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2021-06-30-accounts

NOVEMBER 2021

ROYAL COLLEGE OF PATHOLOGISTS ANNUAL REPORT & ACCOUNTS

Annual report & accounts

– 2020 2021

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Introducing the College

The Royal College of Pathologists is a professional membership organisation with more than 12,000 fellows, diplomates and affiliates worldwide. We are committed to setting and maintaining professional standards and promoting excellence in the teaching and practice of pathology, for the benefit of patients.

Our members include medically and veterinary qualified pathologists and clinical scientists in 17 different specialties, including histopathology, haematology, clinical biochemistry, medical microbiology and veterinary pathology.

The College supports pathologists at every stage of their careers. We set curricula, organise training, run examinations, publish clinical guidance and provide opportunities for continuing professional development.

We engage a wide range of stakeholders to improve awareness and understanding of pathology and the vital role it plays in everybody’s healthcare. Working with members, we run programmes to inspire the next generation to study science and join the profession.

Contents

01. Introduction

Welcome from the President

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05 Message from the Registrar

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Our achievements

Shaping pathology services and supporting future pathologists

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Agile working and improving patient care

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Our specialties and clinical case studies

Our specialties

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Targeted cancer therapy using CAR-T cells

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Using molecular pathology to unveil the rare ocular tumour behind masquerade syndrome

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Our governance

Governance of the College

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Financial report

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Welcome from the President Professor Mike Osborn

Hello and welcome to our annual report for 2020−2021.

This report gives an insight into the activities of the College and our members over the last 12 months. Although no such report can ever hope to cover the whole range of exciting and important work that College members and staff have been involved in over this strangest of years, it can provide an overview − a flavour if you like − of the huge selection of activities that pathologists are responsible for and are vital to.

integral to providing high-quality healthcare whatever the situation. Like our members, College staff have worked extremely hard in often difficult circumstances to support and develop the work of the College and of our members. Members and staff have worked closely to promote excellence in all areas of pathology practice, ranging from writing nationally and internationally recognised guidelines, to providing expert advice to the NHS and government, to developing novel and effective treatments through research and providing teaching and training for doctors, scientists and other healthcare professionals. The topics covered are diverse too − from cancer genomics to blood testing in livestock − and reflect the diversity of our specialties and how the work of our members affects almost everyone's life.

This report contains examples of activities across our 17 specialties. It demonstrates the innovation, dedication and hard work of the clinical scientists and pathologists who are involved in and vital to so many healthcare interactions.

Despite the COVID-19 pandemic continuing to overshadow all our lives and activities − both professional and personal − our members have continued to work and contribute to providing excellent healthcare, teaching, training and research. Much of this work relates directly to COVID-19, but so much does not. This demonstrates how pathology and pathologists are

I would like to congratulate and thank everyone involved in our work − members and staff alike − for their considerable efforts during this difficult time.

Message from the Registrar Dr Lance Sandle

This year’s annual report is again very different from previous years.

The content of last year’s report was agreed as we were going into the first lockdown and since then remote working has become the norm for many. This has raised challenges, not least for pathology trainees who rely on uninterrupted support during training and examinations as a core College function. The enforced contingency of developing an online examination platform in such a short timescale has been a major achievement that could not have been anticipated last year. We should applaud the work of the Learning Directorate who have sought to minimise the effect of the pandemic on training and career progression as much as possible. Our thanks also to trainees who have been tolerant and highly adaptable as we have responded to an unprecedented situation.

launched in early 2021, providing essential updates during a fastmoving situation, and reaching hundreds of weekly attendees.

The inevitability of staff turnover means that some teams have staff who have never physically met, as is the case with the current honorary officers since the last Annual General Meeting was an online event. However, one of the advantages of holding events virtually is being able to connect with more people and from all around the world. Our virtual fellowship ceremonies allowed more fellows to attend and share this proud moment with their families and friends.

On behalf of the honorary officers I thank all our volunteers and College staff for the extra time and effort required to ensure continued College activity. We live in a time when the availability of information technology has ensured operational continuity for the College and we should be prepared to spend more time in virtual workplaces in future. Nevertheless, given that between 70 and 93% of communication is non-verbal we will always be more effective with conventional human interaction, and I look forward to the day when this can resume.

Many other teams across the College have had to adapt their way of working, with much of the work that would normally take place at our Alie Street premises moving online. This includes conferences, training courses, committee meetings, honorary officer meetings, management and team working, as well as interaction with government departments, other royal colleges and professional bodies. The second series of COVID-19 webinars was

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I'm thrilled and honoured to be the 1,000th medical examiner trained by the College. The medical examiner system is vitally important to support bereaved families, the work of the coroner and improve patient care. The College course has provided me with an excellent grounding in the role of the medical examiner and I

Our achievements

support bereaved families, the work of the coroner and improve patient care. The College course has provided me with an excellent grounding in the role of the medical examiner and I am looking forward to integrating this new role with my career as an emergency medicine consultant in the future. – Dr Yasmin Kapadia, an Emergency Medicine Consultant from London 02. 6 7

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Shaping pathology services and supporting future pathologists

The College is at the forefront of developing standards for pathology education, training and research to improve patient care and safety. We continue to support members to excel in the practice of pathology in the face of ongoing and severe constraints of SARS-CoV-2. We have adapted significantly with major changes to support our essential work in relation to examinations and curricula with impressive progress and expansion of the medical examiner service. We continue to support and inspire the next generation of pathologists.

the process of developing the new curricula with timelines. It is vital that we support trainees, trainers and education supervisors during this transition. The Training team hosted three launch events in August 2021 to introduce trainers and educational supervisors to the new curricula.

Launching our 19 new curricula

The curricula produced by the College for all specialties and subspecialties ensure trainee pathologists develop the highly specialised technical and nontechnical skills they will require to provide high-quality patient care.

Certificates of Eligibility for Specialist Registration (CESR) evaluated

At our next New Trainee Welcome Day we will dedicate time to discuss the new curricula and we will hold events throughout 2022 for current trainees who will transfer to the new curricula from August 2022.

Over the past three years, the Training team has been working with stakeholders across the UK to revise the curricula in line with the General Medical Council's (GMC's) revised standards. This requirement to produce new curricula has provided us with the opportunity to create curricula that better support the needs of patients and will meet future challenges for the workforce as pathology services evolve. In May and June 2021, we obtained GMC approval for seven of our curricula.

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Certificates of Completion of Training (CCT) awarded

Supporting families through the medical examiner service

Despite the challenges of the pandemic, the implementation of medical examiner services has continued. About half of all deaths in England and Wales, predominantly in hospitals, are now scrutinised by medical examiners. Medical examiner services are now extending to cover deaths in the community and, ultimately, every death in

Transferring to the new curricula will require a period of adjustment. To keep our trainees up to date on developments, new pages on the website were developed outlining

England and Wales will be reviewed. With no in-person events being able to take place, medical examiners have completed the interactive ‘faceto-face’ part of their training online and over 100 medical examiner officers have also attended online training days. In February 2021, we celebrated the 1,000th medical examiner to complete their training − Dr Yasmin Kapadia. Over 600 medical examiners and officers have now joined the College as members.

April 2021 saw the first annual Medical Examiner Conference, with 370 delegates attending online to hear the latest policy and implementation updates. The National Medical Examiner, Dr Alan Fletcher, launched his 2020 Report at the conference, highlighting the progress made over the last year.

Supporting bereaved families is at the heart of the medical examiner service and feedback from one relative sums up the importance of the service:

It was brilliant to speak to someone kind, who listened to my concerns and was understanding. It’s like a voice for the person who’s died. My mother would have liked that something good came out of it, with better care for other patients.

Transforming examination delivery

Throughout the last 18 months the College has had to adapt its way of working to ensure continuity of member services. A major challenge for both the College and trainees has been the disruption to examinations. Working closely with the Trainees’ Advisory Committee (TAC), the 153 Examinations team introduced a new online examination format to new specialty get examinations back on track. To registrars registered support trainees as they prepared with the College for the examinations, we launched a series of webinars – What I wish I’d known – which included informal tips and advice from trainees who have previously sat examinations.

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The flexibility and adaptability of both trainees and the College was evident FRCPath, Diploma, during this process. We will continue Certificate, Stage to work with the TAC and trainees A and Biomedical whose feedback will be invaluable as Scientist examination we improve the experience for those results issued participating in future examinations.

Key achievements

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Pathology Foundation Fellows successfully applied for the scheme

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workplace-based assessments were used in annual reviews of competence progression (ARCPs)

Welcoming our new trainees

Our annual New Trainee Welcome Day introduces trainees to the College and the role we play in pathology training. It is also an opportunity for trainees to get a clearer understanding of pathology training programmes, examinations and the support available. The 2020 welcome day in September was held virtually for the first time, which allowed our highest ever number of attendees to attend – over 140.

Adapting training delivery

It is essential that trainees feel supported throughout their training to help with the many and varied challenges they face. The need for support and the wellbeing of trainees are two areas that have been highlighted by the severe disruption to training experienced during the pandemic. The TAC has worked with the College to provide extra support mechanisms and address concerns.

A team of qualified coaches volunteered to provide free sessions, giving trainees opportunities to talk through experiences and develop new strategies to address specific challenges. Peer support is also very important during stressful times and the TAC Chair arranged evening drop-in sessions for trainees to talk about particular concerns that could then be addressed with the help of College officers.

Although the pandemic has disrupted training programmes, there have been some positive changes with the introduction of online tutorial and training sessions. These have allowed specialties with lower numbers of trainees and smaller training programmes to connect with geographically remote trainees.

Engaging Foundation doctors

In 2020, the College launched a new initiative − the RCPath Foundation Fellowship scheme – which is open to Foundation doctors who secure a post in which they will rotate through a pathology specialty. The first 24 Pathology Foundation Fellows were announced at the end of September 2020 and the College will be continuing the scheme in 2021. It gives successful applicants access to a range of information and educational events to support them during their foundation training.

Support is needed to get training back on track. We have been in active discussion with HEE and other organisations around the need to embed training recovery into service reset.

Promoting reflective learning

Reflecting on performance is an important aspect of training and professional development, resulting in self-improvement and increased self-awareness. A new form of workplace-based assessment – assessment of performance (AoP) − was introduced for cellular pathology specialties. AoPs focus on capturing trainees’ progress towards independent practice across the wide range of pathology activities and improving the feedback provided to consolidate learning and reinforce good practice.

Looking ahead

After three years’ work, the College launched the new medical curricula and related workplace-based assessments. To complement this work, the LEPT platform will be developed to map to the new curricula and assessment programmes, with all trainees transferring to the new formats from spring 2022.

The Pathology Portal, which is being developed in conjunction with Health Education England (HEE), will provide pathology trainees with a bespoke and adaptive online learning platform mapped to the new pathology curricula. The Pathology Portal will launch in late 2021 and the aim is to add more specialties as the Portal develops.

Following our first online

examinations in 2020, the College has reflected on the advantages and disadvantages of this format for the different examinations we offer. We plan to continue offering FRCPath Part 1 examinations in their new virtual format while FRCPath Part 2 examinations will return to their former face-to-face format as they are less suited to online delivery.

In the longer term, digital Part 2 examinations are planned for relevant specialties where digital images will be used, negating the need for microscopes. This will help standardise the examination and facilitate the creation of more examination centres globally. A working group has been set up to examine how this can best be achieved.

Many trainees have experienced disruption to their training because of the pandemic for a range of reasons, including a lack of routine biopsies to study or a focus on COVID-19 to the exclusion of many other infections. Some trainees have also experienced redeployment and sickness absence, the need to self-isolate and disruption to their examinations. Support is needed to get their training back on track. We have been in active discussion with HEE and other organisations around the need to embed training recovery into service reset. These discussions will be further informed by the results of our COVID-19 training impact survey, which was circulated to trainees by the TAC.

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trainees used the LEPT system to create annual reviews of competence progression (ARCPs)

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Agile working and improving patient care

The College continues to champion new technology and new ways of working. This has enabled staff to work remotely and support our members. There has been an ongoing focus on guideline development and implementation, quality improvement, and patient safety. We have risen to the challenge of delivering high-quality academic activities during the pandemic with excellent attendance and feedback across a range of events supporting our many specialties.

