The changing role of the Anatomical Pathology Technician Technologist

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The changing role of the Anatomical Pathology
Technician Technologist

• James Lowell
• Manager, Directorate of Cellular Pathology
• Guys St Thomas NHS Foundation Trust
• Chair Association Anatomical Pathology Technology

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What's in a name?

• APT
• Mortician
• Mortuary / Morgue Attendant
• Mortuary / Morgue Superintendent
• Medical Technical Officer
• Morgue Master
• Pathologists Assistant
• Mortuary Technician
• Anatomical Pathology Technician
• Anatomical Pathology Technologist

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Anatomical Pathology Technologist

• Approximately 750 UK
• NHS, Local Authority Medical School
• Hospital Public mortuary

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Anatomical Pathology Technologist

• Royal Society of Public Health - since 1950
• Three to five years to qualify
• Certificate Diploma of Anatomical Pathology
  Technology
• Healthcare Scientists
• Over 50 disciplines
• 3 divisions
• Physiological sciences
• Clinical engineering and physical sciences
• Life sciences

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The role of the APT

• Wide scope of practice Variable depending on
  where you are!
• Technical / Clinical
• Management
• Health safety
• Educational
• Unusual duties
• Deceased patient care

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What's driving change ?
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• Specific Standards
• Regulatory framework

Published 2006
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• The HTA was somewhat surprised and concerned to
  find that as a professional group, APTs do not
  appear to have benefited from regular appraisal
  or training opportunities
• In addition, we understand that the Association
  of Anatomical Pathology
• Technologists (AAPT) is working with Skills for
  Health in consultation with the Royal College of
  Pathologists (RCPath) to develop a modern
  professional educational programme for APTs,
  which, if implemented, will help bring about
  positive change in this area.

Published 2008
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• Principles
• Respect for the individual and Equality of
  provision.
• Core Elements
• Bereavement Support 3 major components.
• Policy Bereavement care pathways.
• Partnership Coordination and Consistency of
  services.
• Before Death Patients wishes, Honest prognosis
  and Organ donation.
• Immediate needs Sensitively inform people of a
  death.

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• Mortuaries provide a vital part of the service
  the NHS gives to patients and their families, but
  it is a part which most people - happily - do not
  encounter. As a result, they are sometimes
  overlooked.
• Mortuary staff have an important and challenging
  role, balancing the very different needs of
  bereaved families and clinical staff. They must
  deliver an efficient, safe, secure service,
  following stringent procedures, while treating
  grieving relatives and friends with respect and
  sensitivity.
• People come into contact with mortuary staff at
  a very difficult time, and they may have to face
  painful issues. The quality of their experience
  can have a great impact, for good or ill.
  Mortuary staff often work closely with a
  hospital's bereavement service to meet needs
  beyond their own remit.
• There is much good practice in NHS mortuaries,
  and many dedicated and caring staff work in them.
  Their role is an integral part of NHS care, and
  deserves to be recognised as such.

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• The Medical Certificate of Cause of Death (MCCD)
  should be completed by the medical practitioner
  responsible for the deceased persons care, as
  now. After completion, the MCCD should be passed
  to a Medical Examiner

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• The Programme will
• Improve the quality and accuracy of medical cause
  of death certificates (MCCDs)
• Introduce a single system of effective medical
  scrutiny applicable to all deaths that do not
  require a Coroners post mortem or inquest
• Provide improved information on cause of death to
  strengthen local clinical governance and public
  health surveillance.

Published July 2009
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• High Quality of Care
• Safe care
• Effective care
• Patient experience

Published June 2008
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A clinical vision for the NHS
Staying healthy
Mental health
Maternity and newborn
Childrens health
Planned care
Long term conditions
Acute care
Acute care
Acute care
Acute care
Acute care
Acute care
End of life care
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• 58 of deaths occur in NHS hospitals When
  asked over 50 of people express a wish to die at
  home.
• Holistic and care pathway approach recommended
• Recognises
• - numbers dying in England set to rise (from
  500,000 to 530,000 by 2030)
• only one third of general public discuss death
  and dying
• Key areas addressed include
• High quality services in all locations.
• Care planning.
• Last days of life and care after death.
• Involving and Supporting carers.

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The End of Life Care Pathway
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Need for Registration

• From DH (The regulation of the non-medical
  healthcare professions)
• we have defined regulation as the set of systems
  and activities intended to ensure that healthcare
  practitioners have the necessary knowledge,
  skills, attitudes and behaviours to provide
  healthcare safely. The goal of professional
  regulation is patient safety.
• This means professional regulation needs to
• set and promote those standards which, for
  reasons of safety, everyone in a profession (or
  branch of a profession) has to meet
• publish a register of those who meet these
  standards, and ensure that everyone on the
  register continue to meet the standards, both by
  periodic checks for all and by procedures for
  resolving concerns which a complaint or incident
  might create.

