Richard Spicer, a recently retired consultant surgeon at University Hospitals Bristol NHS Foundation Trust (UHB) has compiled a timeline of the concerns raised about paediatric pathology during his time working there. The documentary evidence supporting this timeline has been submitted to the current pathology inquiry, which is due to report soon; but there are concerns that long-standing problems in paediatric pathology may be sidelined. What saddens me most is that the Bristol Heart Inquiry found that children’s services often play second fiddle to adult services, and the recommendations to prevent this happening don’t seem to have been implemented.
As Mr Spicer observes:
‘Services for children provided by the Bristol Royal Hospital for Children are uniformly excellent but Paediatric and Perinatal Pathology have been subsumed within the Department of Ault Histopathology. Managers of adult services in the BRI have controlled the destiny of the paediatric department over the last 10 years and managers within the Children’s (now Women and Children’s) Directorate have had little or no influence over the events described below even though they have ultimate responsibility for the children treated within the Children’s and St Michael’s Hospitals.
Paediatric Pathology Timeline
The Cast
GB Dr Graham Bayley, Clinical Director, Laboratory Medicine
NB Dr Nick Bishop, Medical Director
MM Dr Morgan Moorghen, Lead Clinician,Histopathology
GN Mr Graham Nix, Acting Chief Executive (afterHR)
MP Prof. Massimo Pignatelli, Head of Department of Histopathology
HR Mr Hugh Ross, Chief Executive
PR Mr Peter Richardson, General Manager, Laboratory Medicine
JS Dr Jonathan Sheffield, Medical Director (after NB)
LS Ms Lesley Salmon, General Manager , St. Michaels Hospital
The Narrative
10/7/01 Letter from Paediatric Surgeon to HR and NB warning them that actions taken by adult histopathologists and managers (notably PR) threatened to destroy the department of Paediatric Pathology.
16/7/01 Letter from Prof. of Paediatrics to HR and NB supporting above letter.
29/8/01 Letter from 8 senior clinicians in the Children’s Hospital to HR expressing concern that the lack of expert paediatric pathology was threatening the standard of care for children.
8/10/02 Letter from Lead Clinician for Children’s Surgery and Chairman of Division of Children’s Services to GN and NB expressing extreme concern that decisions taken by adult managers had resulted in the collapse of Paediatric Pathology with potential severe adverse effects on patients.
8/1/02 Letter from paediatric surgeon to MP reiterating concerns about standards of care (particularly for children with tumours and Hirschsprung disease) since adult rather than specialist paediatric pathologists were providing histopathology services for children and also concerns that no moves were being made to rebuild the department and specialist paediatric technicians were being diverted to adult histopathology.
14/11/02 Letter from Clinical Director of Obstetrics and Gynaecology to NB ,GN,LS and MM expressing concern at the loss of paediatric pathology and the severe effects of this on neonatal, fetal medicine and genetics services. He lays the blame for the loss of service at the door of UBHT managers.
1/10/03 Letter from Professor of Paediatric Oncology to various managers , including GB expressing concern that there was no management support for paediatric pathology and that a detailed report of the Paediatric and Perinatal Pathology Working Group (which he chaired) had been ignored by the Medical Director and Executive Director.
24/2/04 Letter from Prof. of Paediatric Oncology to GB, MM, MP and PR reiterating above concerns.
19/5/04 Letter from recently appointed Paediatric Pathologist complaining about lack of support from adult pathologists and managers and the difficulty of having to work within an adult department rather than having a separate dedicated paediatric department , as previously existed. This individual subsequently moved to another centre.
29/9/04 Letter from Consultant in Paediatric Intensive Care to MM highlighting the poor quality of Post Mortem services for children. This was particularly based on cases of children dying of cardiac disease and a decision was subsequently taken to send all such cases to London to a paediatric pathologist previously working in Bristol who had been forced to leave Bristol due to decisions taken by adult managers which adversely affected his working environment.
14/2/08 Letter from Prof of Paediatric Oncology to MP and JS highlighting the incompetence of adult managers in attempts to recruit paediatric pathologists. I quote “many of us have been disappointed to see how, over several years, the need for adult pathology development is seen as a competitive and (I regret to say) obstructive element in addressing paediatric pathology. In today’s NHS no one should feel the need to extinguish another person’s light just to help theirs shine brighter”.