Doctors face a losing battle against childhood cancers and genetic diseases unless there is a reorganisation of pathology services responsible for diagnosing causes of death and illness, specialists and parents' groups warned yesterday.
Ten of Britain's 52 consultants posts in child pathology are unfilled, more specialists are planning retirement, three of 26 centres do not have a single consultant, and only half the specialist training places are filled.
In addition, the number of postmortem examinations agreed by parents has fallen in the wake of the Alder Hey and Bristol heart babies scandals and there is evidence that pathologists who are not expert in childhood diseases have made mistakes in one in five cases of autopsies on infants who died suddenly.
The crisis was revealed in a report for the Royal College of Paediatrics and Child Health which said the recent scandals had compounded problems arising from previous failures by both government and medical colleagues to take the specialism seriously. The specialists needed six years training, a year more than other pathologists, since many diseases in childhood were quite different from those that developed later in life.
The emotional pressure to provide quick answers for distressed parents added to other difficulties, said the working group, which acknowledged that "medical practice in the past had become inappropriate and that the retention of organs without proper authorisation was completely unacceptable. New ethical standards must be established to counter the distrust that past practice has generated."
The choice of treatments for malignant diseases depended on the right diagnoses, while postmortem examinations could help parents to come to terms with the deaths of children and babies and to decide whether they wished to try for another baby.
If parents did give consent for hospital postmortem examinations, the material from organs and tissues should still be kept for an unspecified and unlimited time since the archived material was potentially important for the advancement of medicine. Where coroners ordered a postmortem examination in the case of sudden or unexplained deaths, material should be kept as a matter of routine. The law did not specify this at present.
Lady Sylvia Limerick, vice chairwoman of the Foundation for the Study of Infant Deaths, said a recent survey of 305 bereaved parents suggested more than eight in 10 thought that tissues from postmortem examinations from coroner's inquiries should be kept. "They, more than anybody, want to have the opportunity to hope there may some day be an answer to why their baby died.
"Research is proceeding quickly, and it may be possible, say, when there is a marker for disease [discovered], to look back and identify what caused a death. It is extremely important if there is a genetic disorder."
