This interview touches upon a lot of aspects, e.g. the question of automation of lab work and the cooperation with the private sector.

A lot of necessary work in the hospital is hidden. Be honest, how often have you contacted the IT department because you forgot your log-in details? Working together is essential, but they don’t make it easy for us. 

As workers we manage to cooperate and keep society running through our combined labour, despite all the hurdles that this system puts in our way: the self-interest of individual departments and corporations; the outsourcing and high levels of fluctuation of staff; the precarious and militarized global supply-chains; the irrational hierarchy and bureaucracy; the unpredictable movements of markets and the arbitrary and abstract goal of turning our labour into money, rather than a better life for all. These hurdles create a lot of unnecessary work and frustration that we could do away with.

This experience of cooperation against all odds is the basis on which to rethink about an alternative society and the struggle for it. We have to turn our cooperation into real relations of solidarity – between hospital workers and workers who supply us with material, between inpatient care workers on the phone and the IT worker on the other end of the line. In a new society that is not limited by petty profit and power interests we can re-organise our cooperation consciously, for a better life for all.

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The lab

I work in the biochemistry department of the local hospital labs. In that department there are two sections. There’s the automated section, where I work. That’s where we’re trying to get our results out quite quickly. So most of our results, we try to get them out within about an hour. That’s quite fast for lab tests. We mainly get blood samples from patients that are in the hospital, but then also outpatients and samples that come from GP surgeries. We’ve got van drivers that drive around collecting samples all around the local area and bringing them to us.

We’re looking at some enzymes that check to see how your liver, your kidneys and your heart are working. And then also different kinds of hormones that we can check in your body and some drugs, as well. There are about 60 tests that we can do relatively quickly and that support all the services in the hospital. For example, before a patient is going to have an operation, they want to check that their kidneys are working okay. We do a lot of work with dialysis patients, as well.

Work process

Part of our job is that we have to prepare the samples before they get analyzed. So in biochemistry, a lot of the time we want to look at the serum or the plasma. For that we have to centrifuge the blood, which means spinning it really fast to make the red blood cells go to the bottom. And then we’ve got serum or plasma at the top and that’s what we do our tests on. 

In our section, the machines that we use for this are automated to a large extent. The machines will pick up some of the sample and mix it with chemicals and produce the reaction that gets measured. It produces a result. The results get looked at by the biomedical scientists to check that they are definitely right results, because there’s quite a few reasons why sometimes the results could be not right. Part of our job is to make sure that we’re giving accurate results to people. For example, preservatives in blood sample bottles can mess up certain tests.

We probably get about 3000, maybe over 3000 samples a day. And each of those samples, they would do 5 or 6 tests at a minimum on it, sometimes up to 25 different tests on each sample. If you count the number of individual tests, it’s probably around 20,000 to 30,000 a day, just in our section.

We have to run a lot of quality control materials through the machines all the time to make sure that the machines are functioning properly and giving accurate results. Some of the results we don’t actually look at, because there’s a lot of rules built into the analyzer system and the computer systems that we use. So if everything is good and the results look normal then they will go directly into the hospital computer system without looking at it.

We will sometimes phone the ward or the doctor to tell them about results. That can be a bit tricky sometimes because everyone on the wards is also busy. In some cases we try to give out those results directly and make sure that they can act on them quickly – for example if someone came into A&E and they had taken a paracetamol overdose. We would phone the level of paracetamol through so that they can give the antidote appropriately. Or if someone’s got very high potassium, that can cause cardiac problems and potentially a heart attack. We would phone up quickly about that.

Sometimes we do samples for private hospitals. Private hospitals will maybe have labs in them, but they’ll be very small and not able to do anything vaguely complicated or interesting. So they would send us samples if there was anything out of the ordinary that they wanted to analyze. Sometimes universities that are doing studies may send us samples. Other NHS hospitals a,so send us samples for very unusual tests. Certain tests can only be done by one or two hospitals in the country.

Each of the samples that we process represents a patient to us, and it’s hard to reject samples, because it means going back to the patient, getting a new sample and so on. The main reason why we have to reject samples is because people have put the sticker on the wrong sample. And then sometimes to a lesser extent it’s because the blood sample is very small. But they’re the ones where you feel really bad about rejecting it, as it may be from an elderly person or a tiny baby. We sometimes show resident doctors the lab and explain to them about correct sampling.