Remote professional Opportunities 36 development for development

The need to adapt quickly in these challenging times has seen the conferences Events team move all College and educational academic activities online. events managed

Increased workloads and limits on travel have reduced the opportunities for our members to undertake CPD activities. To help members, the CPD deadline was deferred by three months and the Professional Standards team ensured all CPD returns were processed even if submitted late.

This involved many hours running practice sessions and developing best practice for delivering high-quality online events.

Throughout the pandemic, the College has remained committed to providing continuing professional development (CPD) events. This has been highly valued by our trainees and members, with lots of positive feedback and a consistent satisfaction score of over 90%. One of the benefits of our online events was the engagement with more of our members, both regionally and internationally. This will be reflected in the strategy for our CPD programme, which will incorporate face-toface events and online learning.

Weekly and monthly postings were included on our website, social media and in the President’s newsletter directing members to the various ways in which they could collect CPD, be it through reflective learning, participating in clinical audit certification or attending College educational events. This resulted in a CPD return rate of over 90% by March 2021.

Improving maternity safety

Progress is being made on improving

maternity safety in the UK, but more improvements are still required to achieve the national aim of halving rates of stillbirths, neonatal deaths, maternal deaths and brain injuries that occur during or shortly after birth, by 2030.

The College is advocating for improved maternal safety and pathological investigations after stillbirth. Alongside the Healthcare Safety Investigation Branch (HSIB) and NHS England, we are working to understand and overcome the barriers to wider implementation of our guideline for histopathological examination of the placenta. A shortage of specialist paediatric pathologists is also an issue in some parts of England.

We have recommended that medical examiners (ME) work with coroners to investigate stillbirths and neonatal deaths. This would help identify unusual patterns, such as high numbers of deaths at one hospital, which can be a strong indicator of poor care.

Our evidence to the Health and Social Care Committee’s Expert Panel on the safety of maternity services in England showed the value of the role of MEs, noting ‘…a further benefit of expanding the jurisdiction of MEs to include

stillbirths would be their ability

to provide independent scrutiny of maternity services, including speaking to relatives to hear their views.’

3,515

people attended events

We have recommended that medical examiners work with coroners to 271 investigate stillbirths events approved for and neonatal deaths. continuing professional development This would help identify unusual patterns, such as high numbers of deaths at one hospital, which 90%+ can be a strong indicator satisfaction score of poor care. for our new online-

satisfaction score for our new onlinemanaged events

Key achievements

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Learning through experience and collaboration 10

NICE-accredited Patient safety bulletins are submitted guidelines were case studies that recall an experience in the workplace where something published happened, action was taken and where lessons were learned.

They are an excellent tool for selfreflection and a valuable resource for sharing knowledge and experience among pathologists in different specialties. The College is committed to improving patient care and safety and we have developed our patient safety bulletin programme, publishing eight in the past year.

14 audit templates were published

In January 2021, we signed a Memorandum of Understanding (MOU) with the Care Quality Commission that will safeguard the wellbeing of people receiving care in England and support improvements in care. The MOU confirms that we will share information about the quality of pathology services including any concerns or evidence of safety risks.

Providing pathology input into consultations

As a NICE stakeholder, the College represents the professional interests of our members by providing expert pathology input into consultations. Our members are instrumental in providing the evidence and advice

NICE relies on to inform clinical guidelines on patient care and to appraise the clinical benefits and cost of technologies.

Supporting the implementation of our guidelines

The clinical guidelines produced by the College are important resources for members, providing data on best clinical practice and ensuring a high standard of care for patients. It is therefore important that the guidelines are implemented quickly and consistently.

A survey of our members in 2020 highlighted the difficulties they faced in implementing specific areas of the guidelines. A webinar programme was proposed by the Clinical Effectiveness team and Working Group on Cancer Services to provide support.

Patient safety bulletins … are an excellent tool for self-reflection and valuable resource for sharing knowledge and experience among pathologists…

A programme of guideline implementation webinars is now in place and these have proved a popular learning resource among our members, with over 450 people attending the first two webinars. The webinars provide practical tips on how to collect data and clinical scenarios for data items.

Looking ahead

The increasing use of digital pathology and artificial intelligence in the management of patients across pathology specialties has the potential to improve patient safety and support the pathology workforce. While the College supports the use of such technologies, we will continue to highlight the need for investment in IT, workforce and staff training.

Through our Digital Pathology

Committee, we will promote digital pathology in both diagnostic services and research arenas by producing standards, best practice guidance and resources for the profession.

There is the opportunity to increase the use of digital pathology in screening programmes and the Digital Pathology Committee has engaged with Public Health England on the proposed changes to breast screening. The Committee will continue this dialogue.

To ensure the success of digital

pathology as a diagnostic tool, it must be integrated into curricula and trainees’ learning must reflect the need to develop these skills.

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audits were submitted to the audit certification scheme for evaluation

Digital pathology can also assist in the education and training of pathologists through online educational platforms and its use in the delivery of examinations. The College will work with stakeholders and committees both in the UK and internationally to identify areas where digital pathology can support our members, share experiences and improve its implementation.

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patient safety bulletins published

To ensure the success of digital pathology as a diagnostic tool, it must be integrated into curricula and trainees’ learning must reflect the need to develop these skills.

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Influencing policy, championing pathology and strengthening the workforce

The College greatly values and promotes the expertise of our medical and scientific workforce across all our pathology specialties. We have been very actively engaging with governments, ministers, parliamentarians and policymakers to raise awareness of pathology as essential to safe, high-quality patient care. We are highlighting the ongoing challenges that have arisen during the COVID-19 pandemic with the need to address the backlog of tests to support diagnosis and treatment. We have focused attention particularly on concerns over cancer services and screening, the backlog of diagnosis and treatment, and pathology workforce issues.

Our COVID-19 response

and evidence on testing, vaccines and how core NHS services could be delivered during the pandemic. Professor Mike Osborn spoke to the media about the need to use the data and information currently available to inform decision making and to adjust advice as the situation evolves.

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With pathology at the core of the healthcare response to the pandemic and many of our job descriptions trainees and members involved, reviewed and the College has an important role approved in advising the government, and engaging stakeholders, media and members of the public.

The focus now is on what we can learn and recovery. Members have given evidence to APPGs and the Health and Social Care Committee on the testing programme, long-term health implications and the next steps for diagnostics. Our members listened to the concerns of patients whose diagnoses and treatments have been affected by the pandemic.

The College continues to publish guidance to reflect advances in knowledge and changes in policy. Although much of this guidance is for our members and healthcare professionals, it’s important that the public can access up-to-date guidance. We published a userfriendly guide to COVID-19 tests that covers the most widely used diagnostic tests, exploring their accuracy and when they should be used. The guide is one of the most visited pages on our website and was referred to in the media.

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College assessors recruited for advisory appointment committees in England, Wales and Northern Ireland

Raising concerns on the backlog and patient care

The pandemic has affected services across healthcare and there have been growing concerns about the backlog of tests to diagnose and treat a range of illnesses, including cancer. The College anticipates a backlog of

Our members attended All-Party Parliamentary Groups (APPGs) and various committees to provide data

as many as a million pathology tests. Anxiety among patients, together with limitations to services, have caused a significant drop in cancer referrals with an estimated 350,000 fewer referrals over a period last year and a gap of 36,000 in the number of first cancer treatments in England. ¹

The College submitted evidence and attended roundtable discussions and cancer summits informing reports, including ‘Catch Up With Cancer – The Way Forward’. This report sets out seven recommendations to the government, highlighting the need for urgent action. We will continue to support colleagues, raise members’ and patients’ concerns and advocate on workforce issues as the backlog is tackled.

Tailoring diagnosis and treatment

Genomic medicine is an opportunity for faster diagnosis and tailored treatment for people with cancer and inherited diseases. One of our core strategic aims is the development of a high-quality, user-friendly genomics service and we will ensure the voices of our members are heard as NHS England roll out the Genomics Medicine Service (GMS) via the seven Genomic Laboratory Hubs (GLHs). All seven GLHs and their equivalents in the devolved nations now have cellular pathology representation, and we will support these leads as the service develops.

Our Cellular Pathology Genomics Focus Group has become the main contact group for NHS England for cellular pathology and we aim to achieve representation on working groups involved in the National Genomic Test Directory.

The College has continued to showcase the benefits of genomic medicine through discussions with other experts and policymakers. The President has emphasised the potential of genomic medicine to transform healthcare and the need for investment in genomic services, with laboratories with the right equipment and enough staff trained and equipped with the right skills.

The College anticipates a backlog of as many as a million pathology tests and the number of first cancer treatments shows a gap of 36,000 in England.

Key achievements

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Only 8% of inflammatory bowel disease services have enough histopathologists.

Succession planning

Succession planning is an important aspect of the work carried out by the College’s Workforce team to ensure continuity of the profession and patient care. Accurate and current data is central to this planning. A new feature on our website uses pop-up reminders to encourage members to complete the online workforce census and this has resulted in a huge increase in submissions. Around 30% of UK members have responded in the last month compared with 1.5% across the whole of 2020 – a 180% difference in response rate.

We used the workforce data collected to lobby Health Education England (HEE), highlighting the widening gaps in the pathology workforce and the need for urgent action. HEE have now allocated funding for 35 additional histopathology training places and four haematology posts.

Collaborative working

As well as collecting data through the census we also use workforce surveys to gain a better understanding of the changing

landscape of both the pathology workforce and pathology services. Our workforce data was used by Cancer Research UK in their report on the cost of growing the cancer workforce. We were closely involved in the production of the report, which indicated a 45% staff increase is needed across seven cancer-related professions to provide a worldclass cancer service by 2029. ² This included histopathology, for which current trends suggest a decline in staff numbers.

It is not just cancer services that are affected by a shortage of pathologists. A recent report by the IBD UK alliance (of which the College is a member) found that people were waiting too long for Crohn’s and colitis diagnoses and only 8% of inflammatory bowel disease services have enough histopathologists. ³

Succession planning is an important aspect of the work carried out by the College’s Workforce team to ensure continuity of the profession and patient care. Accurate and current data is central to this planning.

Bringing pathology to those who would not usually access our activities and resources is important in diversifying the future pathology workforce…

Pathology for all

Bringing pathology to those who would not usually access our activities and resources is important in diversifying the future pathology workforce and improving public confidence in pathology services. We have worked with a range of different partners, including the Social Mobility Foundation (SMF) who provide opportunities for young people who aspire to study at university but who lack the support at home. We ran several medical ethics workshops over the past year with over 380 school students attending.

Approximately 15,000 people in the UK have sickle cell disorder − a group of inherited health conditions that affect the red blood cells – and haematologists treat patients with sickle cell disorder. We worked with the Sickle Cell Society to produce interviews with several of our members who detailed how they treat patients and how treatment has changed over time.

The virtual science festival for visually impaired young people organised by the charity VICTA provides inspiring activities and careers talks about different areas of science. Five of our members contributed to the festival providing recorded interviews about their careers and running a virtual artscience workshop about the heart.

Starting conversations

To mark the start of British Science Week 2021, we launched a new set of free resources called Viruses and Vaccines, which aim to stimulate discussion and improve understanding of the vital role vaccines play in preventing disease.

The Viruses and Vaccines collection includes colouring in and origami activities, hands-on STEM activities for primary and secondary schools, and video interviews with pathologists. We also ran several online events for schools, families and undergraduates, with the help of our members who kindly volunteered their time and expertise to answer questions from the virtual audience.

We reached out to faith leaders and members within specific communities to help dispel misinformation and concerns about the COVID-19 vaccines. Imam Mohsen Elbeltagi from Swansea University Mosque prepared answers to questions surrounding the COVID-19 vaccines and fasting during Ramadan.

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volunteers delivered public engagement activities

£4,000

was awarded across seven projects by the Public Engagement Innovation Grant Scheme

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We also created a series of 27 short videos with information about the COVID-19 vaccines. The videos feature messages from eight pathologists that address specific myths and misconceptions that exist within their community or ethnic group. The messages have been recorded in English as well in French, Spanish, Arabic, Hindi, Punjabi, Urdu and Tamil.

Delivering virtual NPW

With restrictions in place during November 2020, we delivered our first online National Pathology Week (NPW), which provided the opportunity to innovate and engage with a wider audience both in the UK and beyond.

