New laboratory plan aims to address national deficiencies

The HSE launched the Outline Strategic Plan for Laboratory Services 2026-2035 last month.

The document, which is the first national strategy for the area, is quite honest about the current state of services and lays down a path about where development is needed.

One of the main recommendations is that comprehensive laboratory networks should be developed within each HSE health region in the form of a hub-and-spoke model.

According to the document, some regions have already established networks using this model. These provide “a significant degree of consolidation of services that lend themselves to consolidation of those services at the hub”.

“[The] networks retain essential services as spokes on each hospital site other than the hub,” the strategic plan states.

“In other areas there is very limited integration of service. Less progress on integration may in some cases relate in part to challenges related to independent governance systems for the hospitals where the laboratories are based.”

The document notes there is significant variation between laboratories on progress in the development of near-patient testing (NPT) in both acute and community settings.

“There is also variation in the extent to which NPT services are integrated into the laboratory quality system,” it states.

“The variation within and across regions in relation to integration and NPT is a challenge, but there is also an opportunity for peer-to-peer learning from those services that have or are pioneering new approaches.”

Consultant pathologists and appropriately qualified scientists in each discipline should function within laboratory networks as part of sub-regional or regional teams providing support for the hub-and-spoke networks.

“This should provide more equitable access to expertise, [a] more resilient service to patients and more equitable and sustainable rotas for out-of-hours work,” according to the document.

The strategy admits the HSE has strong dependence on private laboratory providers for delivery of routine clinical testing, for response to surge, and for certain specialised testing.

The HSE laboratory service is also “critically dependent” on private services for sample transport between HSE and HSE-funded laboratories and private providers.

The document also notes: “HSE laboratories should continue to provide clinical and health protection laboratory services to private providers on request, subject to a service level agreement, if the HSE laboratory provides specific services that are not otherwise readily accessible and if this does not compromise services to HSE.”

“The private provider should cover the full cost of the service, with fees generated used to support the laboratory providing the service.”

The document states the go-live of the first laboratory with the new national laboratory information system, MedLIS, in August 2024 was a major milestone for the HSE.

However, there is no acknowledgement about the significant controversies surrounding the implementation of the system to date.

The Medical Independent reported last year about the long delays in the roll-out of MedLIS, its high cost, and the various concerns of staff regarding its deployment.

The strategic plan states that “many laboratories are currently using information systems that are not satisfactory”.

“Lack of order communications systems and systems for communication between laboratories constrains the ability to improve use of existing human and material resources and delays receipt of results by the requestor,” according to the document.

Another area which needs to be addressed is the “significant gaps in capacity with respect to adequately resourced and integrated clinical reference laboratories”.

The strategic plan was developed through consultation with laboratory scientists, clinicians, the Department of Health, public bodies, patient and service user partners, professional bodies, staff representative bodies, and international colleagues.

In the foreword to the document, Clinical Lead, HSE Laboratory Services Reform Programme, Prof Martian Cormican, admits that laboratory services are going through “challenging times”.

“The workload is heavy and growing in volume and complexity,” Prof Cormican writes.

“We are experiencing challenges with recruitment and retention and with facilities and equipment.”

It is to be hoped that the new plan points a viable and practical way forward to improve services.