Bulletin January 2020 Number 189

So, it has been an interesting time in the UK in relation to the general election, and the result has promised more interesting times ahead with the withdrawal of the UK from the European Union.

So, it has been an interesting time in the UK in relation to the general election, and the result has promised more interesting times ahead with the withdrawal of the UK from the European Union. We have written to you previously regarding thinking about the consequences for pathology services. There are mitigations to the risks relating to imports of drugs, supplies and diagnostic equipment that are being planned for by the government, but once again we would encourage you all to think about your local contingency plans in the event of shortages of the things you need to provide services for patients. Shortages of drugs and particular reagents have happened fairly regularly before Brexit and you have managed these through planning and cooperation, but do have a think about contingencies. Plan for the worst, hope for the best! 

Ten doctors and several others with a health background have been elected in the new parliament in the UK, including Tom Randall from our own College Examinations team, who has been elected as MP for Gedling – his home area. We are so glad to see an MP with a deep knowledge of pathology services and our work in government!

The Queen’s Speech saw the announcement that the NHS’s multi-year funding settlement would be enshrined in law, new visa arrangements will allow qualified doctors, nurses and health professionals to have fast-track entry to the UK, and the bill to fully establish the Healthcare Safety Investigation Branch as an arm’s-length body. Among elements of the bill, it will amend the Coroners and Justice Act 2009, giving NHS bodies in England the power to appoint medical examiners and placing a duty on the Secretary of State to ensure that enough medical examiners are appointed in England. 

Our own election has seen Fellows select my successor, and we are very pleased to welcome back a familiar face as President-Elect, Professor Peter Furness. Peter’s portrait already hangs in the College as a past President, and he was instrumental in establishing the medical examiner system, a key patient safety development. His passion for the College has seen him return, so we welcome him and wish him all the very best when he takes over as President in November 2020! 

There has been a great deal of soul-searching about encouraging people to work in and stay in health services in light of global, national and local staff shortages. One of the key features that you may start to hear about is improving working lives. We all need better working lives. Part of this relates to IT that helps not hinders, part of this is flexibility and control over your work pattern, and another large part is compassion. The General Medical Council has started a large piece of work around ensuring compassionate leadership, and while the phrase may jar a little with some, the fundamentals relate to kindness and respect in the way you deal with colleagues, things that, generally, we are known for in pathology.

There has been a lot of public scrutiny of health services recently, in the UK and abroad. The UK has seen waiting times increase for patients in emergency, elective and cancer services, and the patient demand and workforce issues that lie behind this you will be aware of (not least from reading my last Bulletin article!). We have been pleased to see a stop-gap solution to the pensions issue in England that was hampering pathologists from taking on additional work, even where they wanted to. This is an in-year solution, but welcome none the less. We will continue to press for a more sustainable system. 

In the Republic of Ireland our members have been seeing extensive press coverage of issues relating to discrepancies in cervical cytology screening and subsequent reports on the service. The Faculty of Pathology of the Royal College of Physicians of Ireland have been advocating for investment in workforce and for better public understanding of screening, and we have been supporting them in this. No system is perfect, but the screening programmes do save lives. What has been particularly poignant in this press coverage has been the role of patient advocates, who have lived experience of the imperfections of the system. Many have developed cervical cancer and been found to have discrepant results from the original report. I was particularly impressed by the integrity of one woman in particular, who despite having undergone life-changing treatment herself, has continued to publicly urge women to attend screening.

Public benefit through national-level programmes is also part of the brief for the chief medical officer (CMO) of each the four devolved governments in the UK, and we work closely with them. Professor Dame Sally Davies has stepped down as CMO for England following a very successful term of office, and having made a considerable impact across a range of programmes, including raising the profile of antimicrobial resistance. Our ‘One World’ work with her on this has included the important contributions from our veterinary pathologists as well as our microbiologists. I have enjoyed working with her and have been really impressed by her pragmatism, energy and commitment. Into the CMO for England role we warmly welcome Professor Chris Whitty, a physician and epidemiologist, with considerable expertise in infectious disease and research. He has already come to the College to meet with me and talk though key issues. We also had a very productive meeting at the Academy, with the other Colleges present, and we very much look forward to working with him.

Our calls for investment in pathology infrastructure are seeing some ‘green shoots’ growing. Some networks have seen investment in new LIMS systems, which, while well overdue, is very welcome. Others have seen a roll out of digital pathology. This is patchy and not at a scale that we know needs achieving, but pleasing to see. There is also a process for rolling out digital and AI exemplars more widely, with a £20m investment across England, where imaging and pathology are competing for this considerable investment. At a personal level I cannot help but think that these investments will help us feel less neglected, and that they may pave the way for the implementation of decision support AI tools that can help save us time. Tools to help haematologists by highlighting potential malarial parasites or babesiosis in blood films, tools to quantitate types of blood cells without the need to use manual counters, ‘bug finder’ tools for histopathologists to help point to potential Helicobacter pylori in gastric biopsies, or the single pink Ziehl-Neelsen positive mycobacterium in a granulomatous tubulointerstitial nephritis (please!). So, do think about what tools would be helpful, and work with your organisations and industry to help make sure they help and that they can be implemented.

It has been fantastic to see the quality of entries for the Hugh Platt foundation essay prize – won by Keir Edwards, and the Professor Paola Domizio undergraduate essay prize – won by Toal O’Connor, and you can read more about these at: www.rcpath.org/discover-pathology/competitions/essay-competitions.html. Seeing and encouraging potential pathologists is a key part of our work.

Particularly pleasing on the research front has been the recent appointment of a brand new chair in pathology in the south of England, and a major programme grant to a neuropathologist. The academic strength in many of our specialty areas, including neuropathology, continues to grow with our next generation, with great advocacy from the chair of our Trainee Advisory Committee. There is ongoing work around support for cancer research, and I was pleased to see the commitment to diagnostics by Cancer Research UK. I will continue to work with them, sitting on their Clinical Advisory Panel.

As we come into 2020, I would like to congratulate Sir Simon Stevens and Professor Dame Sally Davies for their recognition in the New Year’s Honours, as well as all of the other recipients working in medicine and healthcare.

Finally, I wish you all the very best, and hope that you, and all pathologists, have a very good 2020.