Our theme was ‘Pathology: at the heart of healthcare’ and new art-science resources that explored health and disease were developed. Families were able to attend workshops where they could make their own origami ‘beating heart’ and ask questions about the heart and how it works.

NPW 2020 also saw the launch of our RCPath Book Club series. The virtual event featured ‘Pandemic Century’ and explored a range of topics, including pandemics through recorded history and what we can

learn from them. Since then, we have delivered three more book clubs reaching audiences around the world, with 20−35% of the audience based outside the UK.

…a new set of free resources called Viruses and Vaccines … aim to stimulate discussion and improve understanding of the vital role vaccines play in preventing disease.

Inspiring the next generation of pathologists is a core function of our public engagement activities and NPW is a chance to showcase the diverse nature of a pathology career.

We engaged with school students through our ‘Meet the Pathologists’ series, which gave students an insight into a typical day and the different paths you can take to work in pathology.

NPW 2020 showed once again how successful online events are with more people than ever coming to our website to view activities and career resources.

Looking ahead

After a signification reduction in the number of patients being referred for cancer diagnosis and treatment during 2020, we are now seeing a surge in referrals both for cancer and other illnesses. This will severely affect pathology laboratories and our members. The College will continue to raise this issue with policymakers to ensure that funding is prioritised and appropriately distributed among laboratories, to ensure there are sufficient numbers of staff to cope with this sudden increase in workload.

Genomic medicine has tremendous potential and investment is essential to ensure its success. To better understand the effect on the pathology workforce, and to gain an overview of how testing is implemented, can be improved and the effect on service delivery and patient care, we surveyed members in September 2021. The evidence will be used in discussions with health agencies and commissioners of pathology in genomic medicine. It will provide us with information for our advocacy with parliamentarians.

The Genomics Medicine Service roll out will require user-friendly and integrated IT systems, as well as workforce recruitment and training. The College has positioned itself to be part of the conversation around logistics and financing and will put forward its concerns and suggestions to MPs, civil servants and policymakers.

The [Genomics Medicine Service] roll out will require user-friendly and integrated IT systems, as well as workforce recruitment and training. The College will position itself to be part of the conversation around logistics and financing…

1 Summary of the Commons Health and Social Care Committee session on Cancer Services. 13 July 2021.

2 Cancer Research UK. Estimating the cost of growing the NHS cancer workforce in England by 2029. Published October 2020 .

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Resourcing the future of the College

The College is a responsible, sustainable organisation committed to delivering firstclass services to all members. We have worked hard to improve our financial stability in the face of the challenges of the pandemic to achieve our strategic aims and charitable objectives. We are committed to supporting and developing our staff, and we have reviewed and strengthened lay involvement in key College activities and function.

The outsider inside: taking advantage of lay involvement

Following a governance review, several changes were agreed and approved to provide greater continuity of experience and broaden available skills. These changes relate to the extension of available terms by lay members from one to two, the appointment of a third lay trustee and the appointment of a lay trustee as Board Chair. The previous Lay Governance Group was replaced by a Lay Network comprising eight members who provide a lay point of view to College business and are a ‘critical friend’ to the College.

We all have views and perceptions, but often when you have a group of like-minded individuals with similar experiences, the views and perceptions you have can be too similar to allow for effective challenge. This limits opportunities and thinking. The College recognises this and engages with non-medical members of the public to ensure the work of the College is challenged and benefits from diverse views and thinking. This is achieved in two ways – through the lay trustees on the Trustee Board and a Lay Network, which supports the committees and work of the College.

Our lay members provide an outside, independent perspective on the activities of the College, helping us work to maximise the contribution of pathology to high-quality patient care.

The College’s Trustee Board has previously had two lay members as trustees. With elected College trustees they are responsible for the management and administration of the charity to ensure it is solvent, well run and delivers the outcomes for which the charity was set up. The lay trustees provide independent views and strengthen the overall Board with specific skills in areas such as business, governance or legal experience.

The Lay Network brings expertise from diverse backgrounds and their input and feedback helps ensure the College’s outputs are in line with the needs of our members and the public and our work is transparent. The Lay Network is involved in work to develop a robust framework for external quality assurance and the delivery of patient safety awareness weeks that will support improvements in care and promote patient safety. They are also involved in decisions around award nominations and review public engagement resources, which allow the College to champion pathology, and raise the profile of our members, our work and our specialties with the public. Lay members also have specific roles for designated areas of College work according to their expertise, for example reviewing best practice recommendations and clinical guidelines that support patient safety by promoting best practice in pathology.

I joined RCPath as a lay trustee in May 2021 and it has been a pretty immersive experience so far… Everyone has been incredibly welcoming to such an extent that I feel I will suffer from some level of ‘imposter syndrome’ but hopefully, will be able to genuinely contribute to the great work being done!

Key achievements

The Lay Network will continue to develop and provide valuable input into College work.

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Supporting and motivating staff

The College recognises the positive effect that investing in its staff has in terms of continuity, productivity and achieving our strategic aims. After several years of using the Investors in People framework as our strategic benchmark for organisational development and following external appraisal from Investors in People, including an opportunity for staff members to provide feedback, we received accreditation in June 2021.

As a membership organisation this is a significant achievement − it means that we have the principles and practices in place to support our staff and everyone understands how to use them to make the College a better place to work. The people management strategy follows this framework to support, motivate and develop staff to deliver the best services to our members.

Some of our achievements recognised during accreditation include the transition to remote working between 2020 and 2021. Staff were supported during this transition by IT and HR and wellbeing measures were put in place to support staff's wellbeing. Collaboration has been key during this period of remote working and teams have ensured a continuous service to members regardless of location.

Our focus on learning and development of staff has continued with training now delivered online and adapted to reflect the new challenges staff face working remotely. For example, management training focused on specifically how to support teams while working remotely. Our 2020 annual staff survey showed increased scores under leadership and communication despite teams not being together in the office, which shows the value of adaptable and reflective learning.

As we transition to a hybrid model of in-office and remote working, we will continue to provide staff with the resources they need to provide a high-quality service to our members.

Collaboration has been key during this period of remote working and teams have ensured a continuous service to members regardless of location.

Member engagement through committee work

The College’s 37 committees engage with members to advance and disseminate knowledge across all pathology specialties. Despite

COVID-19 and increased workloads, members continued to give time and provide expert advice and perspective through their committee roles. For example, they contributed evidence-based insight to a myriad of national consultations, including the development of clinical guidelines in the management of COVID-19.

Two new committees were developed during 2020 and 2021 to support work of immediate importance. The COVID-19 Advisory Group was created to respond to urgent requests for opinions and advice relating to SARS-CoV-2 from a range of organisations and members. As part of self-evaluation exercises within both Trustee Board and College Council, the Diversity & Inclusion Advisory Group was created.

The Advisory Group considered how the College could promote inclusivity and diversity in committee membership. Changes to and new processes for committee appointments have been agreed to improve transparency and fairness. The intent is to ensure College committees reflect the diverse nature of our membership and our commitment to diversity and inclusion. In May 2021, the Trustee Board agreed the establishment of a Diversity Network, which will focus on the changes needed to improve diversity and inclusion within the College and in all aspects of the College’s work.

Despite COVID-19 and increased workloads, members continued to give time and provide expert advice and perspective through their committee roles.

There has been a growing move towards building networks for members to be better involved and supported. This included ending the formal structure of the England Regional Council and developing four English Regional Representative roles to better represent members across the English regions.

...the Diversity Network ... will focus on the changes needed to improve diversity and inclusion within the College and in all aspects of the College's work.

Throughout the year, the Governance Committee has continued work to deliver organisational governance aligned to best practice and effective committee governance, service and engagement for members.

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We are regional

The College’s Regional Councils provide professional leadership within their regions and contribute to a national steer on the development of pathology services and the quality of care that patients receive. They form links to help influence stakeholders and build strong relationships with key decision makers on behalf of the College. The Councils for the devolved nations have continued to facilitate two-way communication between the College and its members. The England Regional Council has been replaced with four new representatives exploring new ways to strengthen connection with members in their regions.

Our election priorities

with people in these areas facing longer waits for appointments and diagnoses. This was further worsened by the pandemic. Difficulties in recruiting and retaining staff and a reliance on agency staff to fill gaps in the workforce can affect patient care.

As a medical royal college one of our aims is to work with governments, associated bodies, opinion formers and decision makers across all devolved nations to raise awareness of the critical role of pathology.

There were overlapping priorities that highlight the challenges all pathology services face regardless of where they are based within the UK. These included investing in workforce, IT and infrastructure.

In May 2021, the people of Scotland and Wales elected their representatives to the Scottish parliament and Welsh Senedd, respectively. These new governments have now taken responsibility for a range of devolved areas, including health services. Prior to the elections, the College launched its priorities for the new governments, which were drawn up by members of the College Councils for those countries.

Our policy calls have been welcomed by parliamentarians in both countries and we will continue to advocate for the vital role of pathologists in prevention, diagnosis and treatment.

The College priorities for Scotland focused on the challenges facing already stretched laboratory services and we called on the new government to address these areas. Our priorities for Wales highlighted the variation in access to services depending on location. For people in rural areas of Wales access to healthcare can be limited,

Workforce concerns

The need for investment in the pathology workforce and infrastructure to prevent delays in the treatment of patients for nonCOVID-related illnesses has been a key message from the College over the past year. Dr Jonathan Kell, Chair of the Wales Regional Council, met

Chris Bryant MP to discuss workforce concerns in Wales and the backlog of cancer diagnosis and treatment as a result of the COVID-19 pandemic.

Chris Bryant has highlighted workforce concerns leading to delays in treatment in parliament and the media and has been supportive in promoting the College’s key messages.

We are calling for increased investment in pathology services, particularly in the recruitment and training of pathologists and scientists. More funded training places are needed to help meet the rising demand for cancer diagnosis, which has been exacerbated by the COVID-19 pandemic.

– Dr Jonathan Kell, Wales Regional Council Chair

The Northern Ireland Regional Council has been voicing its members’ concerns about the workforce challenges they are currently facing. Following a meeting between Professor Ken Mills, Chair of the Northern Ireland Regional

Council, and Department of Health officials we updated our briefing on pathology specialties involved in cancer services in Northern Ireland.

Key messages from the policy briefing included the need for capital investment in pathology modernisation and investment in pathology services, particularly in the recruitment and training of pathologists, scientists, biomedical scientists and laboratory staff.

There are concerns around training posts, with trusts indicating they will not take on future Scientist Training Programme posts unless there is a consultant post available for them in the future, as well as a lack of funding for higher specialist training. It is essential funding for posts is supported to bridge gaps in the workforce and address the issues facing specialist services such as paediatric histopathology.

The Elective Care Framework published in June 2021 proposes investment over the next five years and plans to reduce the backlog of patients currently waiting for assessment and treatment. It commits to supporting the pathology Network so Health and Social Care pathology services are equipped to support delivery across all relevant rebuild programmes.

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Scotland

Pathology services are critical to prompt and accurate diagnosis of patients with cancer and other diseases. It is essential that the Stormont Executive recognises the impact that pathologists and clinical scientists make and invests in their expertise and technologies.

– Professor Ken Mills, Northern Ireland Regional Council Chair

Improving regional representation

One of the College’s priorities is to support our members across all regions and ensure they are part of College discussions and strategies. We recognise that the challenges our members face can be region specific and these issues need to be explored with that in mind. The disbanding of the England Regional Council was an opportunity to put a new structure in place that provided more digital and interactive forms of communication for local and regional representation.

Four new English Regional Representatives were elected to represent the North, Midlands and East, South, and London. They will explore new ways to connect with members in their regions and will represent their interests across all specialties at College Council meetings.

The COVID-19 pandemic has once again highlighted the importance of laboratory tests and laboratory professionals within the healthcare landscape. As we emerge from the pandemic, it is vital that such services are reinforced and supported to optimise healthcare recovery...

– Dr Bernie Croal, Scotland Regional Council Chair

In response to a letter sent to the Cabinet Secretary for Health and Social Care Humza Yousaf, Dr Bernie Croal, Chair of the Scotland Regional Council, received a welcome letter from the Scottish government recognising the vital contribution laboratory professionals have made in these unprecedented circumstances.

