Bulletin October 2020 Number 192

Dr Mike Osborn will become our 20th President on 19 November at our 2020 AGM. In this interview, I asked Mike what attracted him to pathology and what his aspirations are for the College as he takes the helm during these unprecedented and challenging times.

Tell me about your career so far. What attracted you to pathology?

I qualified in London from Guy’s and St Thomas’ Hospitals in 1995. I enjoyed most subjects at medical school and could easily have followed many career paths, but I did a BSc while there in Experimental Pathology. I found it, together with our general pathology course, really relevant, interesting and very well run by some fantastic and entertaining teachers, such as Professor Isabel Phillipe, a gastrointestinal (GI) histologist, and Professor Jangu Banatvala, a virologist. Honestly, everyone in my year enjoyed the pathology course and it was a real highlight of our training, but perhaps me more than most and this inspired me to become a pathologist.

I graduated at a time when there was unfortunately a national block on new training positions in pathology, but having wide ranging interests I took up the St Mary’s Hospital surgery rotation instead and passed the MRCS exam in 1998. The surgery training was excellent experience and I made friends with many great people that I still work with today as surgical colleagues. At the time I passed my MRCS there were very few SpR posts but I maintained my interest via key contacts within histopathology such as Professor Rob Goldin. Again, they inspired me and nurtured my interest in pathology so that when a training post did come up at St Mary’s, I took it, got on the North West Thames Histopathology training rotation and the rest is history.

I passed MRCPath in 2004 and became a consultant specialising in GI pathology, post mortems and teaching undergraduates in 2004.

What do you think are the main challenges for pathology and the College?

The main immediate challenge remains the COVID-19 pandemic. It is far from over and will dominate everything we do as a College, as healthcare workers and individuals for a long time to come.

Firstly, there are issues relating to COVID-19 testing. The entire national response to this disease is dependent on quick, accurate testing of individuals, be that in the community or in hospital, to see who is infected and who is not. Only when we have this level of testing can we as a country efficiently manage the outbreak and, in the NHS, deal with the post-COVID-19 lockdown treatment backlog.

Our College, particularly our virology and immunology colleagues, are at the forefront of developing and running these testing programmes and as a College we need to ensure they have the funding, resources and support they need to be able to do that effectively. We also need to lobby government and other involved parties to ensure healthcare professionals are able to clearly direct how we respond to and deal with the pandemic.

While one challenge is testing, the other is the treatment backlog as a legacy of lockdown. Cancer care is the most obvious area affected and there is a huge issue in relation to delays in diagnosis and treatment of patients. However, this backlog has impacted on many and varied areas of healthcare; for example, I saw an article about tooth decay in children reaching extremely high levels following lockdown. So there are major effects on many aspects of patient care and this backlog will dominate the lives of all our members whatever their speciality.

Workload will increase dramatically and we need to ensure this is recognised, supported and funded. So often in my work for my trust or the College I have seen local or national plans highlighting all the steps in a certain patient care pathway that include nursing, radiology, surgery, palliative care, etc. – all discussed, supported and funded. All these and other services are invaluable and have to be included, but I often see that pathology is missing in these plans, despite our specialties being absolutely vital to so many areas of patient care, be that in the initial diagnosis or in the assessment of the patient before, during and after therapy. As a College we will have to lobby hard to ensure that this does not happen in the COVID-19 recovery phase and beyond.

All our work, be that related to COVID-19 or other aspects of healthcare, must be recognised, properly funded and fully supported. The pandemic and subsequent recovery have really highlighted and concentrated the major challenges affecting every specialty in the College in many other areas. Of these, workforce clearly remains a significant issue. We must ensure adequate staffing and recruitment in all our specialties going forward. While we are doing well in many areas, I know there are significant difficulties particularly in some regions in filling training and consultant posts. An example of such difficulties was highlighted to me in my recent discussions with microbiology colleagues.

Funding and support for pathology, as I mentioned earlier, remains a significant challenge and this will certainly be further exacerbated by the current poor state of national finances. We have a strong case to make to the UK government and the devolved administrations to ensure that we as a group are not forgotten and have the resources we need going forward. Pathology services save money as well as improve patient health, through prevention and early diagnosis. Pathologists are vital to screening programmes; for example, those which have led to early diagnosis of cancers resulting in improved survival rates.

