NHS must move beyond 19th century cancer diagnostics to save 11,000 more lives

Radical recommendations were set out by England’s Independent Cancer Taskforce in July. The goal: to allow an additional 30,000 patients every year to survive cancer for 10 years or more by 2020.

11,000 of these patients could survive cancer and live longer as a result of earlier diagnoses, sparking a new national ambition.

Backed by NHS England chief Simon Stevens, the taskforce’s plans call for significant increased diagnostic capacity in the NHS so that 95% of patients can receive their results within four weeks and so that GPs can gain direct access to key investigative tests.

But numbers alone will not be enough to deliver the increased diagnostic capability needed to make these ambitions reality.

When it comes to pathology, a key cancer diagnostic function, many of the processes and practices in the NHS remain largely unchanged since the birth of modern pathology in the 19th century. The discipline has also been facing diminishing capacity and now faces a serious challenge in attracting younger people, many of whom don’t relish the idea of decades stood at a microscope.

The chance to save so many lives is without a doubt too good to miss. So what can be done to make sure the NHS is able to deliver diagnostics needed to make the new national ambition a reality?

Modernising pathology requires urgent action to save lives

Significant and immediate action must be taken to modernise pathology and provide pathology departments with technology that a rapidly growing number of pathologists are calling for, so that they can more effectively share expertise and findings with clinical colleagues, and carry out their reporting much more quickly.

Digitisation of the discipline is essential to achieving this, a move which is already having a significant impact on improved diagnoses and timely cancer care in other parts of the world.

Frequently lost slides, difficulties in collaborating across disciplines and subsequent delayed diagnoses cannot remain as common facets of today’s pathology set up if the NHS is to deliver timely and successful cancer treatment.

Put simply, the microscope can no longer be relied on if the NHS is to keep more people from dying from cancer.

Change has begun in the NHS already

The good news is that pioneering parts of the NHS are already doing something about this. Salford Royal NHS Foundation Trust has become a pioneer in the North of England by piloting a digital pathology system that has shown immediate benefits for speedy and connected pathology reporting.

Despite early hesitations, pathologists using the technology have insisted they don’t want to go back to microscopes, now being able to compare multiple slides at once on the same screen, with extremely high standards of image quality. They are able to report much more quickly and effectively, no longer having to keep manually changing slides. And crucially, reception in multidisciplinary team (MDT) meetings has been very strong, as images and specific areas of samples are quickly shown on screen, eliminating time consuming processes of preparing and loading slides to share with clinical colleagues.

The digital pilot at Salford Royal has shown ergonomic benefits, and the technology used at the trust can enable fast access to second opinions from colleagues either within the hospital, or through remote access, from pathologists from anywhere across a region or even from across the country, making confirmation of new or difficult cancer diagnoses a great deal easier.

The results have seen major interest from pathologists and clinical staff both within the trust and at other hospitals throughout the region and beyond. A regional conference held at Salford Royal this year showed a huge appetite for digitisation from pathologists who turned a Q&A session into a passionate open discussion on regional collaboration, the potential for super labs, and ways to make digitisation reality.

So how can we get there?

As a former NHS radiographer, I have seen the clinical benefits of digitisation first-hand. Radiology embarked on the digital journey 15 years ago to eliminate x-rays being lost in the backs of cars and from the draws of office desks, which at the time led to approximately 10–15 per cent of all imaging being mislaid, with a detrimental impact on timely care. The results of radiology digitisation have been transformative beyond this, allowing imaging to be rapidly shared and analysed. As a closely related fellow diagnostic function, there are undoubtedly many lessons that can be shared with pathology as it embraces digital ways of working. In many instances, pathology may even find that it can utilise radiology technology already deployed in hospitals on which it can base its own applications.

Pathology, however, does not have the same luxury of central funding that radiology enjoyed in its digital shift and hospitals must now find their own way to fund digitisation as a matter of urgency. No one should pretend this is easy at a time when NHS purse strings are held more tightly than ever, but there are options.

Large trusts with control over their own budgets can procure pathology solutions that they can sell to other hospitals. Doing so can allow them to generate revenue and a fast return on investment.

Smaller trusts do have more options than to simply buy from the foundation trusts. Hospitals can come together collaboratively to buy a shared system. The challenge is to put the framework in place and overcome competing demands from different trusts.

This challenge does however not come from pathologists—many of whom want this to happen now. There is a real hunger to shift to digital. This has been seen in the North of England where clinicians and radiologists are eagerly viewing what Salford is already doing.

The challenge is at the organisational level, not the clinical level. But with an opportunity for the NHS to match those countries that have the highest survival rates, organisational differences cannot be used as an excuse. It should now be a priority for NHS hospitals to move away from analogue approaches to pathology, so that growing demand can be matched, access to specialist expertise increased and the speed and accuracy of reporting improved so that, ultimately, timely intervention can save more lives.