Northern Ireland

Professor Ken Mills, Chair of the Northern Ireland Regional Council, met Department of Health officials to discuss the workforce challenges facing pathology specialties involved in cancer services in Northern Ireland.

England

Four English Regional Representatives were elected to address the specific challenges facing the different regions within England and to give voice to members in those regions.

Wales

Dr Jonathan Kell, Chair of the Wales Regional Council, met Chris Bryant MP to discuss workforce concerns in Wales and the backlog of cancer diagnosis and treatment. Chris Bryant has highlighted workforce concerns leading to delays in treatment in parliament and the media and has been supportive in promoting the College’s key messages.

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We are international

The College has a clear vision and goal to support and advance excellence in pathology internationally as outlined in our ‘Pathology is Global’ strategy. We have appointed new international team members to support many key activities engaging overseas members and sharing knowledge and expertise as widely as possible. Our achievements include a highly successful virtual International Pathology Day, launch of a new International Pathology School toolkit together with essential support for overseas trainees for GMC registrations and preparation for examinations.

The roundtable was a multifaceted discussion on the importance of international information exchange – especially in a pandemic – and how screening, diagnosis, treatment selection and health monitoring differ between countries. Against the backdrop of COVID-19, it was agreed that it has become more important than ever not to place boundaries on our ability to learn from one another.

International Pathology Day 2020

International Pathology Day (IPD) recognises and celebrates the contribution and achievements of pathology and laboratory medicine services in addressing global health challenges and improving the health outcomes of global communities. It is an opportunity to share knowledge and expertise with pathologists around the world based on international best practice.

International Pathology Day 2020 is very important for acknowledging the efforts made by the pathologists around the globe, especially during a pandemic. The day gives us an opportunity to share our knowledge globally and raise awareness about our contributions in the field of medicine.

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IPD 2020 explored how the global pathology community has managed infectious outbreaks in the past and how it is dealing with the current COVID-19 pandemic. For the first time it was delivered online, which allowed participants to join without restrictions.

overseas doctors applied for General Medical Council (GMC) registration

Four COVID-related presentations explored the social, economic, cultural, technical and biological factors that affect the spread of infections, as well as the role of testing, the development of new diagnostic approaches and the search for vaccines and treatments.

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medical schools attended this year’s International Pathology School

Global collaboration

Strong global coalitions that provide reciprocal opportunities to pool knowledge and resources and to share and acquire new skills are vital to the College’s international work. Our aim is to promote capacity building to improve pathology provision, predominately in resource-limited countries.

The importance of international collaboration between intercontinental agencies, government departments, nongovernmental organisations and professional pathology bodies is recognised in the form of a memorandum of understanding (MOU), which allows a clear programme of work over a threeyear period to be agreed.

In November 2020, the College signed a new MOU with the Mohamed Bin Rashid University of Medicine and Health Sciences (MBRU) with agreement to cooperate on a range of activities. We now have MOUs with eight international organisations, including the Shupyk University of National Healthcare of Ukraine (SUNHU) and the National Postgraduate Medical College of Nigeria (NPMNCN).

Several of our MOUs cover areas of shared interest that focus on assisting international medical graduates (IMGs) with their pathology training and FRCPath examinations. They are essential in strengthening our relationships with international pathology institutions.

Representing our international members

20%

With around 20% of our membership located internationally it is vital that they have the opportunity to contribute to the College’s decision-making processes and governance structures. Our International Committee acts as a representative voice for both international members and UK members with international interests.

of the College’s membership are located in one of six overseas territories

Over late 2020 and early 2021, the International Committee went through a number of changes as terms came to an end and new roles were included to provide greater coverage across international regions. A new Clinical Director of International Activities was appointed along with six International Regional Advisors.

Key achievements

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The International Regional Advisors will provide proactive advice, leadership and direction in relation to the development and implementation of the College’s activities and champion the College’s international strategy ‘Pathology is Global’ within their respective regions.

My firm belief is that fellows practicing overseas should maintain strong links and be involved with the College. This belief fired my desire to be an integral part of championing the importance of keeping up to date with high standards of practise, training and assessment.

– Professor Ismail Matalka, Clinical Director of International Activities

Supporting international students and trainees

The Medical Training Initiative (MTI) scheme enables IMGs to come and train in the UK for a maximum of 24 months before returning to their home countries. The College works closely with the GMC and the Academy of Medical Royal

Colleges to assist IMGs in obtaining registration with the GMC and the Tier 5 visa. The College also supports IMGs who wish to pursue a career in pathology through the Sponsorship Scheme, assisting with their GMC registration so they are able to work and train in the UK.

These schemes benefit both the IMGs and UK hospitals. IMGs develop new skills, expertise and practices that can be used to advance the level of patient care in their countries of origin on their return. UK hospitals who provide a placement for IMGs benefit from increased workforce capacity and the experience and skills that IMGs can share with their UK colleagues.

One of the most valuable aspects of the MTI scheme is the immense clinical experience you gain. Every day is a chance to gain new experience and knowledge.

The International Trainee Support Scheme supports and mentors IMGs in preparation for their FRCPath examinations by identifying gaps in their knowledge and training. Our two newly appointed International Educational Leads

will help the College to further develop this scheme, which currently runs for histopathology and medical microbiology.

Strong global coalitions that provide reciprocal opportunities to pool knowledge and resources and to share and acquire new skills are vital to the College’s international work.

Our recently designed International Pathology School toolkit offers international undergraduate medical students the opportunity to learn more about pathology and its integral role in healthcare and how rewarding a career in pathology can be. In January 2021, the toolkit was piloted through a two- to threeday interactive event in the MENA region, in collaboration with the University of Science and Technology in Jordan. The event was attended by over 110 medical students from regions including Jordan, Qatar and the United Arab Emirates.

Looking ahead

According to the British Medical Association, there are approximately 800 refugee doctors in the UK; however, the number of those who are pathologists is unknown. The College has produced a plan to support refugee doctors in pathology, which includes signposting to relevant information and resources from a dedicated College webpage, creation of a mentor database, free College membership for one year, access to a defined number of free College events and free or reduced fees for up to two attempts at FRCPath Part 1.

The International team is working to promote the College’s aims in knowledge and excellence worldwide through the new International Pathology Schools, as well as the established International Pathology Day, which in 2021 will focus on digital pathology and artificial intelligence.

I cannot emphasise enough how useful it can be for UK trainees to work and study alongside overseas trainees … For me this was a mutually enriching partnership in preparation for the FRCPath examination…

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Award winners: celebrating pathology

The College greatly values excellence in pathology practice, research and education. In particular, we recognise the excellent achievements of our trainees with medals for original research and the Furness Prize for Science Communication.

We continue to remember two colleagues through essay prizes named in their memory. The Hugh Platt Foundation Essay Prize this year recognises a heartfelt and personal experience of the impact of pathology. The Paola Domizio Undergraduate Essay Prize was awarded for a clear account on the benefits and challenges of technology. Many congratulations to all our winners.

Trainee Research Medals

The College’s research medals are awarded for outstanding research work undertaken by trainees.

Gold medals

Silver medals

Matthew Clarke Histopathology

Lara Menzies Clinical Genetics

Matthew Clarke won the gold medal with a paper on infant high-grade gliomas that comprise multiple subgroups characterised by novel targetable gene fusions and favourable outcomes.

David Marshall Clinical Biochemistry

Ben Challoner Cellular Pathology

Caroline Watson Haematology

Marwan Kwok Haematology

Caroline Watson won the gold medal with a paper on the evolutionary dynamics and fitness landscape of clonal haematopoiesis.

Thomas Milner Neuropathology

Hugh Platt Foundation Essay Prize – Chuer Zhang

Chuer’s essay, ‘Tiny test, huge impact’ follows the case of a six-yearold boy who was taken to the emergency department by his family to assess ‘an apparently innocuous ecchymosis’ (bruise) on his left arm. The essay is a touching account of the importance of pathology and its effect on patients and their families. Chuer reveals, towards the end of the essay, that the young boy in her story is in fact her brother.

I’m honoured to have my experience read by more people. Entering the competition makes you reflect on your experience more and appreciate the role pathology plays in the course of a patient’s treatment.

Furness Prize for Science Communication – Matthew Clark

Our annual science communication prize celebrates and recognises trainees and undergraduates who have undertaken public engagement activities to cultivate the awareness and understanding of pathology. Matthew’s dedication to delivering public engagement and science communication activities over the last couple of years was clear to see. Matthew has tirelessly promoted pathology and helped to inspire the next generation of pathologists.

It is a wonderful feeling to have won this year’s prize! Winning this prize encourages me to continue pursuing my science communication projects with the general public, undergraduates and junior doctors.

Paola Domizio Undergraduate Essay Prize – Harry Adams

Could pathologists soon be replaced by robots? In his essay, Harry considered the potential benefits and challenges posed by technology, as well as the impact on patients and on pathologists’ working lives.

It is a great opportunity to practice essay writing skills and appreciate topics not usually taught at university.

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Our 17 specialties ... demonstrate
the innovation, dedication and hard
work of the clinical scientists and
pathologists who are involved
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– Professor Mike Osborn, President
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Our specialties

The College is very proud of all our medical and scientific colleagues working across 17 specialties and many subspecialties. Our colleagues make exceptional contributions to health at all stages of our lives. Examples of this essential work range from diagnosing inherited and acquired disease in the fetus and newborn, immunisation in childhood and adults, care of pregnant mothers, diagnoses, investigation and treatment of a multitude of disorders, infections and cancers together with screening programmes right through to post-mortem examinations that inform the care of the living. We have briefly outlined the key roles of each specialty with a further spotlight on just some of the ongoing work in the clinical case studies in the next few pages.

Cellular pathology

with a wide variety of illnesses, from high cholesterol to thinning bones. Chemical pathologists interact with patients at several different points through their treatment journeys – they investigate test results and meet patients in person to support their treatment.

Cellular pathology includes many subspecialties, including cytopathology and dermatopathology. Cellular pathologists are doctors and scientists who diagnose and study diseases including cancer and inflammatory diseases, such as ulcerative colitis, in tissues and organs. Cytopathologists diagnose cervical cancers through the screening of cells. Examination by microscope of a small biopsy or tumour can provide the diagnosis but, increasingly, this is supplemented by DNA examination of cancers to tailor treatment.

Forensic pathology

Forensic pathologists perform medico-legal post-mortem examinations to determine the cause of death, including cases where a crime is suspected. They collect, examine and interpret tissue specimens under the microscope, as well as documenting and interpreting injuries, including on living victims. They provide scientifically objective expert reports for the police, coroners, procurators fiscal and solicitors and give expert evidence in crown, family and coroner’s courts among others.

Chemical pathology

Chemical pathologists and clinical biochemists monitor bodily fluids like blood and urine to detect important changes in the body’s chemistry. They play a key role in diagnosing and monitoring patients

Genetics and genomics

As advances in technology have allowed us to study DNA in ever greater detail, genetics and genomic medicine have become an important weapon in the fight against disease. Doctors and scientists working in genetics diagnose inherited diseases and advise families on treatment. Genomic testing also contributes to the better understanding of infection, including mapping of the COVID-19 pandemic.

Genomic medicine is at the forefront of transforming patients’ lives by enabling a quicker diagnosis for patients with a rare disease; matching people to the most effective medications and interventions; and increasing the number of people surviving cancer each year because of faster, accurate diagnosis and tailored treatment with targeted therapies.

Haematology

Haematologists are experts in blood cells, including those circulating round the body and in the blood cell factories of the bone marrow. Haematologists diagnose and treat malignancies such as leukaemia and anaemias like sickle cell disease. They also deal with abnormalities of the blood clotting system, such as haemophilia. Haematologists care directly for patients on hospital wards and out-patient clinics, and carry out diagnostic work in laboratories.

Histocompatibility and immunogenetics

Histocompatibility and immunogenetics (H&I) is the study and testing of the genes and proteins that are important in the matching of organ and bone marrow transplant donors with recipients. H&I scientists ensure that transplanted organs and cells are compatible with the recipient to lessen the chances of rejection. They also support transfusion of platelets and granulocytes and are involved in investigations into transfusion reactions. H&I tests are important in the diagnosis of inflammatory diseases and can help predict adverse reactions to drugs used to treat disease, e.g. HIV.