The work force

In my section of biochemistry, there are about 30 workers. The wider biochemistry team, there’s probably about 100 people. Then there are the other labs on the site: hematology, microbiology, virology, histology. There’s about 500 to 600 people that work in the entire lab. Then we’re part of a wider hospital trust that’s got labs on three other sites apart from ours. I’m not sure exactly how many of the lab people would work on those sites, but probably about the same again.

In terms of workforce composition, we have Band 2 medical lab assistants, who receive the samples and book them into the computer system. Then there are Band 3 lab assistants, they would do a bit more of the interacting with the machines, like loading the machines, doing some of the maintenance on the pre-analytical parts to the machines, the automated bits, and as well as the same jobs that the Band 2 do. Then we’ve got assistant practitioners as a Band 4 and they look after the machinery a lot more. They can run quality control material, do the maintenance on the bits that actually are analyzing our samples. Then we’ve got biomedical scientists, who are Band 5, 6 and 7. 

The main bulk are Band 5 and 6. If you have a degree in biomedical science, there’s a registration portfolio that you have to do on Band 5. After that, you can start doing a specialist portfolio that probably takes about two years. And then, hopefully, you would be able to move up to a Band 6 job. So the bulk of our workforce are biomedical scientists. They can do all of the jobs that the other people can do, because at night time, we only have one or two people on shift. One of them is a biomedical scientist, because they can do all of the work. Because you need somebody on shift who can authorize the results. The Band 7s are team leaders in the lab, they are still quite lab based. They do manager tasks, but they are in the lab. They’re in the room, providing advice and backup for slightly more complicated things. 

The Band 7s do a lot of quality management stuff. We have to analyze external quality materials, as part of an audit scheme that all accredited labs have to undertake. We have to run these external samples and compare ourselves to all the other labs across the country to make sure that our results are comparable to everybody else’s.

Then we also have clinical scientists who are a bit separate from the lab process. They provide clinical advice to the doctors about what the results mean, especially if it’s complicated endocrine stuff. They will look at some of the results that go out and add comments or interpretations about what the results might mean. And then we’ve got higher management above it. There’s been a big restructuring of all the management. So we’ve got less managers at the very top level now. And so the person that was in charge of my section is now in charge of all of biochemistry, all of hematology and all of sample reception. So her work has just tripled.

Staffing is not such a problem, only on late shifts. With our late shifts, you don’t get any extra money for it. So it’s just basic rates and it’s really, really busy as a lot of the GP work comes in from lunchtime up till at 7:00pm. The late shift is super busy and there’s not as many people on them as during early shifts, so people don’t want to work them.

The automated machines

The automation that we have now, it moves the samples around the lab for us. There are robot arms that load stuff into the centrifuges and take them out, and they go around the lab on little conveyor belts. And so, if a sample was perfect, if it had a beautiful barcode on it and it had enough serum in it, we potentially wouldn’t touch it at all with our hands.

I’ve worked in the lab for 25 years, we definitely didn’t have any robots 25 years ago. We had to move the samples around the lab, take the lids off the samples and so on. I used to have a callus on my thumb from taking lids off all day, but I don’t have that anymore. When this latest automation was introduced, management definitely thought that they were going to be able to get rid of loads of staff, but actually they haven’t reduced staff at all. And in fact they’ve had to grow the service because the machinery actually needs looking after quite a lot. You need people that can fix it, as it’s got a lot of moving parts. 

I guess the company that manufactures the machinery told our managers: “Oh, it’s amazing. It’ll be able to do this and save you this and this. You won’t need that many staff anymore.” But in reality, it needs a lot of support from human beings to make it work. Maybe in the future it’ll get better, but currently we have more people working in the lab now than 25 years ago. 

This means we have a big dependence on the private sector actually, because they provide all our machinery. The current machines that we have are provided by Rush, which is a very big medical company. There are only four or five companies on the market that can provide machines like that. And, we don’t own the analyzers. We get them on a contract that is negotiated and it usually lasts for seven years. And that contract will have the analyzers, all the chemicals and reagents that we need to use, a level of servicing from engineers and the computer software that doesn’t always work. There are three Rush technicians on site more or less every day. One of them used  to work with us in the lab, as a NHS worker. He was a medical scientist, I trained him years ago. It’s nice that he is still around, even for a different company, but it also makes you think: “Maybe we would not need these subcontractors, maybe we could do that ourselves?” We’ve had Rush machines for almost the whole time that I’ve worked there, so I know them really well. Then all the analyzers need pure water to go through them. So we’ve got water purification systems that are also from a private company. 

