COVID-19 backlog

Currently, one of the biggest issues in healthcare relates to the COVID-19 backlog. While much of the media coverage about this has focused on cancer treatment, this backlog is affecting all areas of healthcare and all of our pathology specialties.

There are a variety of projections as to how long dealing with this backlog may take the NHS. The statistic we as a College have been using in our discussions is from Macmillan Cancer Support (based on analysis of Public Health England’s figures) who project that it will take up to 15 months to address just the cancer backlog and only then if the system operates consistently at 110%.

Unfortunately, as you will be aware, the system at present is unable to operate at even 100% in many areas due to the constraints of COVID-19 infection control precautions and other COVID-19-related factors.

There were substantial workforce issues in pathology well before the pandemic, as well as other issues that affected our working lives, such as poor-quality IT and LIMS provision. These issues have not gone away and have only been intensified by COVID-19 and the associated backlog.

In addition to the backlog in direct healthcare provision, the COVID-19 pandemic has caused significant issues in other areas that affect us as professionals, particularly around the training of junior doctors, laboratory staff and other colleagues. There were substantial workforce issues in pathology well before the pandemic, as well as other issues that affected our working lives, such as poor-quality IT and LIMS provision. These issues have not gone away and have only been intensified by COVID-19 and the associated backlog.

Many members have raised concerns around these issues and how they can be addressed. Members have also highlighted concerns around the COVID-19 mega labs and other infrastructure, which were set up to help deal with the pandemic, and how they may be used in future in the provision of pathology services.

All these concerns are extremely valid. Pathology has suffered from chronic underinvestment for decades, with a significant impact on our workload and working lives.

With this in mind, the College has been working extremely hard, in all four nations, to highlight these issues to policymakers and the relevant NHS, training and other bodies. We want all pathology specialties to have the resources they need to provide the highest possible quality healthcare to our patients.

Highlighting the need for investment

The College is a member of the Academy of Medical Royal Colleges (AoMRC), the umbrella organisation for all medical royal colleges. The government tends to focus their liaisons with the medical profession through the Academy. On 8 September, I met Sajid Javid, the Secretary of State for Health and Social Care, through the AoMRC. This was an opportunity to discuss the need for increased resources for pathology to meet the long-term staffing crisis and address the high workload of our members. Mr Javid was extremely receptive to the points I raised and has suggested further meetings through the AoMRC, which will include us. I was extremely encouraged by this first meeting and hope that we can work with the Secretary of State successfully to ensure we have the tools we need to best do our jobs.

I also met Amanda Pritchard – the new Chief Executive of NHS England (NHSE) who replaced Simon Stevens in the summer – and I have met and have further meetings planned with Jeremy Hunt MP (Chair of the Health & Social Care Select Committee). Again, I raised issues around resources for pathology and genomics. In addition to these meetings, on 8 September, I gave a tour of my laboratory and the entire pathology department to the then health minister Jo Churchill MP, once more raising the issues of staffing and resources for pathology.

Meetings have continued with Steve Powis (Medical Director of NHSE) and his team, as well as Chris Whitty (Chief Medical Officer of NHSE) and others involved in high-level decision-making relating to the NHS. This included the chairs of the integrated care system (ICS) who are responsible for health provision regionally in England, and Sir Mike Richards, who is charged with rolling out community diagnostic hubs. We welcomed the announcement that 40 new hubs will open across England, bringing diagnostic services closer to patients. Investment in these new diagnostic hubs, with sufficient resources in terms of staffing, IT provision and connectivity with other systems (such as GP practices), will support their successful introduction. There will also need to be further expansion of the pathology workforce, and new ways of working, to manage the increase in referrals for further investigative tests from the hubs.

All these meetings have been very useful in raising the profile of all our pathology specialties and highlighting our workforce, funding and training needs. In these meetings and others, I have highlighted how any future use of the infrastructure set up to deal with the COVID-19 pandemic must not lead to fragmented pathology services.

Any future plans must ensure that patient-facing pathology specialties can continue with appropriate patient interaction and training is prioritised.

By highlighting the role of pathology and its importance, together with its history of chronic under-resourcing, I am confident our voice is being heard. While we may not receive all the funding or resources we might desire, I believe we are in a good place to receive a significant amount from the increased resources recently promised by the government to the NHS. I also appreciate that much of what I have said relates predominantly to NHSE but that we are a College that represents all four nations. Please rest assured the College is working very hard to engage with governments and relevant NHS bodies in all our devolved nations.

By highlighting the role of pathology and its importance, together with its history of chronic under-resourcing, I am confident our voice is being heard.

I would like to thank all the Chairs of the devolved nations for their hard work in this regard. Through the Chairs we have been in communication with and are working to organise meetings with Robin Swann MLA (Minister for Health, Northern Ireland), Eluned Morgan MS (Minister for Health & Social Services, Wales) and Hamza Yousaf MSP (Cabinet Secretary for Health & Social Care, Scotland), as well as the Chief and Deputy Medical Officers of the devolved nations. We have also been in discussion with the relevant NHS training and education organisations in all our home nations.

Lobbying governments and policymakers is clearly a work in progress but we are being heard and we will continue to be very active in this area to raise the issues that you, our members, highlight as important to you, and us all, as a profession.

