Looking back at my time growing up on a deprived council estate, I became aware of health inequalities at a relatively young age. It was one of the early drivers for me to forge a career in medicine. I spent most of my teenage years as a volunteer for the British Red Cross; it was clear to me that those with less money, mental health and addiction issues, and disabilities were less able or motivated to access the healthcare that they needed.

Fast forward 40 years and I am not sure that things have improved much for these and other minority groups. Cuts to public health funding have compounded health inequalities. Certainly, plenty of evidence now exists that the reduction of healthcare provision – experienced through the pandemic and now residing in waiting lists and a gridlocked NHS – affects deprived and minority groups to a much greater extent, with key health metrics now widening across our population.

The recent Darzi report highlighted many of these deficiencies within the NHS. It is, therefore, important that this College works hard to ensure health inequalities reduce, especially with regard to those pathways where pathology plays a pivotal role. The future funding of pathology services, both capital and workforce spend, are hugely important, but so is improving the way that pathology services are used, misused and accessed.

This edition of the Bulletin focuses on many of the health inequalities that currently exist across healthcare. It would seem that such inequalities are present across the entire range of services we are involved in: prevention, screening, diagnosis, treatment and outcomes. The first part of reducing inequalities is, of course, being able to identify where and why they are occurring. The articles in this issue focus on examples such as cancer services, genomics and preventative healthcare.

Meanwhile, our new College strategy will focus on important areas such as workforce, reform, digitisation/AI, collaborative ways of working with industry and ensuring our voice is better heard across decision makers within government, both as a College but also as part of a stronger, louder Pathology Alliance.

Pathology has a pivotal role across all of healthcare and is now so important as the NHS tries to mend its “broken” status. Part of this needs to address the widening health inequalities that have emerged and worsened in recent years. Investment in pathology capital and workforce, improving access to pathology, improving knowledge among healthcare professionals and the public will not only improve pathology services but will also optimise the wide array of clinical services that are driven by pathology. Improving pathology will improve healthcare, reduce inequalities and, ultimately, improve outcomes for all.

The report of the independent review of the NHS by Lord Darzi and his team makes stark reading, but its contents are, of course, not a surprise to those of us working in healthcare. There is hope that it is the prelude to much needed increased investment in NHS services in the coming years but it is clear that such investment needs to be accompanied by reform of how we do things. The College is actively involved, through direct engagement with the NHS and government, but also via the collective work of the Academy of Medical Royal Colleges and the Pathology Alliance.

The new NHS 10-year plan for the English NHS and similar plans across the other UK nations are currently in development. They will outline what happens next. It is vital that pathology has an integral part in this. We are, therefore, developing our own 10-year plan for pathology and working with the Pathology Alliance to ensure that the collective voice of pathology is heard.

While the majority of College work within the UK is inevitably focused on England, the College continues to support and advise across the other 3 devolved nations. Many issues, especially workforce, are UK-wide. The College is committed to strengthening relationships across and with all 3 nations. Our regional council members for Northern Ireland, Scotland and Wales represent their respective nations and provide much valued and needed professional leadership locally to healthcare providers, government and other key stakeholders.

Our recent Celtic Nations Summit, held in the College, brought together the chief scientific advisors for the respective Scottish, Welsh and Northern Irish governments, prominent pathology leads, regional council members and other key College representatives, including honorary officers and our staff senior management team. Issues discussed included workforce and training, IT, digital and AI, strategies for key specialties and pandemic preparedness. A report will be published soon.

I also spent a very productive few days in Belfast, meeting with fellows, trainees, CMO/CSO representatives and other pathology stakeholders to learn about and discuss the key challenges and developments across Northern Ireland pathology services. I look forward to visiting Cardiff, Edinburgh and Glasgow in the coming weeks.

The College has many members and fellows working across the globe. While we cannot oversee and input to the pathology needs of other countries to the same extent as we do in the UK, our work in advising, assisting and helping direct pathology services in other countries is much valued and, of course, hugely dependent on the input and support of our members in these countries.

The College International team is as active as ever. We look forward to International Pathology Day on 6 November, which focuses this year on the important topic of antimicrobial resistance. The International team also hosted a series of antimicrobial resistance webinars, with speakers and attendees from over 30 countries.

The College was delighted to finally see the medical examiner system for England and Wales move to a statutory system from 9th of September 2024. This means that all deaths across all health settings that are not investigated by a coroner will be reviewed by NHS medical examiners.

The College has long campaigned for the introduction of medical examiners and worked closely with key stakeholders for many years to implement this important patient safety initiative. Since the roll out of the non-statutory system in 2019, the College has trained over 3,000 medical examiners and officers.

It will, of course, be interesting to compare and contrast the now quite different arrangements across the UK, with only a small proportion of deaths in Scotland and Northern Ireland undergoing equivalent scrutiny. Health is devolved, of course, and while the medical examiner/investigator systems are arguably less robust, this means that scarce funds can be spent elsewhere. Achieving the right balance overall is what matters. Such balance may be different in other settings or driven by different priorities and opinions.

Return to October 2024 Bulletin

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