A Journey to Pathology 3.0: Outside the Red Box

The political and economic factors shaping pathology often feel complex and elusive to many of us. Pathology is present at multiple stages along every single patient pathway and across all care categories. It contributes to diagnostics, screening, disease monitoring, and treatment management. To paraphrase my friend Khosrow Shotorbani , pathology can join its low-latency, longitudinal data streams with other sources of patient data, including emerging home monitoring, public health data and relevant social determinants. It has a unique position in the healthcare ecosystem. If the basics of network science are applied, pathology would be expected to have a very high Katz centrality score because it could act as the catalyst for care integration and connecting pathways and as a conduit of influence, ideas, and resources. ?

Why is it, then, that pathology services often receive only crumbs from the proverbial cake, treated more as an afterthought than a priority? The UK Autumn Budget 2024, allocating “￡1.5 billion for new surgical hubs and diagnostic scanners to build capacity for over 30,000 procedures and 1.25 million diagnostic tests as they come online”, does not explicitly mention investment in pathology; unlike radiology, it is invisible and, I bet, will be expected to somehow deliver on a short notice. ?

I cannot blame the Chancellor for not spending time learning what we could do for the entire healthcare system with a pretty modest jumpstarting investment. She is doing her job, and whatever your economic philosophy may be, you must admit that, given the circumstances, she is bold and consistent. Many people who understand the economy much better than me prefer the fiscal choices made – “Scandinavisation” of the UK economy with more spending and capital investments rather than Austerity 2.0. We are in an economic environment that has not been seen since the Napoleonic Wars: wages and productivity did not grow while the annual deficit is hitting the ￡130 billion mark, and debt is in the range of 100% GDP. Not to mention austerity, Brexit, COVID-19, the energy crisis, decreasing global trade efficiency, demographics, and a few unenviable scores on tests evaluating society in the twenty-first century.

However, if we read between the lines and look around, we can spot a few challenges we must face boldly and consistently.

The first critical challenge is productivity. That is where the rubber meets the road. Getting out of the economic mess requires not only grit but results as well. We have discussed using technology and organisational development to change the service model on these pages. And we have discussed strategy and innovation. It will not be a quick win, but it is all doable and in our hands.

The second one is the workforce. A lot has been written about the staffing crisis in pathology. I’d like to add another point to this topic. Like the rest of the healthcare system, pathology is dependent on immigration, and, as we know, it is not the favourite topic at the moment. However, pathology may have some opportunities in this space, and we do not need much help.

The third one, which we do not do particularly well, is about strategic visibility. It is entirely different from aggressive promotion, social media presence, bragging about our achievements and that kind of untasteful noise. It is about building relationships and actively showing all relevant parties what we bring to the table and how our actions and integrative superpowers align us and them with the broader goals. If we become good with this one, we may be inside the red box next time.

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