DoH Pathology

Lord Carter of Coles’s review of NHS pathology services in England.

Our work on this assignment highlights our approach to planning and detailed business analysis in a sector involving multiple stakeholders. The success of the work hinged as much upon effective communication as it did upon robust analysis.

Collinson Grant was commissioned to support Lord Carter of Coles’s review of NHS pathology services in England. The overarching objectives were to increase capacity and capability and to reduce unit costs. It was vital to challenge current thinking and to debate new ideas thoroughly. But it was also important to engage properly with the professional staff of the NHS.


The NHS Pathology Service employs over 25,000 clinicians, scientists and technologists, interpreting over 700 million pathology tests in over 160 different organisations at 400 locations. There was a wide discrepancy in the efficiency, effectiveness and costs of services. But this was hard to quantify. Our task was to plan and run a major programme to collect, test and analyse information from 12 pilot sites; to liaise with The Royal College of Pathologists and other industry bodies; and to understand and challenge national data and consider evidence from international comparators in the private sector. We then had to construct a robust cost model that would stand rigorous examination from pathologists and leaders in the field. The review was designed to generate and test new ideas, which would lead to the improvement of healthcare services.


Pathology services are central to the effective provision of healthcare. Yet they are fragmented and their complexity is not generally well understood. An underlying theme of the work was to ensure that interactions with the rest of the NHS were properly analysed, the drivers of costs clearly recognised, and the activities of the workforce allocated accurately.

The pilot sites included five teaching hospitals, managed and networked pathology services, and five district general hospitals serving diverse communities. Our work depended on close cooperation and sustained support from their staffs. So we developed an iterative process that allowed us to test assumptions at every stage, reinforcing feedback and providing adequate time for clarification. We reviewed the data at the outset, and designed and tested three separate questionnaires. These were issued, with a set of working definitions and comprehensive guidelines. We ran a pilot to ensure that the process for collecting data worked. We then launched the programme. It involved collecting information about 4,000 NHS employees and 39 million tests.

We set up a secure web space (using Documentum eRoom) to encourage collaboration and communication. It acted as a forum for the exchange of ideas. When initial results were available, we revisited the pilots, discussed the findings and cleansed obvious discrepancies in the data. We allowed additional information to be submitted and sought any clarification needed. The information collected was used to build a cost model, which accurately reflected the direct and indirect (overhead) costs associated with each test or representative ‘basket’ of tests. It included the number of employees (full-time equivalents) by department and job.

Dissemination of the results

When the results were available, they were first presented to representatives of the pilot sites, who signed off the findings. We then supported Lord Carter’s review team in publishing and promoting the results. We prepared and gave presentations at relevant industry conferences, contributed to speeches, and compiled a report of our results. There was a ‘knock-on’ effect locally and regionally as new ways of providing pathology services were considered.


At his speech to the Congress of the Institute of Biomedical Science, Lord Carter said:

‘We now have a strong evidence base for pathology – better than has existed before. It has enabled us to move on to the modelling of future options.’

He directly complimented our work at other conferences. Since this assignment, Collinson Grant has completed many other analytical projects in the health service, including a Review of the National Pathology Benchmarking Service, and support to the Expert Working Group considering the introduction of a tariff for Primary Care Pathology in England.

Our Clients