Irish Labs Are at an Important Crossroads

GLOBAL OUTSOURCING OF CLINICAL LABORATORY TESTING IN IRELAND has entered its second phase. The Irish Health Service Executive (HSE) granted Quest Diagnostics Incorporated a contract for an additional two-years of cervical cancer screening tests while awarding 25% of the nation’s annual Pap testing to Sonic Healthcare Ltd. in a similar two-year contract.

These developments are significant, because as long as the Irish outsourcing experience is favorable, it makes it easier for other nations to outsource laboratory testing to lab testing companies located in other countries.

But there is another dimension to the lab testing story in Ireland which fascinates me even more. As clients and regular readers of THE DARK REPORT know, the Irish HSE has announced a complete restructuring of laboratory services throughout the country. (See pages 6-8 and TDR, January 25, 2009.)

I’d like to make two observations about this ambitious project, which is a typical government health official approach to saving money. First, veteran pathologists and lab managers know all too well that, over the past 25 years, there are more disasters than successes when a government health system decides that it can take out costs by consolidating pathology testing, laying off medical technologists, and reducing the number of labs and blood collection centers serving a community.

Certainly the cost of lab testing did go down in the short term in these cases. But it was physicians and patients in these communities who often endured service deficiencies, glitches in the process of consolidating lab testing, and even serious problems in the accuracy and trustworthiness of lab test results.

Second, I’ll guess that the Irish Health Service Executive, in developing its “total laboratory consolidation” plan with a consulting company from England back in the years 2004-2007, did not spend much money sending a team of experienced pathologists, laboratory scientists, and healthcare policy makers on a tour to several countries to do first-hand investigations of successful, innovative regional laboratories, along with an on-the-ground visit to some of the larger—and often not-so-successful—laboratory consolidation projects.

If this assumption is true, it is an interesting comment on the due diligence of Ireland’s healthcare leaders that they would embark on a major makeover of the nation’s pathology service without having invested a rather modest amount of time and money to send their laboratory profession’s best and brightest out on a fact-finding tour of the world’s best examples of lab testing. To the contrary, might it be true that the HSE, for the cost of a consulting fee to an English company, has gotten the answer it wanted and is proceeding with a laboratory restructuring and consolidation plan that was likely pre-ordained as early as 2004?


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