When most people think of pathology, they would, I’m guessing, think of bodies. Or perhaps the TV cliché of the cranky pathologist, more at home with the dead than the living, telling our detective hero they will “see what they can do” about getting those results by morning. So, I ask Daniel Ross, is that portrayal close to the bone? He laughs. “Categorically no. I am yet to meet a grumpy pathologist.” I’m not sure I quite believe that statement, but we move on.
He is sitting in his office at the corner of an open-plan workspace in central London, within a stone’s throw of Tower Bridge. He won’t be here for long, though. As our conversation continues it becomes clear what’s preoccupying Ross at the moment is the construction of the Royal College of Pathologists’ (RCPath) new premises. The purpose-built offices are the culmination of several years of planning. He is in the unusual position of filling both the FD and chief executive roles, so is responsible for not only the cost but also the quality of the finished product. “It’s taught me many things about the construction industry I didn’t think I would ever need to know. But it’s been really enjoyable.”
Considering the importance of pathologists, it’s perhaps surprising the wider public knows so little of what they do. Pathologists may only tend to see names on lab samples (rather than faces), but their work is as vital to frontline healthcare as your GP or those saving lives with a scalpel. Pathology underpins everything that happens in medicine and clinical care. Around 70% of diagnoses are pathology related. In the UK, 900 million pathology tests are performed every year – on the living. There are 19 different specialities, including chemical pathology (the study of the biochemical basis of disease); haematology (the study of disorders of the blood); histopathology (the study of disease in human tissue); and medical microbiology (the study of infection).
Ross admits his knowledge of the profession was limited when he took the job over 21 years ago. “The more I learn about it, the more I realise what a huge impact it has on patient care.”
Not all RCPath members work in the NHS. A substantial amount of work is done in academia, while a number are based in private centres and several in veterinary science. “If you have a blood test, or a cervical smear, or a biopsy, it’s the pathologist that looks at that. If you don’t have a sufficiently trained number of pathologists they won’t be able to tell a surgeon whether or not a tumour is cancerous or what treatment to advise.”
He originally applied for the job of finance director and head of IT, but after three years the then chief executive took early retirement. Ross applied for the vacant position and was asked to take on both roles. “I thought, well that’s an interesting challenge.” It was a smaller operation then with only 20 members of staff. He relishes working with the trustees and pathologists – who are “extremely intelligent people” – doctors and senior scientists, so they can “understand things when you put it to them” even if they don’t always agree. He had to drop the IT side of the role and has been CEO/FD ever since. It’s the more strategic side of the job that really holds his attention, he says, putting together long-term business plans, forecasting trends in the profession, strategising with key stakeholders and engaging with key opinion leaders.
Has he ever considered hiring an FD? He admits it did come up in his last appraisal. Since he took on the role the college’s staff has doubled in size. After the move it could be time to look at it seriously. He stresses the importance of the financial controls put in place that he can’t override, and how he has worked closely with every RCPath treasurer to ensure this is the case.
Before the college he held several positions in the finance function of private sector businesses and in the charity sector. He trained as an auditor at mid-sized firm Cohen Arnold in the late 1980s. “Working as an auditor or in practice you got to see lots of different companies and the best of what they did and take that on board.”
He was financial controller at Mencap, the charity for people with a learning disability, and then managed the finance team at Eurocoin before starting at the RCPath. The college doesn’t have a regulatory role nor is it a trade union, he says, it is the “guardian of the standards”. The RCPath sets training for doctors and senior scientists in the pathology disciplines, runs the examinations, the CPD scheme, courses and symposia, and has a department that looks at trends in the pathology workforce (it takes 10 years to train a doctor).
As Ross explains, it’s crucial that when negotiating with governments about the number of doctors needed in certain specialities they can, for example, forecast when pathologists are going to retire, “so that 10 years before it happens we can tell them how many we need to recruit into the specialty. There have been shortages in the past and there are forecast shortages. It is quite worrying because the government wants to run a seven-day service – so we are going to need more people, aren’t we?”
There are concerns that the pathology labs and their workers will face further budget cuts, consolidation and the creep of privatisation. Another central role of the RCPath is to fight their corner. But every other department and speciality is fighting for theirs too. Health service inflation is currently running at about 7-8% per year, while normal inflation runs at around 2-3% – but funding remains the same. And there have been years of dispute over the health secretary, Jeremy Hunt, trying to impose a working contract on 55,000 junior doctors.
