have only a hazy knowledge of pathology, but see steadily rising costs against a background of constrained NHS budgets. They have responded by tightly controlling inputs, while laboratory staff, for their part, face steadily increasing demand.'

Privatisation is an alternative approach being considered by some managers. However, co-operation between colleagues is likely to be one of the first casualties of a system in which the requirements of the marketplace are paramount. Pathology is a clinical discipline, and cannot be separated from the whole process of patient care. Competition between laboratories is no more appropriate than competition between surgeons. The inevitable consequence of equating laboratory results with fish fingers or clean sheets will be a rapid decline in the high standards of NHS pathology to which we as members of the North West Thames Region Quality Assurance and Audit Working party in Clinical Biochemistry are proud to have contributed.

Yours faithfully,

DANIELLE FREEDMAN (Luton & Dunstable Hospital NHS Trust), BRUCE MULLER (Charing Cross Hospital), CHARLES ANDREW (Edgware General Hospital, Wellhouse NHS Trust), GWEN AYRES (St Albans City Hospital), GRAHAM CARTER (Charing Cross Hospital), PETER HAISMAN (Central Middlesex Hospital NHS Trust), CAROL HUGHES (St Mary's Hospital), PRABHU RANIGA (North Hertfordshire NHS Trust), DAVID REAVELEY (Charing Cross Hospital), BILL RICHMOND (St Mary's Hospital), DAVID WOOD (Ealing Hospital NHS Trust), JOANNA SHELDON (Chelsea & Westminster Hospital), JOHN STEVENS (Chelsea & Westminster Hospital)

Luton

16 June