Immunology

Immunologists deal with the study, diagnosis and management of people with disordered immune systems and immune deficiency. They advise on conditions in which immunological treatment forms an important part of therapy and/or prevention. Immunologists also specialise in the diagnosis and treatment of allergies. This specialty is playing a key role in better understanding the immunological response to SARSCoV-2, including the development of potential therapies and vaccines.

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Microbiology

Medical microbiologists support and oversee the prevention, diagnosis and treatment of illness caused by microorganisms such as bacteria. They give advice on clinical and laboratory diagnosis of infection, identify the best treatment for infectious diseases and monitor patients following treatment. They also ensure antibiotics are prescribed and used appropriately so patients receive the best treatments and to minimise antimicrobial resistance.

Microbiologists have been at the forefront of the response to the SARS-CoV-2 pandemic, advising on infection prevention and control measures, public and occupational health, strategic planning and overseeing COVID-19 testing and diagnosis in centres where there is no onsite virologist.

Molecular pathology

Pathologists working in this specialty examine molecules, particularly DNA, within organs, tissues or bodily fluids to study and diagnose diseases. Molecular tests check for specific changes in genes or chromosomes that can cause disease, such as cancer and infectious diseases. Molecular pathologists have an important role in personalised medicine, which identifies patients that can benefit from targeted therapies based on the molecular characteristics of the tumour present.

Neuropathology

Neuropathology is concerned with diagnosing and investigating diseases in the nervous system,

i.e. brain, spinal cord and nerves, as well as the muscles of the skeleton. These include a wide range of disorders, such as tumours, inflammatory disorders, infections and genetic diseases. Neuropathologists use microscopes to examine samples of tissues but in recent years, findings from molecular tests have been increasingly incorporated into their reports, for example for brain tumours. This provides much more detailed information to the clinicians with whom they work closely.

Oral and maxillofacial pathology

This lesser-known branch of dentistry – oral and maxillofacial pathology – is concerned with diagnosing diseases in the head, neck, mouth, jaws and face. Oral and maxillofacial pathologists use soft tissue and bone biopsies alongside information from dental examinations and X-rays to investigate patients’ cases. They are also involved in research into the development of treatments for head and neck cancer and the investigation of the genetic causes of developmental diseases.

Paediatric and perinatal pathology

Paediatric pathologists diagnose, investigate and monitor disease in children from conception up to 18 years of age. This includes areas such as genetic disorders, congenital diseases, cancers, disorders of metabolism, inflammatory disorders and infection. They are experts in a range of pathology specialties, such as cellular pathology, laboratory medicine and medico-legal pathology. Perinatal pathologists diagnose and

investigate disease processes that affect unborn babies, neonates and infants. They investigate causes of pregnancy loss, miscarriage, stillbirth and neonatal disease. They are experts in pathology involving the placenta.

Reproductive science

Using increasingly sophisticated technology, scientists working in reproductive science can give hope to couples who are having trouble conceiving. They are experts in diagnosing infertility, as well as investigating, offering advice and insight on treatment options and delivering treatments, such as in vitro fertilisation.

Toxicology

Toxicologists are scientists who work across a broad range of environments in healthcare. In hospitals, they analyse samples from patients who have, for example, taken recreational drugs or overdoses of prescription medicines. They also advise public health bodies and industry on chemical and environmental hazards and on drug safety.

Transfusion medicine

Transfusion doctors and scientists are haematologists who specialise in transfusion medicine. They make sure that every patient who needs a transfusion is matched with blood from a suitable donor. They oversee the health and wellbeing of donors, the testing of blood for infections, the management of hospital blood stocks and promotion

of the safe and appropriate clinical use of blood and components. Transfusion staff participate in and contribute to haemovigilance activities promoting patient safety.

Veterinary pathology

Veterinary pathologists work in animal disease surveillance, prevention, diagnosis and treatment. They play a key role in the development of safe and effective medicines and vaccines for animals and humans. They investigate diseases in pets and farm animals, as well as exotic species. They also contribute to animal conservation and protection, and public health.

Virology

Virologists are doctors and scientists who oversee the diagnosis, management and treatment of patients with viral infections, from common viruses like chickenpox to emerging infections like Zika and Ebola. Virologists are also involved in public health – studying and advising on infections spreading globally as a result of travel and climate change. Some virologists specialise in vaccine development. This specialty has been particularly recognised in making an enormous contribution to COVID-19 testing and diagnosis, which have been essential to the care of healthcare staff and patients throughout the pandemic.

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Targeted cancer therapy using CAR-T cells

Reprogramming a person’s own immune system to target cancerous cells provides a truly individual approach to cancer treatment, which involves collaboration between haematology and pathology services. Here, Dr Julia Wolf and Dr James Griffin describe how CAR-T therapy was used to treat an aggressive form of blood cancer.

CAR-T therapy is a novel and highly complex immune therapy that redirects the body’s own immune system to fight cancer. CAR-T cells are often described as ‘the living drug’ because they actively search and target malignant cells. It uses a type of immune cell called a T-cell, which is extracted from patients’ blood before being genetically altered to allow it to target surface proteins found on cancer cells.

Since Food and Drug Administration approval in the USA in 2017, CART-T therapy has emerged as one of the biggest breakthroughs in cancer therapy in decades. Several products are now used routinely or in trials to treat a range of haematological and non-haematological malignancies.

The collection, processing and storage of patient cells that form the basis of CAR-T therapy depends on a multitude of clinical and laboratory processes, which are supported by NHS Blood and Transplant (NHSBT) and pathology services.

CAR-T cells are often described as ‘the living drug’ because they actively search and target malignant cells.

Prior to the emergence of CAR-T therapy, treatment options for relapsed ALL following stem cell transplant were extremely limited and outcomes sadly often extremely poor.

The cell collection is performed by passing the blood through an apheresis machine that separates the white cells, including T-cells. The collected cells are then transported to manufacturing sites where the CAR-T cell drug is created by inserting a man-made gene, the chimeric antigen receptor (CAR), into the DNA of T-cells. As a result, the engineered cell can recognise and fight cancer cells. The CAR-T cells are then expanded and infused back into the patient after chemotherapy.

The first patient to receive CAR-T therapy at University Hospitals Bristol and Weston (UHBW) NHS Foundation Trust was Nitya. Nitya was diagnosed with acute lymphoblastic leukaemia (ALL), an aggressive form of blood cancer, at the age of 16. She received standard multiagent

chemotherapy and achieved a good initial response but, unfortunately, her leukaemia relapsed only 23 months into treatment. Nitya required more chemotherapy, which achieved a complete remission from ALL. Despite her intensive treatment she also managed to complete her A-levels and received a place to study at University College London (UCL). However, these remissions are a fragile and temporary state and need to be consolidated with allogeneic (donor) stem cell transplant.

Nitya was accepted as one of the first NHS patients to receive CAR-T cells … What followed was a journey filled with anxious waiting.

The histocompatibility and immunogenetics laboratory in NHSBT Filton carried out tissue typing, which tests to see how closely a donor’s stem cells or tissue match your own, and found that Nitya’s sister was a full match for her. Her sister underwent successful apheresis stem cell collection. Nitya received more chemotherapy to prepare her body for transplant before having an infusion of her sister’s stem cells. She tolerated the treatment well despite developing graft versus host disease (GvHD). GvHD is a frequent complication of allogeneic stem cell transplant that occurs when the donated cells view the healthy cells of the person receiving the transplant as foreign and attack them. Unfortunately, three months after the transplant, Nitya had relapsed again.

Prior to the emergence of CAR-T therapy, treatment options for relapsed ALL following stem cell transplant were extremely limited and outcomes sadly often extremely poor. However, UHBW had set up its own CAR-T programme and was now offering this treatment as one of only six sites in the UK. As CAR-T therapy is associated with significant and complex adverse events, the decision of whether to offer CAR-T therapy to Nitya was not taken lightly. Specifically, there were concerns that Nitya’s GvHD could recur and be exacerbated through further immune therapy.

As other treatment options were inadequate, Nitya was accepted as one of the first NHS patients to receive CAR-T cells in December 2018. What followed was a journey filled with anxious waiting. Nitya received further chemotherapy, which again put her into a complete remission. She achieved a good apheresis collection but cells had to be cryopreserved and shipped to the USA for manufacture. The manufacturing process for CAR-T cells is complex and not always successful meaning some patients need further chemotherapy to hold their disease at bay. Some relapse despite this, making CAR-T treatment impossible. In Nitya’s case, the CAR-T cells were returned to the UK four weeks later. Nitya underwent yet more chemotherapy to prepare her body for the CAR-T cells before receiving the infusion.

Her treatment went well but was complicated by severe GvHD affecting her liver. While this was predicted as a possible complication, it had not been previously described in the literature. Nitya was very unwell and required treatment with extracorporeal photopheresis. This is an apheresis-based therapy that involves collecting the patient’s white blood cells, adding a chemical to the cells and exposing them to ultraviolet light outside of the body to cause programmed cell death. The dying cells are re-infused back to the patient where they affect how the patient’s immune system works. Nitya received this therapy regularly for a year after CAR-T treatment but has now stopped after achieving a complete response.

And Nitya’s leukaemia? The CAR-T therapy appears to have cured the ALL with no detectable disease in her bone marrow within a month after treatment. This remains the case 18 months later.

Despite her often tumultuous treatment course, Nitya managed to start her studies at UCL and is planning on spending a year abroad soon. This would have been impossible without the close collaboration between pathology and clinical haematology services at UHBW, NHSBT and international manufacturing sites, highlighting the need for teamwork and partnership when aiming to achieve the best outcomes for our patients.

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CASE STUDY
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Using molecular pathology to unveil the rare ocular tumour behind masquerade syndrome

Molecular testing is becoming a vital tool in diagnosing cancers, as well as guiding and monitoring treatment. Here, Professor Sarah Coupland, a Consultant Histopathologist specialising in ocular pathology, explains how molecular pathology is improving the detection of a rare type of eye tumour and, potentially, patient outcomes.

The use of novel molecular diagnostic technologies is advancing at a fast pace not only in the most common cancers, but also rare types. An example of the latter is vitreoretinal lymphoma (VRL) − a highly aggressive B-cell lymphoma that is associated with central nervous system lymphoma. ¹ B-cells are a type of white blood cell called a lymphocyte that make antibodies specific to pathogens, such as bacteria or viruses, and are involved in the immune response. B-cell lymphomas develop when the body produces abnormal B-cells that grow out of control.

wide range of other ocular diseases; therefore, it is often called the masquerade syndrome. It can affect one or both eyes, and can present before or at the same time as brain disease.

The use of novel molecular diagnostic technologies is advancing at a fast pace not only in the most common cancers, but also rare types.

VRL has an estimated incidence of 0.46 to 1 per 100,000 persons per year. However, the incidence of VRL is increasing, in patients both with and without immunosuppression (where your immune system doesn’t function as effectively). VRL is currently associated with a poor prognosis, typically due to delays in diagnosis and a lack of ¹[,] ² effective therapies once it spreads to the brain.

Once VRL is suspected, a vitrectomy (the surgical removal of a gel-like fluid that fills your eye called vitreous) is performed by ocular surgeons. Cytological examination − where cells within the vitreous fluid are examined under a microscope − is required, followed by immunocytology (where stains are used to highlight specific cell types) and, when possible, molecular analyses.

VRL most often affects patients over the age of 50 years, with a mean age of 63, and affects ¹[,] ² both males and females equally. VRL is known for its gradual and slow onset, often mimicking a

Since these samples are often small and consist of fragile cells, clear communication between the ocular surgical team and the receiving

laboratory is essential to ensure the samples are transported quickly after the operation to the laboratory. In turn, experienced biomedical scientists and ocular pathologists play a major role in successfully processing the diagnostic material and interpreting the results.

The advantage of NGS panels is that they are flexible and allow for the inclusion of new genes as more is revealed about the different types of cancer.

