The theme for this Bulletin is ‘Quality in pathology’, a topic that has been occupying much of my time recently. I am grateful to Dr Lance Sandle, Vice-President for Professionalism, for guest editing this issue.
The other vice-presidents will edit the next two issues, giving an overview of all College business over the course of the year.
College response to the Pathology Quality Assurance Review
January saw the first anniversary of Ian Barnes’ Pathology Quality Assurance Review (PQAR). I was delighted to be invited to speak at the Frontiers in Laboratory Medicine meeting in Birmingham at the end of January about the College’s response to the report. I joined Professor Jo Martin, National Clinical Director for Pathology, Professor Eric Kilpatrick, President of the Association for Clinical Biochemistry and Laboratory Medicine and Nick Kirk, President of the Institute of Biomedical Science, to give the College’s perspective on the implications of the report and what the College has done so far to implement the recommendations.
Reassuringly all the organisations had a very similar approach, the main themes of which were the importance of communication and collaboration. You may have seen and commented on the College’s two documents summarising a proposed approach to implementing the PQAR’s recommendations. The first document set out the proposed committee structure to deal with the changes and the second looked at how personal proficiency might be assessed.
I am very grateful to everyone who took the time to respond to the documents when they were circulated for consultation; your feedback is much appreciated and will be carefully scrutinised and incorporated into the next iteration of the documents. Unfortunately, but not surprisingly, there isn’t likely to be any money from NHS England to accompany the recommendations for the College, which will limit what we can do. Progress will be reported in future issues.
Much of my time over the last few months has been spent highlighting the advantages of implementing the long-delayed medical examiner system. Reform of death certification and the way in which deaths are investigated has been called for repeatedly for decades, most recently by Dr Bill Kirkup CBE, who chaired the investigation into maternity and neonatal services at Morecambe Bay, and Sir Robert Francis in his report into Mid-Staffordshire.
Both are seeking recommendations made by Dame Janet Smith in her report of the Shipman Inquiry to be realised. Legislation was passed with cross-party support in 2009 and pilot centres around the country
tested the system. Feedback from the pilots was uniformly positive, with increased accuracy of death certificates, a reduction in the number of deaths being referred to the coroner unnecessarily and a significant number of deaths being identified that should have been referred to the coroner but were previously missed. Interestingly, litigation in the pilot sites fell dramatically as families received answers to their questions about their loved ones’ death without having to resort to legal action.
The pilot sites were also quick to spot patterns of deaths, with a cluster of just three similar deaths in one organisation being highlighted and action taken to prevent further such deaths. It appears that medical examiners improve accuracy of death certificates, ensure that the correct cases are referred to the coroner, improve relatives’ satisfaction, improve patient safety and save money – an unusual combination.
Former College President, Professor Peter Furness, has been appointed National Medical Examiner and is ready to lead the network of examiners when they are appointed. A training curriculum has been developed and guidance and a job description are ready to use.
There was a surge in media interest in medical examiners in January to coincide with the 15th anniversary of Harold Shipman’s conviction. I was interviewed live on the Today programme with Chris Bird, whose mother was one of Shipman’s victims.
To hear him speak so powerfully reinforced just how important the role of medical examiner could be. Other
interviews included BBC News, BBC Radio Manchester, BBC North West television and Radio 5 Live and phone interviews with Channel 4 and the Health Service Journal. An eight-minute interview on Going Underground on RT UK, a global online news service, was aired several times and gave an opportunity to explore the topic in more depth. Letters outlining the main issues were sent to parliamentarians, including the Prime Minister and Secretary of State. Shadow Health Secretary Andy Burnham quoted the College
statement in his response to the Francis report on whistle-blowing in the House of Commons in February and Liz McInnes MP referred to it in the discussion of the Morecambe Bay inquiry.
In that debate, Secretary of State Jeremy Hunt said, “I can only commit now to us introducing independent medical examiners as soon as possible. We are wholeheartedly committed to this,” which is probably as much as we can hope for at this stage in the parliament. It is unlikely that anything will happen before the general election but we will keep the pressure on and contact the new government as soon as they’re in power.
Medical Innovation Bill
You may have been following the College’s response to Lord Saatchi’s Medical Innovation Bill; it has occupied the College for some time and my predecessor Archie Prentice reported on it in detail in the July 2014 Bulletin. I have continued to build on Archie’s work opposing the bill, talking and writing to peers and MPs about our objections. Crossbencher Lady Masham quoted from one of our letters in the House of Lords debate and the amendments we, and others, called for were made. The last opportunity to oppose the bill came in the House of Commons at the end of February. Despite supporting the bill in the Lords, the Liberal Democrats withdrew their backing in the Commons, effectively blocking its progress this parliament.
The Lib Dems said concerns from patient groups and experts had changed their minds so I believe the College’s continued opposition and reasoned arguments contributed to the decision. Despite opposing the bill, the College remains committed to supporting innovation in healthcare and will work with national and local organisations to promote and facilitate research. The College will play a significant role in the newly formed Cancer Taskforce chaired by Harpal Kumar, the Chief Executive of Cancer Research UK, for example.
Trainees and undergraduates
One of the pleasures of being President is the chance to meet many trainees in all specialties around the country. I was recently put on the spot by London trainees in a recorded interview about my career, the College and the future of pathology.