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Need for Registration

• Voluntary Registration (Professional Regulation)
• First step towards Statutory Regulation
• Allows Technologists more control over Regulation
  process
• Input from Professional Bodies
• Statutory Regulation
• HPC Registration
• Protected Title

First registrants 2006
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Need for Registration

• The DH continues
• Professional regulation becomes statutory
  regulation at the point where the State regards
  it as so important for public safety that it
  legislates for a ban on either using the
  professional title or doing certain things unless
  your name appears in the register.
• This protects patients from the harm caused by
  people practising a profession which they are not
  fit to. It engenders public confidence by
  allowing members of the public and the employers
  of professionals to check on a persons
  registration status, knowing that the information
  they find will be correct and up to date.

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VRC

• Membership Groups
• NAC - Cytoscreeners
• BARS - Retinal Screeners
• AOSP - Ophthalmic Science Practitioners
• BATB - Tissue Bankers
• SCCT - Critical Care Technologists
• AAPT - Anatomical Pathology Technology
• ACC/CMGS, represented jointly by the AGTC
• - Genetic Technologists

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Modernising Scientific Careers

• Consultation Process
• 4 country wide consultation closed 6th March
• Outlined a new training and career pathway Key
  themes
• Recognition of the need to change
• Support to modernise education and training
• Need for further detail to be developed in
  certain areas
• Where we are and what happens next
• Deliberative events over summer to help develop
  further details
• Final policy proposals in Autumn

Published November 2008
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Underlying principles of the Modernising
Scientific Careers Programme

1. Protection of the public and delivery of safe and
   effective services
2. Standards and quality underpinned by assessment
3. Explicit training and career pathways
4. Planning the workforce
5. Funding which is secure and sustainable
6. Raising the profile of healthcare science
   workforce and scientific careers
7. Adding Value to healthcare

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Role definition of the Modernising Scientific
Careers Programme

• Healthcare Science Assistants and Associates
  supported to perform task and protocol based
  roles through range of vocational qualifications
  underpinned by a learning and development
  framework
• Healthcare Science Practitioners supported to
  perform applied scientific techniques through a
  work based training programme and relevant
  accompanying academic award leading to regulation
• Healthcare Scientists supported to undertake
  complex clinical scientific roles through a 3
  year broad base clinical training programme,
  including themed rotations and a vocational
  Masters level qualification leading to regulation
  

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Service review APTs

• Role evolving
• tissue retrieval and storage in some
  cases/locations in line with HTA, involvement in
  more advanced techniques and possible future use
  of imaging, move into bereavement services/care
• Coroner and NHS Post Mortems
• implications for training e.g. consent, tissue
  retrieval for education and research, forensic
  evidence
• Training
• more breadth and depth, modernised involving
  all stakeholders ( MSC, RSPH and RCPath), role of
  regulation

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The professional body

• The Association of Anatomical Pathology Technology

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AIMS AND OBJECTIVES

• COMMITTED TO WORKING WITH THE APPROPRIATE
  AUTHORITIES AND ORGANISATIONS TO HELP ENSURE AND
  IMPROVE THE PROFESSIONAL, EDUCATIONAL AND
  PRACTICAL STANDARDS FOR TECHNOLOGISTS

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STRONG LINKS

• HUMAN TISSUE AUTHORITY
• ROYAL COLLEGE OF PATHOLOGISTS
• INSTITUTE OF BIOMEDICAL SCIENCE
• SKILLS FOR HEALTH
• MSC
• ROYAL SOCIETY FOR PUBLIC HEALTH
• GOVERMENTAL DEPARTMENTS

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CONTINUING PROFESSIONAL DEVELOPMENT (CPD)

• AAPT PROVIDES A CPD PORTFOLIO AS A BENEFIT OF
  MEMBERSHIP TO RECORD CPD ACTIVITY
• ON-LINE LEARNING IS AVAILABLE THROUGH
  www.aaptuk.org in the LEARNING ZONE
• CPD AWARD CERTIFICATE

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CONTINUING PROFESSIONAL DEVELOPMENT (CPD)

• 15 multiple-choice questions on a relevant
  article to APT staff
• Score of 12 5 CPD credits

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Next steps

• RCPath approval
• Learning Pack for APTs
• Continue to
• promote VRC -Leading to submission for inclusion
  under the Health Professions order and regulation
  with HPC
• Work with all stakeholders to positively improve
  the profession
• Introduction of TEC programme
• Training, Education and Competency

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Next steps

• National and International Emergency Response
• Continue to work with all relevant stakeholders
  to ensure that the profession can respond.
• Training at different levels for APTs
• Trainee
• Team member
• Senior

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Final Thought
The care with which our dead are treated is a
mark of how civilised a society we are. Much goes
on, for understandable reasons, behind closed
doors. For this reason there is a special
responsibility placed on those entrusted with
this work and the authorities who supervise it,
to ensure that the bodies of the dead are treated
with the utmost care and respect. That is what
bereaved and loved ones are entitled to expect
and what society at large demands Charles
Haddon-Cave QC representing the Marchioness
Action Group