Introduction
In this issue ...

· EQA Pilot Schemes: Funding 2002
· Use of human tissue in EQA Schemes
· CPA Annual Conference 2001
· Substantial or major changes in a Department

EQA PILOT SCHEMES:
FUNDING 2002

CPA would like to invite applications for the fifth annual round of EQA Pilot Scheme funding. Bids will be welcomed both from established EQA providers and others.

Applications must be received by CPA by 31 October 2001 and successful applicants will receive funding before the end of the current financial year.

Application forms are available from: Miss Rachel Boyer at CPA (UK) Ltd, 45 Rutland Park, Botanical Gardens, Sheffield S10 2PB (tel: 0114 268 6151, fax: 0114 268 6251, or 
e-mail: office@cpa-uk.co.uk)

David J Goldie
Cheif Executive (EQA)

Use of Human Tissue in EQA Schemes

Dr Philip Roberts, in his capacity as Chairman of the Steering Committee for EQA in histopathology for the Royal College of Pathologists, has recently issued advice on this issue to EQA scheme organisers.

With his permission we reproduce that advice here to inform both CPA inspectors and applicants of the current guidance.

"Concerns had again been expressed about the use of tissues. A representative of the Department of Health stated that guided by the recommendations in the Nuffield Report "Human Tissues: Legal and Ethical Issues", the use of such archival material in an EQA scheme (involving the cutting of many sections and circulating them to scheme participants) may not require either local ethical committee approval or individual consent provided that:

1. no more tissue had been removed from the patient in excess of that required for their ordinary clinical care;

2. the EQA use of the tissue did not compromise its routine diagnostic assessment;

3. the EQA material was anonymised;

4. the EQA scheme was a not-for-profit activity.

It was a method of auditing the quality of care."

The 'house full' notices were up once more for the CPA Annual Conference held in London on 22 March. Ticket touts were out in force which explains why the bemused Japanese tourists who thought they were at Madame Tussauds walked out in disgust as they only came to see Posh and Becks.

The morning session was chaired by Professor Sir Duncan Nichol, Chairman of the CPA Board of Directors, and the topical theme focused on perceptions of pathology by patients and how the media influenced these perceptions. There were some intriguing titles for the talks and Mr M Walker the legal advisor for CPA kicked off with Human Rights Act and CPA. Had Cheryl been torturing the girls in the office? Is the preparation for a CPA inspection so stressful that it infringes human rights? (and this is before the new standards). The truth was far more complex and Mr Walker described the relevant articles of the universal Bill of Human Rights. The various articles cover the right to life which is relevant to the storage and retention of human organs (with implications for future generations if tissue samples are not available to study genetic disorders for example). Article 3 on the prohibition of torture cannot possible relate to CPA. Or can it? Under the Mental Health Act if a particular form of pain relief is withdrawn does this constitute torture? In future clinical decisions may be affected by "you're infringing my human rights". The right to a fair trial could affect suspended staff if the Trust delayed the tribunal hearing. I thought Jehovah's Witnesses would get a mention and the difficult issue of blood transfusion in children was discussed. Again in children the use of recombinant Factor VIII treatment for haemophilia was compared with the non recombinant products used in adults who are then exposed to more risks of infection. Any such choice based on cost or policy exposes the Trust to a Human Rights application. Many other examples were quoted ranging from bodies in chapels to life support systems to ageism. A fascinating talk ended with a Civil Rights video from 1963 and the words of Martin Luther King.