You highlighted the importance of returning the College to its core functions. What are your main priorities as President over the next three years to achieve this?

There is a clear appetite for change. Members have told me that they feel that the College no longer fully represents them, fails to support them and represents poor value for money. Tackling this is one of my main priorities.

COVID-19 (sorry to go on about COVID-19 but it has and will continue to dominate everything) and the associated lockdown has severely stressed the College’s finances, as it has stressed the finances of all similar institutions. For example, with no commercial events

happening in the College we lost a significant income stream. The College management team and trustees under Professor Jo Martin have done fantastic work in keeping the College solvent during this crisis. I plan to review the finances and to build on this fiscally prudent culture going forward to maximise savings while still delivering the College services the members want.

I plan to review and strengthen our relationships with other organisations. We work closely with many other organisations such as the UK Accreditation Service (UKAS), General Medical Council (GMC), and Human Tissue Authority (HTA) and this will continue. However, we have to ensure they value our input and listen to our perspective – and act on our advice where appropriate.

I plan to foster closer ties to relevant research and training organisations such as the British Division of the International Academy of Pathology (BDIAP) and The Pathological Society of Great Britain and Ireland. Working together we can reduce duplication of activities, better use resources and develop a truly fruitful training and research environment for the benefit of all in pathology and beyond. Our work with the charity sector has become increasingly important, whether it’s with Cancer Research UK to advocate for a stronger pathology workforce, supporting Blood UK where they have concerns about people who have needed to shield due to COVID-19, or helping raise awareness of less understood or rare diseases.

I have already discussed my priorities with regards to ensuring we get the funding, support and recognition we deserve from government and other stakeholders. By doing this we will support our members in their working lives, allowing them to provide the best pathology services and, through those, the best patient care possible.

Professor Jo Martin and the team have done a fantastic job setting up the new Digital Now platform for the College. I plan to champion and develop this platform to allow all members from all around the country and indeed the world to interact with their College. It will be a fantastic resource for teaching and learning, overcoming barriers of travel, time and cost and allowing anyone to provide teaching. My hope is for people to be able to easily, quickly and efficiently access bite-sized or larger teaching sessions, fully and automatically CPD accredited, anywhere that they can use their mobile devices. As well as teaching, we aim to develop the Digital Now platform to host meetings and discussion forums to enable pathologists to have their voice heard and their needs met by the College.

How do we ensure all specialties are represented by the College, across all levels of our work?

I have met with representatives of many of our specialties already and discussed with them their work, training, workforce and other issues that they feel are important in their area. Going forward I plan to have meetings with the leads of many College committees and groups and hope to get a perspective from them on what they need from the College and how best we can deliver that. I will also restart the lab tours – either face-to-face or digitally. These have, for previous presidents, proved an excellent way to gain an insight into our multiple pathology specialties and so help us to better represent them all.

We are working hard to encourage pathologists from all specialties to become involved in College activities at local or national level. I want to improve digital connectivity at the College, which will allow for very simple and easy interaction from all specialties and grades in all regions of the country and indeed the world, ensuring everyone has a chance to be involved and to be heard.

How can we get more members engaged and involved in College work?

I aim to encourage all pathologists to engage with the College, to end the ‘them and us’ culture. I want to expand diversity among those taking on College roles and beyond. Everyone’s view is valid, we may not all agree, but we can listen to each other’s opinions and in that way harvest the best ideas our profession has to offer. Everyone has something to offer, be that teaching, being on a committee, developing guidelines, mentoring, etc. and be that local or national. It is your College so please get involved. Improved digital connectivity will really help with this by breaking down the barriers of travel, time and cost that have hampered so many people from getting involved in the past.

What are your plans for addressing greater diversity and inclusion across all strands of our College activities?

The College needs a strong, supported and inclusive membership reflecting the diversity in society as a whole. With this in mind, we are setting up the College’s Equality, Diversity and Inclusion Group to highlight and address many of the relevant issues, including working with outside organisations wherever needed. We also need good data to better understand the needs of our membership. Essentially, we want to be open and welcoming to all our members whatever their background or situation, and truly represent them at all levels and we will strive towards this goal.

