Lord Carter of Coles photographed outside the Hull Pathology Laboratory at Hull Royal Infirmary (Credit: Jonny Walton)
Completing the NHS pathology transformation program could unlock around £450 million a year to reinvest in workforce, digital infrastructure and quality improvement, according to an independent review commissioned by the Institute of Biomedical Sciences (IBMS).
‘The review of the transformation of pathology 2026′led by Coles’ Lord Carter, says pathology services have made significant progress since its 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 reforms, the review argues that the NHS should focus on completing the rollout 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 management of long-term conditions.
According to the review, aligning pathology services with the operational standards used by fully integrated pathology networks could create an annual opportunity worth around £450 million, rising to a cumulative total of £1.4 billion by 2029/30.
The report says this should not be seen as a cost-saving exercise but as an opportunity to reinvest in pathology services.
Coles’ Lord Carter said: “Pathology is fundamental to modern healthcare. It supports urgent care, cancer pathways and long-term disease management, while operating largely out of public view.
“Since my previous reviews, the direction forward has been clear: organize at scale, standardize what should be standard, and measure performance in ways that support improvement.
“Real progress has been made, but in many places the full operating model needed to make integration work in practice has not yet been completed.
“The task now is not to review the arguments 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 necessary for safe and resilient services.”
The review highlights significant variation in performance across England. Less than half of providers meet strict turnaround standards in blood sciences, while less 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 incidents of Datix remaining open for more than 30 days than fully integrated services.
Around two-thirds of trusts reported at least one type of unaccredited test in 2025, consultant vacancies remain high in cellular pathology and only 23% of pathology networks were assessed as digitally “matured” or above.
Dr Sarah Pitt, chair 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 improved opportunities for staff at all levels, from profession entry routes to advanced practice and consultant level.”
The report recommends five priorities for the next phase of transformation: completing operational integration, introducing comparable national performance data, strengthening workforce planning and advanced practices, aligning digital infrastructure with workforce redesign and funding reform, and embedding clear accountability across pathology service models.