Molecular examination of these samples has become a valuable tool to confirm the diagnosis of lymphoma. For example, B-cell immunoglobulin gene rearrangement tests detect changes (rearrangements) in specific genes in B-cells. Rearrangements are part of the normal development of B-cells and create an array of B-cells with different profiles that can protect you against different kinds of infections. In lymphomas, the abnormal B-cells produce identical copies of themselves, creating rearrangement profiles that are identical. The test determines whether the rearrangement profiles are diverse or identical and is a mainstay in VRL diagnosis.

The sensitivity of these tests ranges from between 65% and 95%, depending on a number of factors, including the quality of material and ¹[,] ² experience of the laboratory. False-negative results, however, may still occur in these analyses, because of the large number of naturally occurring (somatic) mutations that occur in B-cells reducing the effectiveness of the test.

To overcome this problem, bespoke next generation sequencing (NGS) panels, which allow DNA and RNA to be sequenced, have been ³[,4] The designed over the last five years for VRL. panels have been created based on the improved understanding of the molecular biology of the disease, including the revelation that around 75% of VRL show a mutation in the MYD88 gene in neoplastic B-cells. ³

Consequently, MYD88 mutational analysis is becoming part of the routine work-up of VRL in many laboratories worldwide, and has enabled earlier definitive diagnoses in patients.

In a recent multicentre collaboration, VRL was shown to display additional mutations and alterations in their tumour cells. These involved the following genes: PIM1, CD79B, IGLL5, TBL1XR1, ETV6 ; and deletions in chromosome 9p21/CDKN2A. [5] The study also showed that cell-free DNA of the vitreous fluid supernatant (i.e. the non-cellular component of the sample) could be used to demonstrate the presence of the above mutations with reliability. This is of importance since the number of viable cells within vitrectomy samples can be very low.

[Vitreoretinal lymphoma] is currently associated with a poor prognosis, typically due to delays in diagnosis and a lack of effective therapies.

The advantage of NGS panels is that they are flexible and allow for the inclusion of new genes as more is revealed about the different types of cancer. It is likely that the VRL NGS panels will be modified further to include some of the new genes discovered in the multicentre study, to further improve the detection of this disease. There is also promise that one or more of these genes could be targeted by new therapeutic agents designed to treat this aggressive and usually fatal disease.

1. Araujo I, Coupland SE. Asia Pac J Ophthalmol 2017;6:283−289. 2. Fend F, Ferreri AJM, Coupland SE. Br J Haematol 2016;173:680−692.

3. Bonzheim I, Giese S, Deuter C, Süsskind D, Zierhut M, Waizel M. Blood 2015;126:76−79.

4. Cani AK, Hovelson DH, Demirci H, Johnson MW, Tomlins SA, Rao RC. Oncotarget 2017;8:7989−7998.

5. Bonzheim I, Sander P, Salmeron-Villalobos J, Süsskind D, Szurman P, Gekeler F. Blood Adv 2021; doi: 10.1182/bloodadvances.2021004212 (Epub ahead of print).

Image (page 44): May Grunewald Giemsa (MGG) stain of a cytospin made from the intraocular biopsy taken from the affected area.

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CASE STUDY

The role of pathology and healthcare scientists in the diagnosis and management of bowel cancer syndrome

Medical pathologists and healthcare scientists work collaboratively to improve pathology services for patients. Here, Dr Jo Horne and Patrick Kumah describe the role of consultant scientists in the diagnosis and treatment of bowel cancer.

Every year over 40,000 cases of bowel cancer are diagnosed in the UK. ¹ Most diagnoses are made through diagnostic biopsies, taken at colonoscopy, where images are taken of the colon to detect any abnormalities. Biopsies (small samples of tissue) are taken to investigate symptoms that patients presented with, such as a change in bowel habit or bleeding. We usually receive biopsies from patients who are being investigated via the national bowel cancer screening programme.

since 2012. Our main role is to produce a histopathological report on the patient’s specimen. For biopsies, the report will contain diagnostic information and molecular test results.

Diagnosis is usually made on a glass side using a light microscope but, increasingly, digital pathology is being utilised for routine diagnostic histopathology. In digital pathology, images of the glass slide are created and captured with a scanning device to provide a high-resolution image that can be viewed on a computer screen or mobile device.

Surgical resection specimens (larger pieces of diseased tissue) are examined, described and dissected by both medical histopathologists and healthcare scientists, with representative areas of individual specimens sampled and processed through the laboratory. The samples are stained to assess any significant changes in the structure of the tissue.

Cells that have grown normally have a uniform and organised appearance. By contrast, abnormal cells show a different range of features, a deeper colour on staining and a disorganised growth pattern. The bowel is made up of tissue layers, and when these abnormal cells grow in the wrong areas, this is known as cancer. To aid diagnosis, further investigations, using genetic testing or immunohistochemistry (a technique that makes proteins visible and helps to identify whether the patient has abnormal mismatch

Consultant histopathologists, and increasingly, consultant scientists make the diagnosis. Consultant scientists have been eligible to train to report histopathology samples from the gastrointestinal tract (and other sites)

repair genes), are performed. Mismatch repair genes are responsible for correcting any errors that are made when DNA is copied within a normal cell. Cells with abnormal mismatch repair genes build up many DNA mutations, which can lead to bowel cancer developing. Knowing whether there are abnormalities in the mismatch repair genes helps to exclude an inherited disorder called Lynch syndrome. It can also predict how the tumour will respond to any treatments that are planned for the patient.

Part of the role of healthcare scientists is to attend colorectal multidisciplinary team meetings (MDTs). In these meetings the team confirms the cancer diagnosis and sets out the patient’s individual treatment pathway. We review the histopathology reports beforehand. With increasing access to rapid molecular testing, we inform oncologists of any gene mutations that may indicate Lynch syndrome. All newly diagnosed cases of bowel cancer are assessed for Lynch syndrome. This is an inherited condition that puts people at a much higher risk of developing bowel cancer, as well as increasing the risk of other cancers including ovarian cancer, stomach cancer and womb cancer. Family members may have the condition, and they can be referred for genomic testing and counselling.

Attending MDTs allows scientists to fully integrate within clinical teams and has the added benefit of releasing time for medical histopathologists to undertake other, more complex work. The role of pathology in the diagnosis, staging and monitoring of colorectal cancer has increased greatly over the last few years. Scientists and pathologists are responsible for ensuring that the right tests are carried out to the highest standard on behalf of patients. As the workload continues to increase, there must be an appropriately trained and experienced clinical workforce, comprising both medical histopathologists and healthcare scientists.

Scientists are highly qualified and experienced individuals and, with appropriate training programmes and opportunities, in line with other healthcare professions, are in a perfect position to contribute to safely managing the increasing workload within histopathology. We can act as the

conduit between the laboratory, MDT coordinators and clinicians, ensuring that cases are ready for discussion at MDT. We have the skills and knowledge to increase collaboration and integration between histopathology, molecular pathology departments and genomic testing laboratories, and to develop and quality assure new tests and ways of working, such as digital pathology or rapid molecular testing and interpretation.

The key now is to develop new, improved and widened workplace and academic training programmes for scientists in histopathology. We need to work towards more collaborative and integrated training programmes for medics and scientists, both nationally and within pathology networks. Undertaking this work, alongside increasing training places for medical histopathologists, is essential to safely sustain and improve histopathology services, ensuring that every person diagnosed with bowel cancer receives the right diagnosis and right treatment at the right time.

1. Cancer Research UK. Bowel cancer statistics .

Image (page 46): H&E section of the patient’s colonic biopsy showing a malignant tumour (adenocarcinoma).

Image above: Positive staining within the tumour cells in the patient’s biopsy for the mismatch repair protein, MLH1.

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Image: A bag of combined red blood cell and plasma treatment.
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CASE STUDY Improving patient outcomes through clinical studies

To ensure the best outcome for patients, early intervention is essential in cases of major traumatic haemorrhage. Here, Dr Harriet Tucker, Trauma Research and Whole Blood Fellow, and Dr Laura Green, Consultant in Haemostasis and Transfusion Medicine, share the story of a patient who received a combined red blood cell and plasma transfusion from paramedics at the scene of the injury.

of injury, and acute traumatic coagulopathy begins at the point of injury. Trauma-induced coagulopathy (TIC) is a clinical syndrome driven by the combination of shock and tissue injury, resulting in uncontrolled bleeding; management focuses on stopping the bleeding, reversing the shock and preventing worsening TIC by restoring the circulating blood volume.

The red cell and plasma study was a multicentre cohort study to establish the feasibility of pre-hospital transfusion of a combined red blood cell and plasma product delivered at the roadside to critically injured patients. ¹ The study was a collaboration between NHS Blood and Transplant, Barts Health NHS Trust and Queen Mary University of London.

The use of a combined component … can overcome … logistical challenges allowing quicker, earlier delivery of blood products in equal ratios, and the potential to improve survival rates.

Most potentially preventable deaths for people who bleed due to traumatic injury occur in the first three hours of injury…

To help reduce these early deaths, which often occur before the patient reaches the hospital, most UK Air Ambulances carry separate bags of red blood cells and plasma. The latter is carried either in the form of pre-thawed fresh frozen plasma (which has a short shelf-life and must be stored cold) or lyophilised plasma (which has a longer shelf life but must be reconstituted prior to use). The use of these separate components in

The UK standard of care in-hospital for traumatic haemorrhage is early haemostatic resuscitation – delivering a balanced ratio of blood products to the patient as early as possible. Most potentially preventable deaths for people who bleed due to traumatic injury occur in the first three hours

three bags of red cell and plasma through this single line and through one blood warmer. By only having to transfuse three bags (instead of six separate bags) through one intravenous line, Alvin could be resuscitated rapidly, reducing the time needed for blood transfusion on scene, correcting TIC earlier and allowing the small team to perform other time critical interventions, all of which was paramount to his survival.

a pre-hospital setting presents storage, resource, logistical and operational challenges. These challenges include a limited number of transfusion sets, limited blood warmers to warm the blood prior to use to prevent hypothermia and prevent worsening of TIC, storage constraints to carry enough bags of each component, and the time taken to ensure safety checks are carried out appropriately for each blood component transfused.

Alvin was flown to the Royal London Hospital arriving just 70 minutes after the time of his injury, where he was met by the ‘Code Red’ trauma team. The Code Red team manage patients who are bleeding and who need immediate attention to stop their bleeding and save their lives. He received a blood transfusion in the Emergency Department and was taken directly to the preprepared operating theatre. Here, he underwent repair of the blood vessels that had been damaged in his leg and further blood transfusion. Alvin was transferred to the intensive care unit and less than ten days after being admitted, he was discharged home to his family. Alvin was able to move independently and was shortly back to work with support from the hospital’s After Trauma Team.

The use of a combined component, such as red cell and plasma, can overcome many of these logistical challenges allowing quicker, earlier delivery of blood products in equal ratios, and the potential to improve survival rates. For example, one bag of combined red cell and plasma is the equivalent of transfusing one bag of red blood cells and one bag of thawed plasma – all of which need to undergo safety checks, be transfused separately and sequentially, through limited intravenous sites.

Alvin’s story

In December 2018, Alvin suffered a stab injury to his right thigh, just above the knee. He lost a lot of blood on scene, and a bystander performed initial first aid by putting pressure on the wound and applying a tourniquet made from rope. The paramedic team then applied three combat application tourniquets to reduce the bleeding.

Alvin’s story highlights the benefits of trialling new products and interventions and constantly striving to improve patient care to give them the best possible opportunity to go home to their families and continue their lives as they would want to.

1. Red cell and plasma study. Available at: https:// www.c4ts.qmul.ac.uk/research-programmes/ red-cells-and-plasma-transfusion-study

Alvin’s story highlights the benefits of trialling new products and interventions and constantly striving to improve patient care…

20 minutes after the injury, the London Air Ambulance arrived. Alvin was unwell, displaying signs of shock from significant blood loss. He had a reduced level of consciousness, his heart rate was very fast and his blood pressure was low. In the 22 minutes that the pre-hospital critical care team were on scene, they performed a pre-hospital anaesthetic, gained intravenous access into a large central vein and transfused 49

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CASE STUDY

A One Health approach to high blood cholesterol

As the past 18 months have shown us, the health of humans, animals and ecosystems are interconnected. Here, Dr Simon Spiro, Wildlife Veterinary Pathologist at the Zoological Society of London, explains how studying disease in one species can further our understanding of pathogenesis in humans.

