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Restructuring of laboratory services by DHBs

From: The New Zealand Institute of Medical Laboratory Science

Contact: NZIMLS President, Mr. Chris Kendrick

Subject: Current restructuring of laboratory services provision by New Zealand’s DHB’s.

The Medical Laboratory service throughout New Zealand (NZ) is under siege from the District Health Boards. In the name of cost savings, well established laboratory services are being closed down, consolidated or contracted out, in some cases to providers with no current track record in NZ. The savings to the NZ tax-payer will only be short-term and the real cost will be the loss of diagnostic expertise within this essential service. Approximately 70% of all patient diagnoses require some form of laboratory testing. This rate is higher in patients with disease requiring monitoring of expensive medications.

It’s not only the Pathologists (doctors who specialise in Laboratory Medicine) who will be affected by rationalisation within the sector, but also the Medical Laboratory Scientists and Technicians who run the laboratories. These medical laboratory professionals make up 90% of the staff who perform the specimen analysis, validate the results and ensure that laboratories meet and maintain the quality standards that make this service world class. With the proposed changes at a growing number of locations and the resultant redundancies, highly trained and experienced scientists will be lost to New Zealand, further contributing to the knowledge drain from the country.

Three NZ universities (Otago, Massey and AUT) currently offer the Bachelor of Medical Laboratory Science (BMLSc) degree. These institutions are already struggling to obtain practical training placements for their 4th year students and some students are already choosing to go to Australia to complete their programmes. With further rationalisations in the sector yet to come there is the real risk that student training will be further compromised in the years ahead. Laboratories are not well funded for scientist training but most are committed to training out of a sense of professional responsibility and the desire to maintain a succession of highly qualified staff. This policy has in the past ensured a continuation of the excellent diagnostic services that exist in NZ. The profession is concerned that new laboratory providers, who have won contracts on cost alone, will not have a similar commitment to provide for the training of BMLSc students in the future.

By international standards, New Zealand has a very cost effective medical laboratory service. The current round of laboratory rationalisations fails to address the real drivers of the increased costs facing laboratories. The current strategy of community based medicine seems to expect GP’s to manage more complicated cases at the same time discouraging any increase in their use of diagnostic tests. A more appropriate strategy would be to recognise that increased laboratory testing has the potential to improve patient outcome that in the long term will result in a reduction in overall health expenditure. Diagnostic laboratories have no control over the level of testing performed in their labs, yet it is they who are the targets of the administrators. The strategy of punishing the gate keeper undermines the role of the laboratory in the diagnosis of disease and is preventing improved patient health services. The most recent decision by the combined Auckland DHB’s to award the contract for laboratory testing from Diagnostic Medlab to Labtests Auckland, is another example of cost cutting in the sector. In doing so the DHB’s have threatened the high quality community laboratory service that currently exists in the region but also the training of medical laboratory scientists.

Chris Kendrick
New Zealand Institute of Medical Laboratory Science


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