The same afternoon I attended my first meeting of the College’s Trainees’ Advisory Committee since my term of office began. This was a valuable opportunity for the trainees to ask questions about all aspects of College work and for me to learn about their concerns and update them on what’s happening at the College.
We know that the more undergraduates are exposed to pathology and pathologists at medical school, the more likely they are to consider pathology as a career and understand how to use pathology services as junior doctors. Dr Nicki Cohen has developed an undergraduate pathology curriculum using the Delphi method, a process to which many Fellows contributed.
The curriculum sets out the minimum knowledge all students should have by the time they qualify. It will be launched in June and shared with all medical schools in the hope that core pathology knowledge will be included in all medical schools’ curricula.
Last August saw the first pathology summer school, organised jointly by the College, the British Division of the International Academy of Pathology and the Pathological Society. Following extremely positive feedback from participants, the second summer school will be held in Oxford this August.
Temporary and permanent premises
As you know, the College moved out of 2 Carlton House Terrace, its base for the last 40 years, on 6 February and reopened at its temporary premises at 21 Prescot Street on 9 February. The move went without a hitch, largely thanks to the excellent planning and organisational skills of the College staff. I would like to take this opportunity to thank all the staff for their hard work and good humour, particularly those who worked over the weekend to ensure that all the IT equipment, phones and furniture were in place to enable everyone to start work as normal on the Monday morning. I had seen the new office space before meeting rooms were built and before desks were installed but was pleasantly surprised when I arrived after the move to find that the new premises were very spacious and light and much bigger than I’d expected once everything had been moved in.
The staff of The Royal College of Psychiatrists, who occupy the rest of the building, have been very welcoming, and even invited the College staff for drinks on their first day. I don’t think we could have found a better temporary location while our permanent home is refurbished.
The most exciting news is that we have bought our permanent premises at 6-8 Alie Street, a few hundred yards from Prescot Street in an up-and-Being interviewed about medical examiners on Going Underground coming part of East London close to good transport links. Our design team are currently putting together plans for the new building and will submit them to the local council as soon as possible.
It is likely to take six to eight months for planning permission to be granted, following which building work will start without delay. Apart from the façade and the core of the building, everything else will be completely rebuilt to our specifications, including a lecture theatre, meeting rooms and staff offices. It is anticipated that there will be some spare space on the top floor, which can be rented out until we need it, much as The Royal College of Psychiatrists is renting their fourth floor to us at the moment. This income will offset some of the costs of the renovation work.
Updates about the new building will be posted on the College website and future Bulletins. In the meantime, do come and visit 21 Prescot Street if you’re passing; there are plenty of spare desks, free wifi and hot drinks are always available.
Having led the College’s public engagement programme for the last seven years I’ve found it surprisingly easy to hand over responsibility for this area of College work to Dr David Bailey, Vice-President for Communications. However, public engagement remains close to my heart and I’ve enjoyed continuing to contribute to public lectures, schools careers days and professional meetings. I am delighted that National Pathology Week (NPW) and International Pathology Day will be taking place again this year and am particularly pleased that molecular pathology will be the focus for NPW. David is also working to reinvigorate lay involvement at the College, something I believe is vital for our work.
Clinical Excellence Awards
If there’s one topic guaranteed to provoke strong opinions it’s the Clinical Excellence Award (CEA) scheme administered by the Advisory Committee on Clinical Excellence Awards (ACCEA). This year’s round appears to have been more controversial than ever, with many consultants failing to have their awards renewed. I’m grateful to all the members who took the time to respond to the email circulated by Dr Rachael Liebmann, the College Registrar, asking for feedback. The (anonymised) information provided has been used to inform the College’s response to several consultations on the role of ACCEA, including feeding back directly to ACCEA as part of its triennial review.
A College response has also been submitted via the Academy of Medical Royal Colleges and the British Medical Association. The feedback submitted has focused on the challenges of providing evidence of excellence in all five scored domains, the disadvantages faced by pathologists compared to more patient-facing specialties, the differential distribution of awards to academic and non-academic consultants and the unfairness of consultants returning to their basic salary if their national award is not renewed. The future of
CEAs is uncertain, although it appears that there will be a round this year.
At one of the meetings to discuss the awards, someone pointed out that they are very good value as for every award given, another ten people are motivated to excel. I would suggest that the opposite is true – for every award not awarded or renewed, there will be ten (or more) people who are demotivated – a real worry for the College as it may result in reluctance to contribute beyond the already challenging day job and reduce the number prepared to take on national roles.
I hope this has not already started; no applications were received for the recently advertised role of Assistant Registrar, an Honorary Officer post that has previously been very popular. This post is being advertised again (see page 107) and I hope that Fellows will recognise the opportunity to contribute to the future of the profession and consider applying. I or any of the College Officers would be very happy to have an informal chat about the role if you are interested.
A recurring theme in this issue is the difficulty of recognising and rewarding quality, whether it’s personal proficiency, laboratory performance or clinical excellence. There are no easy answers but I will do what I can to clarify and simplify the process, supporting members to provide a high-quality service for their patients and ensuring that their efforts are recognised.
Dr Suzy Lishman