The great joy of being the veterinary pathologist for the Zoological Society of London (ZSL), the international conservation charity behind ZSL London and Whipsnade Zoos, is getting to work with the widest possible range of species, from the smallest corals to the biggest whales. Every species presents its own challenges at post mortem. For an elephant, these are mostly solvable with a team of helpers and a JCB, while a starfish may require long hours of reading and Googling just to familiarise myself with the anatomy. Against this background, a post mortem of a medium-sized, non-venomous, softbodied animal like a meerkat may seem like an opportunity to relax into familiarity. However, as this case will demonstrate, nothing can be taken for granted in the world of wildlife.

Meerkats are a common species at zoos around the world and their high levels of activity and anthropomorphic qualities make them a favourite of visitors and keepers alike. We were all very saddened when one of our older meerkats, Hari, was found collapsed and semi-responsive in his enclosure at ZSL Whipsnade Zoo last December. Hari was immediately rushed to our veterinary hospital, where radiology revealed changes to the meninges (the surface coverings of the brain) that blurred the distinction between brain and skull. Because of the poor prognosis and lack of response to supportive therapy, the sad decision was taken to put Hari down. Postmortem examination quickly revealed the true nature of the brain lesion − a gelatinous mass fusing the parietal lobes of the brain and the overlying skull into a single, indivisible unit.

The great joy of being the veterinary pathologist for the Zoological Society of London … is getting to work with the widest possible range of species, from the smallest corals to the biggest whales.

Meerkats are most closely related to cats, of all the domesticated species. If I had seen a similar lesion in a domestic cat, I would have expected the symptoms to have been caused by tumours, such as a meningioma or osteosarcoma, or a chronic inflammatory process such as osteomyelitis. Histopathology revealed that the true diagnosis was one almost unique to meerkats − a meningeal cholesterol granuloma.

Cholesterol granulomas are an inflammatory lesion formed of needle-shaped cholesterol crystals surrounded by foreign-body type inflammation. In humans, they are most commonly found in the petrosal bone around the ear, while in veterinary medicine they are sometimes found within the lateral ventricles of horses’ brains. In both cases, they are thought to be the result of chronic haemorrhage, with the cholesterolrich membranes of the blood cells slowly breaking down and inducing a granulomatous response. In meerkats, no association with haemorrhage has been shown. Instead cholesterol granulomas seem to be directly related to high blood cholesterol (hypercholesterolaemia).

Hari’s do still present. We know that a minority of visitors to our zoos ignore our signage and will attempt to feed the meerkats with inappropriate treats. When we were closed during the COVID-19 lockdowns we saw the meerkats start to lose weight, suggesting that they were receiving significant amounts of unsuitable food in this way.

ZSL takes a rounded approach to animal health, and employs specialists in veterinary medicine, pathology, behaviour, welfare and nutrition to tackle these knotty problems. By thoroughly investigating and publishing these cases, we hope to not only improve the health of captive and wild meerkats around the world, but also understand more about the fundamental pathology of disease in animals and in humans.

In human medicine, hypercholesterolaemia leads to cholesterol plaques being deposited in the walls of arteries (atherosclerosis), potentially leading to coronary heart disease. In meerkats, these plaques are deposited in the brain causing neurological disease. In both humans and meerkats, hypercholesterolaemia is, at least in part, the consequence of poor diet choice. In the wild, meerkats eat a wide variety of arthropods, such as beetles, termites and scorpions. In captivity, however, such variety is hard to replicate, and zoos have traditionally fed meerkats high calorie, high fat foods like mealworms, mice and day-old chicks. These are the meerkat equivalent of burgers and chips.

By thoroughly investigating … we hope to not only improve the health of captive and wild meerkats around the world, but also understand more about the fundamental pathology of disease in animals and in humans.

At ZSL, we carefully monitor the blood cholesterol of our meerkats and feed a high protein, low fat diet including crickets and mixed vegetables to minimise and manage the risk of hypercholesterolaemia, although cases such as 51

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Our governance

04.

The Lay Network brings expertise from diverse backgrounds and their input and feedback helps ensure the College’s outputs are in line with the needs of our members and the public and our work is transparent.

NOVEMBER 2021

ROYAL COLLEGE OF PATHOLOGISTS ANNUAL REPORT & ACCOUNTS

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NOVEMBER 2021

ROYAL COLLEGE OF PATHOLOGISTS ANNUAL REPORT & ACCOUNTS

SECTION 04 OUR GOVERNANCE

Governance of the College

College review of the Royal Charter, Ordinances and Bye-Laws

Following a review of our Royal Charter, Ordinances and Bye-Laws and in consultation with College fellows, proposed changes were approved at the 2020 Annual General Meeting and subsequently put forward to Privy Council. These changes have now been approved and will see the role of College President rotating between candidates working in different specialties. The President will be unable to stand for re-election after serving their three-year term. Gender-neutral terminology will replace masculine pronouns in the Charter and Ordinances and voting rights have been extended for our diplomate members. They will now be able to participate in the election of honorary officers, general Council members and, if the diplomate lives in England, English Regional Representatives on Council. This will provide diplomates with a valuable opportunity to contribute to the future of the College.

The Trustee Board also enacted a change that provides for a lay trustee to take on the role of Chair for the Board. A third lay trustee appointment has been added to the Board to strengthen overall diversity of skills and experience.

Council and Trustee Board as at 30 June 2021

Nationally Elected Members

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NOVEMBER 2021

ROYAL COLLEGE OF PATHOLOGISTS ANNUAL REPORT & ACCOUNTS

SECTION 04 OUR GOVERNANCE

Financial report

The income of the College amounted to £6.7 million, with expenditure of £5.9 million, and a resultant surplus of £803k.

During the previous financial year, the College was unable to run the spring 2020 examinations owing to the COVID-19 pandemic, which were deferred until this financial year. The fees payable by candidates, although received in the bank account of the College, could not be brought into the accounts until the point in time that examinations had actually taken place, hence the reason why income from postgraduate education and examinations has increased to £2.2 million compared with £895k last year.

will continue virtually for the ensuing financial year. Savings in building-related costs (including cleaning, energy consumption and building maintenance) have been identified as a result of closing the building on 24 March 2020. All staff have been working remotely since that date. The office reopened on 13 September 2021, with the conference centre opening fully from 19 July 2021.

The last 12 months proved eventful for world economies and markets. Equity and other risk markets have performed well against this backdrop, with financials, industrials and materials challenging technology returns for the first time in decades − their rally being prompted by the vaccine news in November. Unsurprisingly, given the strong economic upturn, defensive sectors like utilities and consumer staples lagged at the bottom. The College’s portfolio has seen a good return of +24.5% in the 12 months to 30 June 2021. Over the longer term, the portfolio has delivered +40.5% and +74% on a three-year and five-year timeframe, respectively.

Income from the trading activities of the College through the Events@No6 conference centre had to cease operation in March 2020 and have operated on an extremely limited basis for allowable educational events as and when permitted to do so. Some staff from the commercial arm of the College, unfortunately, had to be made redundant because of the severe reduction in income.

Some other staff for this activity and generally across the College were furloughed under the Coronavirus Job Retention Scheme. All such staff have returned from furlough as of 30 June. Costs for the trading area of activity were reduced and managed wherever possible, with a conscious decision to retain the sales and marketing function in place to ensure that the College is on the front foot as this activity recommences. Further savings have been made against the salaries budget due to vacant positions that were not filled during the year, or which were delayed before being recruited to.

The accounts published overleaf are not the statutory accounts, but a summary of information relating to both the statement of financial activities and the balance sheet. The full financial statements have been audited and contain an unqualified audit report. They were approved by the Trustee Board on 5 August 2021 and have been submitted to the Charity Commission. Any member may request a copy of the full accounts by writing to the Chief Executive.

The College has been holding virtual committee meetings rather than face-to-face meetings throughout the year, so there have been savings on travel and related costs and the provision of refreshments at meetings. Most meetings

Dr Andy Boon, Treasurer Mr Daniel Ross, Chief Executive

Income 2020−21

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33%
Postgraduate
education &
56% examinations
Subscriptions 4% 3%
Digital education
Conferences
project
& academic
activities 0%
Total 1%
International
1%
100% Professional standards
development
Other 1%
income 1%
Trading
Investment
activities
Expenditure income
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Expenditure 2020−21

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30%
19%
Postgraduate
Communications
education &
examinations
6%
5%
16% Professional Conferences &
2%
Trading standards academic activities
activities &
Digital education
education 7% project 5%
centre
Total Workforce
Advisory committees 4%
100% 0%
Investment Clinical
6%
management fees effectiveness
International development
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NOVEMBER ROYAL COLLEGE OF PATHOLOGISTS SECTION 04 2021 ANNUAL REPORT & ACCOUNTS OUR GOVERNANCE

Consolidated Statement of Financial Activities for the year ended 30 June 2021

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Unrestricted Unrestricted Restricted Total Funds Total Funds
General Designated Funds 30 June 30 June
Funds Funds 2021 2020
£ £ £ £ £
Income from:
Donations & legacies 1,483 - - 1,483 3,892
Charitable activities
Subscriptions 3,785,867 - - 3,785,867 3,622,145
Postgraduate education & examinations 2,194,501 - 5,000 2,199,501 894,774
Pathology Portal - - 175,000 175,000 100,127
International development 14,316 - - 14,316 108,787
Conferences & academic activities 262,107 - - 262,107 187,950
Professional standards 52,626 - - 52,626 59,788
Communications 423 - - 423 5,000
Trading activities 68,324 - - 68,324 743,280
Investments 91,757 - 2,189 93,946 147,619
Other 79,820 - - 79,820 79,751
Total income 6,551,224 - 182,189 6,733,413 5,953,113
Expenditure on:
Raising funds
Trading activities 945,670 600 - 946,270 1,408,765
Investment management fees 23,557 - - 23,557 14,472
Charitable activities
Postgraduate education -
1,737,826 13,000 1,750,826 1,672,503
& examinations
Pathology Portal - - 138,871 138,871 26,153
-
International development 355,670 5,000 360,670 420,827
Conferences &
-
262,873 91,943 354,816 385,451
academic activities
Research - - 3,462 3,462 3,884
Professional standards 269,543 - - 269,543 332,372
Clinical effectiveness 251,717 7,583 - 259,300 299,697
Workforce 313,000 - - 313,000 337,097
Communications 1,095,270 - 820 1,096,090 1,235,916
Advisory committees 391,165 22,584 - 413,749 478,274
Total expenditure 5,646,291 30,767 253,096 5,930,154 6,615,411
Net income / (expenditure)
904,933 (30,767) (70,907) 803,259 (662,298)
before net gains on investments
Net gains on investments 871,548 - 164,075 1,035,623 150,475
Net income / (expenditure) 1,776,481 (30,767) 93,168 1,838,882 (511,823)
Transfers between funds (604,420) 603,420 1,000 - -
Net movement in funds 1,172,061 572,653 94,168 1,838,882 (511,823)
Reconciliation of funds:
Total funds brought forward 6,424,037 28,864,164 1,364,466 36,652,667 37,164,490
Total funds carried forward 7,596,098 29,436,817 1,458,634 38,491,549 36,652,667
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Consolidated Balance Sheet

as at 30 June 2021

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2021 2020
£ £
Fixed assets:
Tangible assets 38,403,585 39,036,481
Investments 6,294,113 5,281,517
Total fixed assets 44,697,698 44,317,998
Current assets:
Stocks 4,900 11,231
Debtors 477,465 564,210
Cash at bank and in hand 6,143,921 5,202,564
Total current assets 6,626,286 5,778,005
Liabilities:
Creditors: Amounts falling due within one year (4,040,079) (4,332,997)
Net current assets 2,586,207 1,445,008
Total assets less current liabilities 47,283,905 45,763,006
Creditors: Amounts falling due after more than one year (8,792,356) (9,110,339)
Total net assets 38,491,549 36,652,667
The funds of the College:
Unrestricted funds − general funds 7,596,098 6,424,037
Unrestricted funds − designated funds 29,436,817 28,864,164
Restricted funds 1,458,634 1,364,466
Total College funds 38,491,549 36,652,667
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The financial statements were approved by the Trustee Board on 5 August 2021 and signed on behalf of the Trustee Board by Professor Mike Osborn, President, and Dr Andy Boon, Treasurer.

