Pathology transformation could unlock £450m a year for the NHS

Completing the NHS’s pathology transformation programme could unlock around £450m a year for reinvestment in the workforce, digital infrastructure and quality improvement, according to an independent review commissioned by the Institute of Biomedical Science (IBMS).

‘The Pathology Transformation Review 2026’, led by Lord Carter of Coles, says pathology services have made significant progress since his reviews in 2006 and 2008 but warns that inconsistent integration, workforce shortages and uneven digital maturity are preventing services from delivering their full potential.

Rather than calling for another round of structural reform, the review argues that the NHS should focus on completing the implementation of existing pathology service models through stronger operational management, better data, clearer accountability and sustained investment.

Pathology services perform more than two billion tests each year and support 95% of patient pathways, including cancer diagnosis, urgent and emergency care, elective treatment and long-term condition management.

According to the review, aligning pathology services with the operating standards used by fully integrated pathology networks could create an annual opportunity worth around £450m, rising to a cumulative £1.4bn by 2029/30.

The report says this should not be viewed as a cost-saving exercise but as an opportunity to reinvest in pathology services.

Lord Carter of Coles said: “Pathology is fundamental to modern healthcare. It supports urgent care, cancer pathways and long-term condition management, while operating largely out of public view.

“Since my earlier reviews, the direction of travel has been clear: organise at scale, standardise what should be standard and measure performance in ways that support improvement.

“Real progress has been made, but in too many places the full operating model needed to make integration work in practice has not yet been completed.

“The task now is not to revisit the case for change, but to complete it. Pathology needs common standards, comparable data, clear accountability and sustained investment in the workforce, quality systems and digital infrastructure needed for safe and resilient services.”

The review highlights significant variation in performance across England. Fewer than half of providers meet acute turnaround standards in blood sciences, while fewer than 10% of trusts achieve seven- or 10-day turnaround targets for histopathology.

Performance against the 10-day standard has deteriorated from 14% of trusts meeting the target in 2020 to just 2% in 2025.

The review also found that partially integrated pathology services had almost five times as many Datix incidents remaining open for more than 30 days as fully integrated services.

Around two-thirds of trusts reported at least one non-accredited test type in 2025, consultant vacancies remain high in cellular pathology, and only 23% of pathology networks were assessed as digitally “maturing” or above.

Dr Sarah Pitt, president of the IBMS, said the review highlights the pressures facing pathology services and sets out recommendations on workforce, training and digital capability.

“Successful implementation of the recommendations of this review must include better opportunities for staff at every level, from entry routes into the profession through to advanced and consultant-level practice.”

The report recommends five priorities for the next phase of transformation: completing operational integration, introducing comparable national performance data, strengthening workforce planning and advanced practice, aligning digital infrastructure with workforce redesign and funding reform, and embedding clear accountability across pathology service models.