Maturing or Truly Integrated? The Next Question for NHS Pathology Networks

NHS England’s Pathology Network Maturity Matrix has provided a structured way for pathology networks to assess their development. The framework considers seven domains, including governance, leadership, operating model, quality, IT and digital, workforce and shared supply chain. Networks progress through five stages, from pre-emerging to thriving.

That framework remains important. But the Pathology Transformation Review 2026, commissioned by the Institute of Biomedical Science and chaired by Lord Carter of Coles, introduces an additional perspective. The review uses the Pathology Network Maturity Assessment as contextual evidence, but explicitly states that it is not used as a standalone performance measure.

That distinction matters because it raises an important question for pathology leaders: if a network is progressing through the maturity framework, what evidence demonstrates that this progress has translated into a service that genuinely operates as one?

Maturity matters. So does operational proof.

Carter approaches the question from an operational perspective. For its analysis, the review classifies pathology services according to activity flows and the degree of operational integration, rather than self-assessed maturity. Integration is defined through characteristics including shared governance, interoperable digital systems, harmonised operating procedures and quality arrangements, and the ability to redistribute work and workforce across sites.

This creates two useful questions for pathology leaders: how far has our network developed, and what can our network now demonstrably do as a result? At JTG, we believe that second question should become increasingly important.

What does operational proof look like?

Consider a network with an established digital strategy and roadmap. That demonstrates progress, but operational proof is whether information can move reliably between sites, whether workload and capacity can be seen across the network, and whether that information can be used to make better decisions.

Similarly, having a network workforce strategy is important. Operational proof is whether expertise can actually be deployed across sites when demand changes. Common governance is another essential foundation, but operational proof is whether the service can identify a developing backlog in one part of the network and coordinate an effective response across organisational boundaries.

The distinction is subtle but important. Transformation should ultimately be visible in what the service is capable of doing, not only in the structures and programmes that have been put in place.

Technology programmes should face the same test

This has particular implications for pathology technology. A successful LIMS implementation, interoperability programme or digital pathology deployment is a significant achievement, but completing the technology programme should not be the final measure of success. The more important question is what that investment has enabled.

• Can work move more easily?

• Can specimens and results be followed across the pathway?

• Can specialists operate more flexibly across locations?

• Can network leaders see demand, capacity and operational risk more clearly?

• Can the service respond more effectively when one site experiences disruption?

These are not simply technical measures. They demonstrate whether technology has contributed to the network operating more effectively as a single service.

From maturity to measurable capability

The Carter Review is not suggesting that the existing maturity framework should be replaced. Nor are we. The opportunity is to connect maturity more explicitly with evidence of operational capability and performance.

That means asking not only whether the right governance, workforce, digital and operating arrangements exist, but also what those arrangements allow the service to achieve. For pathology networks, the next phase of transformation should therefore include a stronger focus on three questions: what can we now do at network level that we could not do before; where do organisational or technical boundaries still prevent us operating as one service; and what evidence shows that integration is improving resilience, access, workforce flexibility, quality or efficiency?

Carter’s analysis makes clear why those questions matter. Its operating-model segmentation is applied across quality, workforce, access, digital capability and value so that integration can be considered alongside measurable performance.

The NHS has already established a framework for assessing how pathology networks mature. The next challenge is demonstrating what that maturity delivers.

For JTG, that is where the conversation around pathology transformation should now move: from progress against a programme to evidence that the network can genuinely operate, respond and improve as one service.