Paediatric and perinatal pathology

What is the role of paediatric and perinatal pathologists? The work of perinatal and paediatric pathologists provides vital information to families during the most difficult periods of their lives, such as the loss of a baby or diagnosis of a child with cancer

There is a crisis in paediatric and perinatal pathology services in the UK. Persistent staff vacancies mean the workforce is unable to meet demand and families are suffering.

What do paediatric and perinatal pathologists do?

Paediatric and perinatal pathologists focus on the study of diseases and pathogenic mechanisms in fetuses, infants and children up to the age of 18 years. Although some pathologists specialise in either perinatal or paediatric pathology, most work across both fields.

Paediatric pathology has a crucial role in the diagnosis and treatment of a variety of conditions in infancy and childhood, including cancer and congenital conditions. Perinatal pathology includes the study of disorders of the placenta, problems affecting unborn babies’ development, and causes of miscarriage, stillbirth and neonatal (newborn) death. The increase in complexity of diagnostics, higher childhood cancer survival rates and greater knowledge of the different types of conditions that affect children requires ever increasing input from pathologists.

Paediatric and perinatal pathologists also carry out post-mortem examinations after the unexplained death of a baby or child. Their work can help families understand why their child died and identify inherited conditions that may put siblings or other relatives at risk. In many cases such information can be vital in treating other family members and aids treatment in subsequent pregnancies. In addition to undertaking post-mortem examinations, they can further support the ongoing investigative and communication process when a child or baby has died.

Technical advances mean that paediatric and perinatal pathologists can now provide much more detailed and comprehensive molecular data on the causes of death from genetic conditions and infectious agents. A recent focus by governments and other agencies to improve care for families after baby loss, improve safety in maternity services and reduce the risks has raised awareness of the provision of high-quality perinatal post-mortem and placental investigations.

Paediatric and perinatal pathology services are in a state of collapse. Paediatric and perinatal pathologists are working continuously under significant pressure, to provide high-quality care, but this is leading to stress and burnout. This leads to the workforce unable to meet demand, and leaving bereaved families waiting for answers after the death of a child – Dr Clair Evans, Chair, Paediatric and Perinatal Pathology Specialty Advisory Committee

The extent of the workforce crisis

The paediatric and perinatal pathology workforce crisis has been worsening since the early 2000s. The latest College report on the paediatric and perinatal pathology workforce – published in 2025 – confirms that:

the UK has 52 PPP consultants working 46.35 whole-time equivalents (WTE). This comprises 43 in England, 7 in Scotland and 2 in Wales. There are no consultants working in Northern Ireland.
37% of PPP consultant posts in the UK are currently vacant. Northern Ireland and the South West and Midlands areas of England have no consultants at all, which has led to total service collapse in these areas.
recruitment is almost impossible due to a national shortage of qualified pathologists; 83% of PPP consultants report issues with recruitment in their departments. Only 3% of PPP consultants believe that current staffing levels are adequate to ensure the long-term sustainability of their service.
25% of the consultant PPP workforce (13 consultants) are expected to retire within the next five years. There are only 13 resident doctors in PPP specialist training posts. This is insufficient to combat both longstanding vacancies and to cover expected retirements, let alone manage increased demand and future workforce needs.

Some services have managed to maintain paediatric pathology services with support from general histopathologists with interest or previous experience in paediatric pathology. However, this has not been possible for perinatal pathology or post-mortems, causing severe delays for families seeking answers. Mutual aid between NHS trusts and hospitals and outsourcing have not been able to avoid the increasing backlog.

The crisis is parallel to workforce problems affecting mortuary technicians with expertise in perinatal and paediatric cases. This also limits the capacity of the consultant workforce. Anatomic pathology technicians (APTs) play a key role to provide a high-quality service to patients and families. Mortuary staff receive and release bodies following Human Tissue Act requirements, helping with post-mortem, reconstructing and preparing the body for viewing and, importantly, running the bereavement suite.

The effect of the paediatric and perinatal pathology workforce crisis on families

The workforce crisis is having a significant and distressing effect on families who regularly report long and harrowing waits for post-mortem reports. 1 in 5 families are now waiting 6 months or more for their post-mortem report, and some longer than 12 months. There are simply not enough consultants to undertake this work and families are suffering.

The national shortage means grieving families are being left in limbo to find out why their child has died, while delays to post-mortem findings can also hold up potentially lifesaving screening and prevention for relatives where an inherited condition may be involved.

In areas where services have collapsed and there are no paediatric and perinatal pathology consultants in post, families are forced to rely on services hundreds of miles away requiring many families to travel long distances for post-mortem examinations.

What is needed to address the crisis

Aligned with the RCPath Workforce Strategy 2025–2028 action is needed to train more pathologists, retain existing staff and reform service models. Contingency measures must also ensure that families remain the priority by using the current workforce most efficiently.

To address the significant challenges faced by PPP services across the UK, the College is calling on policymakers and employers across the UK to:

introduce a phased expansion of PPP training posts up to 37 across the UK by 2030 to help manage current consultant vacancies and help ensure succession planning. This should be supported by a dedicated, funded and flexible recruitment strategy including support for potential international candidates.
increase protected time and funding for professional development to enable consultants to have time to train the next generation and support their own personal development
increase workforce support with dedicated biomedical scientists, APTs and administrative support in each paediatric pathology unit – delivered flexibly to meet the needs of the service, together with managerial support that recognises the unique pressures facing paediatric and perinatal services
commit funding and resources to continue the development of 10 fellowships; an advanced training program in paediatric and perinatal pathology
upskill scientists and histopathologists to engage in placenta reporting
continue prioritisation and outsourcing as effective ways of managing excess workload informed by clear guidance so that workload aligns with that of the highest value.

Our work in this area

Multiple approaches are needed to increase capacity within the paediatric and perinatal workforce. We continue to make the case for urgent action to NHS leaders and governments and are actively liaising with MPs, charities and the All-Party Parliamentary Group on Baby Loss.

There is recognition among stakeholders that the crisis requires urgent action. However, the results will not be immediate and funding and educational support needs to be in place for workforce development. Investment in digital pathology and in research projects to aid the progress of artificial intelligence and other programmes are also essential to help transform paediatric and pathology services in the NHS.

Recent developments include:

IBMS and RCPath are co-developing a 2-year Diploma in Placenta Reporting for appropriately trained biomedical scientists to take on clearly defined placenta reporting responsibilities under medical supervision
Discussions with NHS England about development of a formalised Clinical Network.

We will continue to work with all external and internal stakeholders to address the workforce crisis. Our priority is to ensure PPP services receive the resources they need so that parents and families across the UK can access safe, high-quality care and support.