Cellular pathology – questions and answers

Cellular pathology and blood transfusion services are different pathology specialties. Cross-matching blood for transfusions is undertaken through blood sciences and transfusion services, not cellular pathology.

Cellular pathology does not directly support emergency department care in the same way as blood tests and transfusion services. Patients requiring urgent blood transfusions will continue to have access to safe emergency transfusion support.

Most cellular pathology work already takes place over a period of days rather than hours. Tissue samples undergo a number of processing stages before being examined and reported by specialist consultants. National cancer and diagnostic pathways are designed around these timescales.

The investment in Gadeon House is intended to provide a modern, purpose-built laboratory environment that will support a safe, resilient and sustainable service for the future.

There are no changes to where patients currently receive their care.

Most tissue samples taken during cancer diagnosis and treatment are processed and reported over several days. As set out in our public statement, arrangements for urgent and time-critical cellular pathology support needed for care at Torbay Hospital will be built into the final operational model.

Most tissue samples are not analysed during surgery. They are processed and examined over a number of days as part of established cancer pathways.

Some people have referred to Mohs micrographic surgery as an example of surgery requiring immediate tissue analysis. Mohs surgery is a highly specialised skin cancer procedure in which tissue is examined during the operation. However, Mohs surgery is not carried out at Torbay Hospital and has never been.

Any urgent or time-critical cellular pathology support required for patient care at Torbay Hospital will be built into the future operational model.

Most cellular pathology samples are processed over several days and do not require immediate analysis. Only a small number of specialist cases require urgent intraoperative support, such as frozen section analysis.

As part of the planning for the future service, clinical teams are reviewing both current and future demand for frozen section services across specialties. Safe arrangements for these time-critical services are a key part of the clinical planning currently being undertaken.

The current cellular pathology laboratory is housed in a temporary facility that is no longer suitable for long-term use. While services continue to operate safely, the building does not meet the standards required for the future.

Cellular pathology laboratories are highly specialised clinical environments requiring:

• specialist ventilation systems
• specimen reception facilities
• laboratory infrastructure
• quality assurance systems
• specialist equipment installation
• compliance with regulatory standards

The challenge is not simply finding a building but providing a modern laboratory environment capable of supporting safe and sustainable pathology services.

Modern cellular pathology laboratories are not comparable to standard office accommodation.

They require specialist design, environmental controls, laboratory infrastructure and regulatory compliance which cannot simply be recreated in standard commercial premises or shipping containers.

A range of options were considered through the formal options appraisal process before the preferred solution was identified.

A number of options were considered during the options appraisal process, including options on the Torbay Hospital site.

Refurbishment of the existing temporary laboratory was not taken forward because the existing building is more than 40 years old and was not considered suitable as a long-term solution.

A purpose-built replacement laboratory on the Torbay Hospital site was also considered but would have required significantly greater investment.

The time-limited NHS England capital estate safety funding was awarded against a specific scheme and purpose.

Owning land does not in itself provide the funding required to construct and equip a specialist pathology laboratory.

A new-build cellular pathology facility would require:

• significant capital investment
• detailed design work
• planning approval
• construction
• specialist laboratory fit-out
• equipment installation
• validation and regulatory approval

The issue being addressed is not simply finding land but delivering a modern, compliant pathology facility within the available funding envelope and timescales.

We understand that colleagues may have concerns about what future service changes could mean for them personally. We have been meeting regularly with our cellular pathology colleagues along with staff side representatives and HR colleagues.

We will continue to engage closely with cellular pathology colleagues throughout the process and recruitment, retention, travel requirements and individual circumstances are key components of this work.

No job losses are expected as part of this programme. If colleagues are unable to relocate for personal reasons, redeployment and other options will be explored.

As set out in our public statement, arrangements for any urgent and time-critical cellular pathology work needed to support care at Torbay Hospital will be built into the final operational model.

We recognise the importance of maintaining services that support acute and urgent care. Patients should be reassured that the future model is being designed to ensure safe and timely care continues to be delivered locally.

These are separate arrangements.

Torbay and South Devon NHS Foundation Trust secured £4.6 million of ring-fenced NHS England capital funding through a time-limited estates safety funding programme to address significant safety risks associated with the current cellular pathology facilities and develop a new laboratory at Gadeon House. We have our own lease arrangement with Torbay Council for this space.

Royal Devon University Healthcare NHS Foundation Trust has a separate arrangement with Torbay Council for other space within Gadeon House. While both organisations will be using space in the same building, the arrangements are contractually and financially separate.

No. Where a pathology sample is processed does not determine where a patient receives their treatment. The proposed changes relate to laboratory facilities used for routine cellular pathology (histopathology) and do not change where patients receive their care. There are no proposals to move patient care from Torbay to Exeter as part of this programme.

We are aware of claims that, for example, someone having a breast lump removed at Torbay Hospital would need to join a waiting list in Exeter or Plymouth for further treatment if their tissue sample was examined at Gadeon House. This is incorrect. Decisions about treatment are made by the clinical team responsible for a patient’s care and are based on the patient’s clinical needs, not on the location of the laboratory that processes a sample.

It is also important to distinguish between routine cellular pathology work and urgent or time-critical diagnostic services. As we have previously stated, urgent and time-critical cellular pathology services will continue to be provided at Torbay Hospital to support emergency and inpatient care.

Claims that routine blood tests for conditions such as sepsis would be transported to Exeter and delayed by hours are also incorrect. The Gadeon House proposal relates to routine cellular pathology (histopathology). There are currently no proposals to move blood sciences services from the Torbay Hospital site. Blood sciences services are critical to supporting urgent and emergency care and will continue to be provided locally.

The purpose of the investment at Gadeon House is to provide safe, modern and sustainable laboratory facilities for routine cellular pathology work while maintaining urgent and emergency diagnostic support for patients at Torbay Hospital.