email PITY II

Histopathology Services

from: Royal Liverpool Children's NHS Trust

For many years histopathology service at the Royal Liverpool Children's NHS Trust was run as a single consultant speciality which was undertaken in an isolated location away from other clinical services. These arrangements were recognised by the Trust to be inappropriate and when the Royal Liverpool Children's Confidential Inquiry was established, the Trust and what was then, the NHS North West Regional Office, worked together to establish and implement an action plan to change the way in which these services were provided. This plan was subsequently endorsed and enhanced in the action plan which was produced following the publication of the Royal Liverpool Children's Confidential Inquiry Report.

Funding was made available which has allowed then Trust to build a completely new histopathology facility. This includes newly built bereavement suites where families can receive support following the death of a child. There is a new mortuary.

In addition, there has been a complete overhaul of the operating procedures within the department to ensure that:

The Trust undertook a major piece of development work including consultation with many bereaved families, to produce new and detailed consent forms. Two sets of forms were produced, one for hospital post mortems and one for surgical procedures. The post mortem consent forms include information about the post mortem process and blocks and slides. Parents have the opportunity to limit the extent of the hospital post mortem process. The booklets are produced with a NCR (no carbon required) copy for parents to retain.

The consent form conforms with the latest Royal College of Pathologists and Department of Health guidance and they have been submitted to the Chief Medical Officer for England as a contribution to the development of national consent forms.

In addition to the development of the consent documentation, a programme of staff training in their use has also been undertaken across the Trust.

Communication between members of staff within histopathology, as well as between histopathology staff and clinicians from other specialities has been enhanced by the establishment of regular meetings to discuss issues of common interest or concern. Specifically, any consultant clinician who is seeking consent for a post mortem is expected to discuss the case and the purpose of the examination in detail with the pathologist.

The histopathology service is no longer a single consultant speciality. In addition to the funding for the new building, additional resources have been provided to support the employment of two additional consultant paediatric histopathologists. There is a national shortage of paediatric histopathologists, but following a rigorous recruitment process, we were successful in filing both posts; we now have three full time consultant paediatric histopathologists working at the Trust. This expansion together with increased laboratory staff has allowed the Roya Liverpool Children's NHS Trust to provide a foetal and perinatal histopathology service across the strategic health authority.

Histopathology laboratories are routinely visited by the Clinical Pathology Accreditation Team, (CPA) an autonomous body who check the laboratory's facilities and operating systems and practice. CPA has authority to accredit Trusts to undertake some or all of the range of histopathology services or to withhold accreditation.

During the week commencing 9 December 2002 the Trust was subject to an accreditation visit. The outcome of the visit will be formally reported to the Chief Executive towards the end of January 2003. However, informal feedback was very encouraging.

Kate Jackson, Associate Director, 10 December 2002