The software that goes between the automated analyzers and the hospital computer system is made by the company that makes our analyzers. The hospital computer system is provided by Epic, a big US IT company. The analyzer software stops working all the time, it freezes. Sometimes it’s not the fault of that system. Sometimes they’ve done a software update to windows and our computer system doesn’t like it. The IT people in the hospital, when you ring them up and say there’s a problem with the lab stuff, they don’t like it. We’ve got our own IT people, but they’re not there out of hours. This causes us problems.

There have been changes to some of the other labs that make up our hospital trust after the introduction of the automated system. But they cannot just close these labs or shrink them radically, because it would cause too many delays in patients getting results. We plan between the different sites. Some of the more specialist tests wouldn’t be done at a smaller site. But unfortunately for hospital management, they need labs. I think they would love it if they couldn’t say: “oh, we only need one giant lab.” Unless you’ve got drones to take our samples around, you’ve got to drive through the city traffic, which takes too long. Even the hospital-internal pod system is often not reliable.

Research

In our section we are not really involved in research. We might process samples for university research every now and then. The main research is done on the machinery, for example if there’s a new test that we want to introduce. The manufacturer would often perform test-runs on our machines before they introduce them in other hospitals. They use our lab as an external research lab at that moment and it’s good publicity for them if they can point out that the test worked in one of the major NHS labs. 

I’ve never worked in a research environment. I came to the hospital when I’ve finished university, basically. I really love our work. I guess some people might see it as not very exciting science, because the technology behind a lot of the stuff that we do has existed for a long time. It’s not like pushing the barriers of science, but I like that it is actually helping people on a day to day basis. It’s something really useful. I am not yearning to do something else. 

Disputes

Years back, when we moved to Agenda for Change, they wanted to cut our ‘out of hours’ payments. There was a lot of back and forth and we came close to strike action, but then they paid us the money.

Then we had lots of grumblings when automation came in about six years ago, especially from the lab assistant level, because they hadn’t really had to have anything to do with machinery before. So they were very reluctant to deal with the machines, also because of training issues. 

Then there’s always a bit of a dispute about when you move from Band 5 to Band 6. Officially you need to finish the portfolio, but if you work in the job for a little bit, you gain a lot of experience anyway. So, then there isn’t a big difference between a Band 5 and a Band 6 in terms of actual experience and knowledge – apart from one of them getting paid more money. At one of the sites a group of Band 5s consider a collective grievance and potential strike action over the issue. 

At the minute there is a strike at a lab in Burnley, where people’s holiday pay wasn’t being calculated correctly. This group of lab staff went to an employment tribunal. Eventually, after lots of grievances, some industrial action, they went to an employment tribunal. And the employment tribunal agreed with the staff that they were being paid the annual leave incorrectly. So the tribunal said that employers should pay and the employer has not paid. So now they’re on strike again about it. I think they have probably agreed to do very urgent lab work, but not the routine stuff. Urgent stuff are the samples that come from A&E, we would always treat them as urgent and they have the stickers that they print out with the barcode on it. They’ve got a red line on them and they come in a different colored path to the system.

On the level of the union, we’ve got a very active staff side, we’ve got 16 separate trade unions in the Trust  that come together at our staff side. So obviously we all talk to each other and keep each other informed. The doctors don’t come to our staff side. They’ve got their own special one. When they’ve been on strike, we’ve not really heard that much about it. I guess the labs do feel a little bit separate, even though we’re on the hospital side. We’re in a separate building.

The resident doctor strike had a bit of an impact on our lab work. When we were trying to phone people up to tell them about results, consultants, who replaced the striking resident doctors, were not used to having to deal with that. So some of them were a bit confused. And also they’re not used to doing the basic ordering of tests. Sometimes they’d order some really weird things or don’t know how to do things. Otherwise the strike didn’t have a massive impact on our work. We didn’t see a big drop in work particularly.

Organise the work differently

I think it’s quite close to being reasonable work, also because there have always been very active trade union people in the labs. Managers are very used to talking to them and referring to them and checking with them if this is or that is okay. But I think as the financial situation is getting worse for the NHS at the minute, there’s more and more pressure not to fill vacancies and things like that. The pressure on staff to work harder, to do more out of hours shifts is getting more. So I think things are not too bad, but I can see them getting worse, unfortunately.

How could we organise the work differently? The NHS is such a big and complex system to make changes in. If I can think of a change for our lab that seems logical to me in my area, management would say: “oh, no, because this would cause this to happen and that to happen”. So all these external factors stop us from being able to implement changes, but we are often removed from understanding these external factors.