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This history has largely devoted itself to the people who delivered Clinical Biochemistry over the last 70+ years and only touches on the changes in methodology which ran in parallel.
There are references to the manual methods, many of which were carried over from the 19th century, and the early adoption of a limited single channel automation in the 1950s and 60s using the AutoAnalyser™. There is more detail in the account for the Royal Infirmary of Edinburgh than for the other laboratories. Very similar methods and equipment were adopted in the other departments around the same time.
I am grateful to Richard Spooner for compiling the following account of how methods and equipment developed in more recent times.
By the 1970s, multi channel analysers capable of delivering Gemmel Morgan's "silly twenty" from a single sample were common place. The Technicon 6/60 (electrolytes), 12/60 (electrolytes & liver function) and 18/60 (electrolytes, liver function and bone profiles) became the workhorses of the larger laboratories.
Problems with "drift" across the sample run, led to the introduction of more discrete sampling and the explosion in the range of testing resulted in laboratories having a multitude of of analysers, each with its own operating protocol and becoming "owned" by its own MLSO staff.
By 1982 the first Immunoassay analysers were appearing with small batch analysers such as the Abbott IMX making routine radioimmunoassay redundant and allowing any laboratory to offer a wide range of hormone tests.
And so the clinical laboratory continued in this manner dealing with increasing demand with more modules occupying more floor space towards the next millennium.
However, the next paradigm shift happened in June 1999 when Richard Spooner came back from the IFCC meeting in Florence with the intelligence that it was probably possible to recapitalise a laboratory and save 10% on expenditure by purchasing for a group of hospitals from a single supplier. Jim Shepherd, the then Clinical Director for North Glasgow, asked Spooner to lead a team and prove this concept for the 4 North Glasgow hospitals.
His team, comprising scientist and technical representation, IT and immunoassay expertise, settled on the offering of Bayer having visited their HQ in Tarrytown. Spooner is recorded as saying, after visiting the demonstration site on an industrial unit, that he had "seen the future" when a circular track with both chemistry and immunoassay attached was shown working. The first Bayer track was installed in Gartnavel General in 2000. A second followed at Glasgow Royal Infirmary. The Stobhill management elected to have discrete analysers and the Western Infirmary hot lab a single chemistry analyser.
Grampian followed Glasgow with a contract with Bayer but the installation was significantly delayed.
The Glasgow contract with Bayer was for 5 years and, by the time renewal approached, the concept had changed significantly. Contracts were now described as Managed Service contracts with the advantage that they were VAT exempt, offering the potential of significant monetary savings.
The decision was taken at this time to tender for both equipment and reagents for both Biochemistry and Haematology. This posed a number of problems for Spooner and his opposite number Henry Smith from Haematology, the principal one being that Biochemistry had chosen Abbott on the basis of an "open" tracking system and an integrated analyser being available for the smaller laboratories, while Haematology chose Sysmex for their major workload rejecting the Abbott Haematology offering. This went all the way up to the Abbott board in Chicago who agreed to become Glasgow's major partner and work with Sysmex. This second contract also broke new ground in that Abbott undertook to include many smaller and niche companies in their contract extending the savings to the Trust.
The first Abbott track was installed in Gartnavel General in July 2005. A contract extension was agreed with Abbott to include the newly merged Argyll and Clyde service.
The move into the new Edinburgh Royal Infirmary resulted in Lothian also having a contract with Abbott.
Tayside committed themselves to Siemens who had bought the Bayer Laboratory Medicine business.
In 2012 Abbott retained the Glasgow and Clyde contract which this time was expanded to include both Microbiology and Histopathology services, allowing both services to expand and update services and equipment. Until this time Glasgow had recapitalised but not truly integrated it's Laboratory Medicine services. The disciplines largely continuing on separate floors.
With the opening of the new Queen Elizabeth University Hospital on the site of the old Southern General, sufficient laboratory space was made available for a truly open Abbott tracking system to link with Haematology analysers. Staff and loading procedures remain separate.
In 2013 the last remaining Board of a significant size, Lanarkshire, entered into a managed service agreement with Roche for all its extended Laboratory Services.
The Scottish experience has spilled over to the rest of the UK but some laboratories have encountered problems when commissioning has take work away from expensively equipped laboratories.
As always with the NHS, the future will be challenging but laboratories cannot continue to expand the footprint of their analytical capacity to meet ever increasing demand.
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