Alan Wright then spoke as the lay Chairman of the Royal College of Pathologists Patient Liaison Group. This was another splendid presentation with a demonstration of visual aid technology that would put most medical presentations to shame. I suspect I was not alone in my lack of awareness of the College Patient Liaison Group which was started in January 1999. The constitution of 6 lay people and 6 medics acts as a conduit between patients and the College. Mr Wright eloquently described how we are all patients and we all have greater expectations of health care professionals. He used the word respect many times and you do not need to look too far to see examples where patients have not been afforded proper respect. Most people have little or no idea of the activities of pathology and, as has been described elsewhere, the image could do with a higher profile. We need to improve our communication over what we do and what we do with all the information we have. Did you know that the NHS has 5 times more data than the Pentagon? When George Bush hears this he will instruct the Pentagon staff to photocopy everything 5 times to put them on an equal footing with the NHS. Most of the audience had missed the shocking story in Private Eye where 'patient leaves hospital alive'. 'Widespread shock at patient not dying because of medical error' evoked the appropriate audience response because the audience was in the hands of a very skilled communicator.

'Follow that' was the difficult task for Peter Homa, the Chief Executive for the Commission for Health Improvement. We listened to the overview of the functions and principles governing CHI's work. The background to clinical governance is the considerable performance variation across the NHS and we are familiar with postcode prescribing and the dent in public confidence after major service failures. CHI's aim is to help bring about the improvement in the quality of NHS patient care throughout England in the NHS. The four major roles include clinical governance reviews (independent assessments) investigations looking into systems failure (not that of individuals), national studies of national service frameworks and NICE guidance and 

finally advice and guidance with comparative performance assessment. Laudable principles of being patient centred, independent and fair, evidence based and accessible were described. Where can CPA and CHI work together? There are areas for continued consultation on technical aspects of the service and these are to be developed. It all sounded very sensible and good, but like most other things in life that are sensible and good for you, not very exciting.

'The media and pathology' was an eye-catching title before lunch and we were fascinated to hear the views of the ITN science editor Lawrence McGinty. Following on from Alan Wright's question of what do you do in pathology, Mr McGinty said the public perception is that you "cut up dead bodies". Much of his talk related to Alder Hey and the misconception amongst parents that the term 'tissue' meant a small piece of tissue and not whole organs. Essentially he felt that no one told them what was happening in a way they could understand. Patients' expectations have changed dramatically. Mr McGinty stated the media's function was to inform (I was surprised no one challenged him during the questions on this). He described the principles adopted by journalists in producing a story. The essential criteria included (1) unexpectedness (man bites dog) (2) consequence (rabid dog bites man) (3) revelatory (cover up over man bites dog) (4) timeliness (man bit dog last year) (5) controversy (did man really bite dog) (6) personality (Blair denies biting dog). Most television reports last 2 - 2½ minutes and are equivalent to 300 words of text. Television news is all about images and images produce emotions. The written word allows more rationalisation, discussion and thought but you cannot change the visual impact of television news. There are parallels between Alder Hey and the Steven Lawrence enquiry where there was an institutional failure. Mr McGinty related how parents had told him that they had not been informed of events because the medics involved felt they would not understand. Parents also said that people asking them about autopsies were embarrassed and that the medics did not explain in detail because they thought the unpleasant details would inevitably result in refusal of permission.

As the delegates returned from lunch for the afternoon session the noisy chattering was interrupted by a tall authoritative figure who strode to the lectern. A hush came over the crowd. Here was a man who exuded authority, confidence and charisma. And when he had finished adjusting the microphone the next person up was Mansel Haeney to chair the afternoon session. There was a distinct theme here with Ken Scott saying histopathologists were overworked, then Alan Potter saying BMS morale was poor. Then Adrian Newland reported how haematologists worked 16 sessions a week and finally Keith Cartwright adding "if you thought the others were depressed wait until you hear from the microbiologists". And a plaintive voice from the crowd came forth "but what about the clinical chemists".

Ken Scott started the gloomy session with his most sombre expression and baritone voice and gave an overview of the CPA survey on workload and staffing in histopathology and cytology laboratories. Replies were received from 191 of the 300 laboratories approached with the figures confirming a 27% shortfall in Consultant numbers and a similar but less readily identifiable shortfall in biomedical scientists. Workload figures had increased both in absolute terms but particularly in complexity. Ken's shoulders slumped a little more as the figures got worse and the modest increase in work force numbers is not meeting the annual increase in workload. Ken wiped a tear from his eye and shuffled off stage. 