The trend for governments and health services the world over, however, is towards early diagnosis, more information and ultimately prevention. Pathology is central to this. So they are continually asked to do more with less. “It is a challenge, yes. Money has been cut from pathology budgets. More reorganisation has been mooted and it doesn’t always work. What’s happened to the junior doctors has had an impact on recruitment.” So the RCPath has a huge public engagement programme. It works with secondary schools and runs National Pathology Week to try to encourage people into the profession.
“The cuts are right across medicine in general. It’s going to be interesting going forward, needing healthcare. I’m in my 50s. If I make it to my 60s and 70s, I’ll be slightly worried.”
He’s speaking from personal experience. There is a history of diabetes in his family and last year he got a call from his GP. “I’d gone beyond a certain sugar marker that is considered pre-diabetic and because they test me every year, they found that. You can manage that by making lifestyle changes. It’s much better to not take medication and much cheaper for the NHS in the long run. It’s the pathologists who play a role in that as they do the sugar level testing.”
As with every professional body, membership organisation or business, Brexit is a factor that Ross is attempting to plan for despite the lack of clarity. “It would be an issue if the members from Europe can’t work in the UK. Across medicine in general the service could grind to a halt if something is not sorted out. But it’s not the only issue, we have medics retiring because of changes to the pension arrangements. We have junior doctors who are demoralised.
“Genetic medicine is going to dramatically advance the health of the population. It will make medicine more personalised than it currently is. Training the doctors to deal with that is going to be a challenge.
“The state of the health service is a challenge. It is in need of a huge amount of funding.”
He uses the example of a project the RCPath has been working on with the government to establish a system of medical examiners to investigate deaths. Its origins go back to the Harold Shipman case (the former family doctor convicted of murdering his patients over 23 years) and the Mid-Staffs scandal (where hundreds of patients suffered unnecessarily due to substandard care between 2005 and 2009). The proposed examiners would identify trends in deaths quicker than the current system. The implementation, however, is taking longer than they “hoped and wanted”. Snap general elections don’t help, as they interrupt government thinking, he adds.
A further knock-on effect is a cut in the amount of time that professionals can devote to helping run the college. “It’s not just us, it’s all medical colleges. There must be about a thousand volunteers who do things for the college who have full-time day jobs in the NHS, but they act as examiners, sit on our committees, sit on our working parties, act as trustees. As NHS trusts get more pressured and squeezed, people may not want to volunteer. If they’re not released by their trusts it could have a major impact. Most of what we do is educating the next generation of doctors. It could be short-sighted.”
Ross has been involved in a lot of voluntary work with charities. A few years ago an opportunity to help one particularly close to his heart presented itself. His then partner, now husband, has bipolar disorder.
He discovered that Bipolar UK needed a trustee and honorary treasurer. They were struggling badly at the time and had no full-time finance professional on board. Ross worked with the board and the trustees to wade through their finances, and after some difficult but necessary decisions, kept them afloat.
Getting accountants involved with helping charities with their finances is something he is clearly passionate about. “They are crying out for good finance people.
“Charities have changed a lot. They have got more professional and they have had to. Gone are the days where they can be run by those well-intentioned but with no professional experience. It’s a challenge but you get to use your skills and your knowledge. And it’s also fun and keeps me out of trouble.”
He likes that everybody speaks to each other in the charity sector, that you can pick up the phone and get support from other organisations. “We have various networks and forums to share ideas. There’s a whole wealth of people you can turn to.”
As well as being a chartered accountant, Ross is a member of the Chartered Management Institute. “Accountants are never trained in management. You take on roles and develop into them.” He’s a believer in letting those who are specialists in their area get on with it. He has a combined finance and membership team of five in the RCPath. Despite his tenure of nearly 22 years at the college, he’s not the longest-serving member of staff. And many have been there more than a decade, which he puts down to the culture.
Unsurprisingly, given his professional and extra curricular commitments, Ross doesn’t have a glut of spare time, but to relax he likes to spend a couple of nights a week at the gym – partly on doctor’s orders – as well as playing bridge and pursuing amateur photography.
Does he see himself still running the ship in five to 10 years? “It’s an interesting question. Is there a right length of time to be in a role? At the moment the answer is yes, because of the property project. That will continue for another two years until we move in. Then it’s about how we operationalise the building, how we generate the revenue to run the college. Then I’m sure some other challenge will present itself.”
And if it doesn’t, it’s clear he’ll find one to get involved in.