Genomics roll-out

Genomics is a very rapidly developing area, both in terms of whole genome testing and testing of solid tumours. It offers huge potential, for example, in tailoring treatments specifically to each patient to maximise responses and improve outcomes. As a College, we are keen to embrace the advances in genomics and to support the widespread roll out of genomics testing around England via the Genomic Laboratory Hubs and the associated Genomic Medicine Service. However, you, our members, have raised significant concerns to us around the implementation of genomics.

Many of these concerns echo those I have described and centre around insufficient workforce and increased workload, particularly given that much of this extra work appears to be unfunded at present. In England, particular concerns relate to the speed of the proposed roll out and to the need to set up complex new tissue pathways involving additional fresh samples to facilitate this increased genomics activity. These are all very real issues that must be addressed if the expansion of genomics is to be as successful as we all hope it will be. The College is very conscious of these challenges, and we have been working extremely hard to ensure pathology and pathologists are involved in this expanded genomic roll-out at the highest level.

To this end, we have set up a group (the Cellpath Genomics Focus Group) consisting of genomics representatives from the devolved nations and pathology leads of all the genomics hubs in England. Working with the College’s Working Group on Cancer Services, this group provides up-to-date information and shares good practice from centres around the UK. They have surveyed members to improve our understanding of the issues and needs of our members and have started a variety of government-funded audit projects to further assess the service and issues with the roll out. All these activities help, and will continue to help, inform the College’s response to the development of genomics nationally.

Through  the  hard  work  of  these  groups  led  by  Professor  Sarah  Coupland,  Professor  Louise  Jones  and  Dr  Michael  Eden,  we  have  already  had  great  success   in   getting   pathology   and   pathologists   recognised  and  involved.  From  almost  no  voice  in  genomics, we now have representation on most of the significant committees involved in the roll-out. 

In addition to these advances, on 28 September we had a very successful meeting with Dame Sue Hill, Chief Scientific Officer for England, who is leading this project in England. As a result of this meeting, a ‘Task and Finish’ group to lead the English roll out of genomics is being formed, which Sue and I will chair. This will allow pathologists to help steer this exciting development in pathology services and help us try to ensure we have the resources we need to provide excellent patient care successfully. Again, I am aware that much of what I have discussed is focused on England; however, the College is very conscious of this and is working, through our representation in the devolved nations, to ensure we make a similar contribution to genomics and its expansion throughout the country, and lessons are learned across the UK.

Blood tube shortage

On a more acute footing, the College has been working extremely closely with colleagues in the Association for Clinical Biochemistry and Laboratory Medicine (ACB), the Institute of Biomedical Science (IBMS) and the National Blood Transfusion Committee (NBTC), together with NHS bodies and others, to mitigate the issues resulting from the Becton Dickinson blood specimen collection (blood tube) supply disruption incident, which began in August this year. Working through the Clinical Reference Group set up by NHSE to deal with this, we were able to provide expert advice to organisations hit by this issue to help them maximise the use of the reduced supply of consumables available. This involved producing guidelines on how to reduce demand for products not simply through reduced testing but, more importantly, through sensible use and ensuring best practice. Through the timely involvement of the College and other professional bodies, the disruption in supply of consumables has so far led to minimum disruption to healthcare provision, particularly around acute services. This is testament to the expertise of the College members whose advice was sought on this issue and without whom we could not have overcome this problem. Thank you to all involved. The College, ACB and IBMS hope to take ownership of the best practice guidelines produced and continue to update them for the benefit of our members and all professionals working in this field.

Patient Safety Awareness Week

As our work on the blood tubes incident demonstrates, patient care and safety are key areas for the College as we work with our members to improve the services they deliver to patients. To mark World Patient Safety day on 17 September, the Professionalism Directorate launched Patient Safety Awareness Week, which ran from 17 to 23 September. Throughout the week, activities and resources were shared on our website to encourage open workplace discussions and help members adopt a safer culture in the workplace, ultimately leading to improved patient safety and outcomes. Thank you to the Professionalism Directorate for developing the resources and all our members who participated and supported us during the week. You can still get involved now and access the resources online.

Opportunities to join the College

Finally, the College is recruiting two co-opted trustees to join our Trustee Board. College members and trainees who are based in the UK are eligible to apply. The recruitment forms part of the College’s drive to bring more diversity of perspective to our Board and we encourage all members and trainees, who fulfil the eligibility criteria, to apply. We especially welcome applications from people from low socioeconomic backgrounds, Black, Asian and minority ethnic communities, the LGBTQ+ community, disabled people and younger people, as these groups are currently under-represented on our Board. The closing date for applications is 5pm on Thursday 21 October and further details on how to apply can be found on our website.

Working for our members

I appreciate members often wonder ‘what does the College do for me?’ I hope that in this editorial I have given you a glimpse of the ways in which the College is focusing on making the needs of its members our prime directive. By advocating strongly for resources, by providing support and guidance, especially in the face of unexpected adversities, and by working to champion inclusivity and diversity, I hope you will agree that the College is trying to do what our members ask of us.

 

Professor Mike Osborn
President