We then had Alan Potter on the IBMS survey conducted between Christmas 99 and January 2000. The majority of the questionnaires were returned from England and Wales and there were major problems identified with the work force, recruitment and retention of staff. Perhaps particularly worrying was the fact that half the Trusts felt that the recruitment and retention difficulties with BMSs were not recognised by the management and Chief Executives as a problem. Low pay was clearly a factor in recruitment difficulties together with training and development issues. Confirmation of this was provided by the figure that 56% of staff leaving had left the NHS altogether.

Professor Adrian Newland reported the increased pressures on haematologists with increased clinical activity, increased laboratory workload (5% year on year), development of the National Cancer Plan, changes in transfusion practice and increased time required for training junior staff. There are still 60 single handed Consultant Haematologists in the UK and the current expansion rate of 2.5 - 3.5% per annum needs to rise to 7% each year for the next 7 years (approximately 60 posts per year). There needs to be a concomitant increase in trainee numbers and a halt put on the expansion of sub-Consultant grades. Similar pressures were described for the MLSO grades, particularly in London with vacancy rates of 10 - 15%. Clinical scientists are well established in areas such as molecular biology but there is a current lack of a training structure and career progression.

The policy that major changes within a CPA applicant laboratory must be notified to CPA is clearly stated in the Handbook. As there have been a number of occasions recently where this has not been the case we are reiterating that policy here. 

The following is quoted from the CPA Handbook: 

"It is also incumbent on the applicant department to notify CPA immediately of any substantial or important changes in staffing, repertoire, workload, organisation, resources or EQA performance as failure to do so may jeopardise the registration or accreditation status. Guidance on what is considered "important" in this context is available through the CPA Office and should be sought where there is any doubt."

Homeworking in
Cytogenetics

Potential problems with staff working from home has been an item for discussion by CPA on a number of occasions. In 1999, homeworking in cytology was abolished and, following professional advice, it has now been agreed that this practice should also cease in cytogenetics.

In order to allow time for cytogenetics departments to phase this out and make alternative arrangements, a period of 18 months has been agreed by the CPA Board of Directors. Any cytogenetics department using homeworkers after 31 December 2002 will not be accredited by CPA.

Up to date addresss 
information

 The use of email is very helpful for ease of communication especially when organising inspection visits. BUT it is essential that the email addresses we use are current. However, we do rely on both applicants and inspectors informing us of changes to telephone and fax numbers, email addresses etc. We simply do not have the manpower to check on a regular basis that the information we hold on the database is current. It would be helpful if you could let us know of any changes so that we can pass on up to date information to our team leaders.

First Notice - CPA Annual Conference 2002
Date: Tuesday 19 March 2002
Venue: The Commonwealth Institute London

For the Annual Conference 2002 we are having a change of venue.  The Royal College of Physicians has served CPA well over the past few years but are not able to provide the required seminar rooms for our afternoon session.  

The morning session will deal with general issues and a more detailed notice will be available in the near future. However, as this annual conference is now well known and usually over-subscribed, this is an opportunity to book your place early. Reservations may now be made by contacting CPA Central Office. The price for registration, including lunch and refreshments, will be £110.

Diary Dates

One-day training courses - Implementation of the new CPA standards

18 September 2001

19 September 2001

23 October 2001

24 October 2001

6 November 2001

7 November 2001

20 November 2001

21 November 2001

4  December 2001

5  December 2001

Manchester

Belfast

Cardiff

Bristol

London

Cambridge

Southampton

London

Sheffield

Birmingham

As the demand for places was high we secured larger venues in some cities. If you wish to register more delegates there are more spaces available as above.

CHRISTMAS / NEW YEAR HOLIDAYS

The CPA Office will be closed as follows:

Tuesday 25 December 2001 
Wednesday 26 December 2001
Thursday 27 December 2001
Friday 28 December 2001
Tuesday 1 January 2002