How do you plan to engage and keep in regular touch with international members of the College?

Our international members have so much to offer in terms of expertise and experience. Accordingly, our international membership is hugely important and something the College is very proud of. I’m looking forward to hearing more from our global pathology community at International Pathology Day in November. I want to harness this expertise and further expand this membership. Once again, digital connectivity will really help with this by enabling us and our international members to engage with each other. It will provide access to international training opportunities and allow members to become active teachers and participants in far more College events than previously, for example by allowing them to attend virtual committee meetings. I will also aim to organise virtual international lab tours to meet our international members and learn more about their needs and how the College can better represent them.

Do you have any particular messages for our trainees and how the College can support them?

Trainees are the future of pathology and of the College and we must do our best to support them. The College has a fantastic training committee and superb trainee representatives. Their input is hugely important and valued. The major factor on most trainees’ minds is passing exams and we must continue to ensure that these are fair and well organised. We must be mindful of the cost of exams and must facilitate and support training programmes in all specialties to help trainees pass at their first sitting whenever possible, so minimising the cost to them.

In some lab-related specialties such as microbiology, virology, haematology and chemical pathology, there are specific issues around access to labs for training that have been exacerbated by centralisation of services. We must ensure trainees can easily access the training they need. In histopathology there is the question of modularisation of the Part 2 exam. This possibility needs to be revisited. Face-to-face learning opportunities are currently limited and we need to help address this safely. We hope to create a library of talks and training tips, e.g. through webinars, for trainees across specialties and this will link in with the Digital Now project.

How should we optimise use of our new College building?

Once again, COVID-19 has and will continue to completely alter how we use the College building, but all other offices and institutions are facing the same uncertainty. Working from home and attending digital meetings have become the norm. Many prefer this way of working and it seems unlikely we will go back to the pre-COVID-19 ways of working when the pandemic is over. Nevertheless, we will need some direct person-to-person interactions, while team building and networking activities need face-to-face contact and events, so the College building will remain vital.

While we may need less space ourselves, we can take on more tenants and we will continue to be a popular venue for events once they restart and this will also provide a valuable source of funds. The management team and trustees have done a great job in responding to the COVID-19 crisis and will continue to do so.

Can you describe your vision for pathology’s place within healthcare, among policy makers and the public?

Pathology has come into the foreground during the COVID-19 pandemic. COVID-19 testing has never been out of the news and articles dealing with virology, immunology and many of our other specialties take up significant amounts of media time and space. This has broadened the public and policy makers’ perception of what pathology is and we certainly need to build further on this.

I want to use our members’ voices to shape healthcare policy and practice, showing how pathology is central to patient care. Our voice is independent and evidence-based and we can raise awareness, influence and bring about change.

The increased appreciation and recognition of all pathology specialties by the public, the NHS, policy makers and governments will help us to lobby for adequate funding, staffing and support for our activities to help us provide the very best patient care we can.

What will be your key message to the Health Secretary?

Do not forget pathology. Without us you will have no testing, no diagnoses and no treatment. Do not forget pathology.

(I once hijacked Sir Simon Stevens – CEO of the NHS – on his way out of a meeting after a cancer pathway had failed to include pathology and strongly stressed this point to him, so I’m happy to raise it in any circumstances to anyone.)

And what impact do you think Brexit will have?

We do not as yet know what our relationship with Europe will be going forward, so in reality we have to wait and see. There has already been a lot of preparation, with many labs moving tests back into the UK and locally. There could be a big impact on many areas such as staffing, access to reagents and consumables, academic activities and research. Hopefully the impact will be minimal in terms of service provision and development, but we are keeping the situation under review and will do all we can to mitigate any negative impact.

Finally, how do you try and maintain a work-life balance?

I try to set separate time aside for work and for life outside work. Obviously, that does not always work out and urgent things on either side may intervene, but I do like to try and keep in touch with my extended family, even if only virtually at present. I enjoy listening to music, with perhaps rather wide tastes ranging from heavy metal to classical, and going to art galleries when feasible. I do enjoy running including 10K runs but less so recently and do hope to get back to this when I can.

Interview by Dr Shubha Allard, Clinical Director of Publishing and Engagement