Independent Auditor’s Statement to the Trustees of the Royal College of Pathologists

The full financial statements were audited by Begbies, Chartered Accountants, and approved by the Trustee Board on 5 August 2021 and signed on their behalf by Professor Mike Osborn and Dr Andy Boon.

Begbies

Chartered Accountants and Registered Auditors 9 Bonhill Street, London EC2A 4DJ 5 August 2021

58

59

6 Alie Street, London E1 8QT 020 7451 6700 | www.rcpath.org

@rcpath /rcpath © 2021 The Royal College of Pathologists Registered Charity in England and Wales | Number 261035

The Royal College of Pathologists Pathology. the sclence behind the cure Annual report and financial statements For the year ended 30 June 2021 Reglstered charity number 261035 The Royal College of P8lhok¥ists 6 Alè Street, LO￿lOn, E18QT, UK T81: 020 74516700, YMw.rcpath.org

The Royal College of Pathologists Indox to th8 financlal statements Pa Report of the trustees Report of the audRors 12- 14 Consolldated ststement of financial activhies 15 Consolld8tsd and College balance sheets 16 Con8olldated st8t8m8nt of cash flows 17 Accounting policies 18-20 Not88 to the financlal 8tstements 20-32

Tho Royal College of Pathologists Report of the trustees for the year ended 30 June 2021 The Trustee Board are pleased to present their r8POrt together with the financial statements of the College for the year ended 30 June 2021. Objectlves & activities The Co116ge's mission is to promote excellence Sn the pr8Ctlce of pathology and to be responslble for maintsining standards through training, assessments, examinations and professional development. to the benefit of the public. The trustees have complied with the duty in the Charitres Acl 2011 to have due regard to guidance published by the Charity Commission, including public benefit guidance. Pathok)gy is the 5¢18nce at the heart of modem medicine, vital for the understanding, diagnosis and plannir@ clinlcal management of disease. 70 80Q/o of all health care decisions affecting diagnosis or treatment involve a pathology invesllgation. It*&rt￿n1ofHe￿Irh, England Repotdthe RevKgw OINHS P8lh(4cgy SoNk8$ln England, chatr$d by Cartarofcdos, 200&J Pathologists study the causes of disease and the ways in which disease processes affect our bodies. Recognlsing the pattems that disease takes allows us lo understand whaV8 at the root of a problem, enabling accurate diagnosis. Following up thls understandSng helps trealmenls to be devised and preventstNe measure5 to be put in place. The fact that much palhobgy goes on behind the scenes may account for the fact that many p8ople are almost unaware of Its ongoing contrlbullons to modem medicine. Without the work of pathologists there could be no firm answers, and improving or even maintaining the quality of medical care would be Impossible. The College's unique role ensures that high quality standards of knowledge and expertlse are maintained in all areas relating to pathology. Tho Coll&ge ensures Ihat pathoioglsts are qualif18d and up to date in their practice by.. Setting standards for 8ducation and tralning In pathology. Examining against these standa￿ls. Providing a leading continuing profe8sion81 development pn)gramme. Running scientific s8minars and expert workshops on a national and regional basis. The College k)oks after the interests of patients by- Producing guid61ines and other documents that set standards of best practlce. ProvidSng advlce to pathologists and governments. Ensuring lay ￿PreSentatIon on all deslgnaled College commfttees. Working with organisations such as Lab Tests On-Line and Labs Are Vital as a resource for patEnts lo find out about the various clinlcal tests that are used in their diagnosis and treatrnent. Th8 College helps in the search for cur8s lo disease by committing to strengthening th8 r6search base of the specialty. This is achieved through.. Supportlng fellows and trdinees who undertake research activities as part of their day to day work. Awarding bursaries and prizes for research. Pa￿1

Tho Royal College of Pathologists Report of the trustees for the year ended 30 June 2021 Objectives & activities (continued) The College has a public eng8gement programme whose aims include inspiring secondary school studenls to learn about Science Ihrough an innovative and creative programme focusing on health and dlsease. The goa18 ofihis programme are lo.. Raise awareness of pathology and ils ¢rucial ro18 in treating and cu￿ng diseas6. Increase interest In pathology as a career option. Contribute to the wider initiativè of engaging the public In contsmpor8ry science. Support the teaching of sclence in secondary schools. Change 8tt11udes towards science, in particular palhology. Actlvltles To achieve our objectlves the College has undertaken significant activities during the year under review". Tralnlng. examinations and ass•ssmonts: Setting the stslldards for training in pathology through t1￿ provision of medi(xl. clinical Scien￿ and veterinary pathology curricula. Administering medical pathology trainlng through College Specialist Training Committees, who advise and provide guidance on all major issues relating to specialist Irainlng in pathology. Managing the development, implementation and evaluatlon of workplace-based assessments for medical trainees and advising on the development of workplac8-based assessments for clinlcal Scien￿ train&es. Registering and monitoring Specialty Registrars for the duration of their tfdining and recommending them for the 8ward of a Certificate of Completion of Training {CCT) to the General Medical Council (GMCI. Providing electronic tTrining portfolios to allow reglst8red trainees to record their progre8s in tralning. Development, implementation and delivery of the FRCPath part 1 and part 2 examinations in the 17 pathoiogy specialties, and the Stage A, Stage C, C8rtificate and Diploma examinations. Ensuring that curricula, assessments and examinations are approved by the appropriate regulator, and that transitional arrangements are in place where these change significantly. Recommending to the GMC whether or not the tralning andlor qualifications and experien of pathologists applying to the Specialist Register under the C6rtificat6 of EquivalencE of Specialist Regislration {CESRI rules is equivalent Sn content and duration to that required for Certificate of Completion of Trdining. Reswnding to Initiatives from the Departments of Health. Management of the process of admission to membership by published works. Attending, and providing support for local and national careers fairs. Supporting training through the provision of 8-leaming materials. Supportlng the provision and promotlon of palhology in undergraduate and foundation trainlng. Pallenl safety Support P8thologlsts and their teams to Improve safety and quality of care. Encourage shared learning to advance patient safety and quality improvement. Page 2

The Royal College of Pathologists Report of the trustees for the year ended 30 June 2021 Actlvltlgs {contlnued) Professional standards Deliver a leading continuing professional devebpment scheme and user friendly online CPD and revalidation portfolio for members. Supporting the Prof8ssional Perfonnance Panel lo deal wlth revalidation queries and conr*ms about professional Performan￿ in all disciplines of pathology. Deliv8ring invited reviews of pathology services for healthcar8 organisations and providing formal advice on professlonal performance in palhology. Supportlng the extemal quality assessment stakeholdèts forum. Consultancy services The provision of consultancy sérvices to providers or commissioners where an authoritative independent review is required on the provision of high-quality pathology services. Cllnlcal Effectlveness Providing guidance and support to members and trainees on patient safety and quality improvement methodologies including clinical audit and to deliver continuous quality Improvement awareness months. Ensuring pathology input inlo guidelines and standards produced by national bodles Continued membership of the International Collaboration on Can￿r Reporting to support the production of common and intemationally validated and evidence-ba8ed palhok)gy datasets for cancer reporting for use throughout the wodd. The production of high-qualily evKlenGe based Glinical guidelin8s in pathology to accredited stand8rtls. Workforce Maintaining standards In pathology by reviewing and approving consutsnt level job descriptions and oVerseeir￿ the College's statutory role in ¢onsultant advisory appointment commrttees IAAC'S). Collecting data from direct Surveys and the outcomes of appolnlmenls lo enable the College to define the workforce required to deliver high quality patiènt centred pathology seNIc8S throughout the UK. Providing data to enable the College to have a clear voice on pathology workf0￿e planning. Conferences and academic actlvltles Management and d8velopmenl ofthe programme of in-house symposia and online webinars design8d to keep participants up lo date Wlth current thinking and practi￿ In the palhology disciplines. Advl$ory commltto8S Much of the work of the College is achieved through the Co118ge's committee structure reporting to Council. These actlvlties provide profesgional advice and guidan￿ through speciatty advisory committees, intercollegiate and joint committees. Committees deal with generic matters crossing all pathology specialties whilst the speciaity advSs0ry committees advise on Specialty specific matters such a8 histopalhology and microbiology. etc. Establishment of a nelwork of lay advlsors to Input Into specrfic committ885. Regional councils for Northèm Ireland, Scotland and Wales maintain valuable regional and local influence and insight. Committees that report lo Ihe Trustee Board Include Council, Nominations Commltlee, G0Veman￿ Committee and the Remuneratlon Committee. Page 3

The Royal College of Pathologists Roport of the Irustees for the year ended 30 June 2021 Activitles (continued) ComrnunlGatlons Production of the quarter￿ publication 'The 8ullgtin' distributed to memb8rs and subscribers. Produclion of a range of publications and guidelines on best practice In patho109y. Production of the monthly President's e-newsletter for members. Development and mainten8nce of the College's web site, Including the members, area. Engagèment with politicians, civil servants and other key stskeholders across the UK to ralse awareness and understanding of the value of pathology and the role of th8 College. Responding to parliamentary questions and ￿nsultations. Identfying oprxJrtunit185 to promote the work of the College via the media and improve the understanding of pathology. ProvidiThJ 8 professional point of conlact for all medla enqulrles. Delivering the College's public engagement programme, including National Pathology Week and InlematKinal Pathology Day. Managing grant schemes and awards. Internatlonal development Advocating for quality laboralory medicine training, research and seThlces around Ihe world. Establishing IntematSonal d6V8lopment and exchange progrdmmes between the UK and overseas. Adminlstering the College sponsorship scheme, Medical Training Initiative, and Intemational Trainae Support Scheme to support international medical graduates wlth thelr pathology IralnlTrJ Coordinating the efforts of College members and olher professionals in pathology in the UK who wish to collaborate with colleagues overseas to Greale sustainable development. Developing and implementing strategies to engage the College UK and international members on global health issues. Fostering inlematronal strategic partnerships, ￿llabOrationS and alliances. Volunlears Many members give their time freely to help the College achieve its objects by attending committeè meeting8. Sltling on working partles, acting 88 examiners, coMmentir￿ on reports. acting in a IoGal liaison capacity, asSi￿1ng with the publlc engagèment programm6, or undertaking Some other task or function on behalf of the COl￿g6. Th8 Trustee Board is greatly ind8bted to these individuals for their commitment and support. Achievements & performance The College produces a full Annual Report, whioh should be consulted for an analysls of the achievements and perfomiance of the College for the year to 30 June 2021. Page 4

The Royal College of Pathologists Report of the trustees for the year ended 30 June 2021 Investment ￿rformanc• The last 12 monlhs proved eventful for world economles and markels. Thanks to vaccines and a combination of fiscal and monetary policy, we went from massively negative economic gr0￿h in lh8 Ihird and fourth quarters of 2020 to one of the sharpest recoveries ever in the seGond quarter of 2021. The US recovered faster than Europe. which in tum did better th8n the UK, but China, amazingly. avoided any GDP drop In the second half of 2020, albeit wilh a more limited recovery since. Unemploymenl was stlll a large lingerfng problem In the US, wlth underamploymenl falling from 18 /0 at the b8ginning ofthe period to 10.2°/o at the end. The UK and European ¢ounlrles relied on furlough5 and other schemes to keep workers from being laid off and hence the job movements were less brutal in both directions. In the second quarter of 2021. inflation surged as the comparison with 2020 and its mostly negatlve inflation data, plus the reopening bottlenecks and skills mismatches. created massive price p￿$S￿res. Nowhere ￿a$ this more visible than In th8 hospilalty and retail sectors, but the most damaging sector for th8 global economy was s8mi<onductors due to a large chip shortage. Equity and other risk mathetg have perfomied well 8gain8t this b8ckdrop, wlth flnancials, industrials and materials challenging tschnology retums for the first time in decad8s, their rally being promptsd by the vaccine news in November. Unsurprisingly, given the strong economic upturn, defenslve sectors Ilke utllities arKJ consumer staples, lagged al the bottom. The College's portfolio has seen a good return of +24.5 % in the 12 months lo 30 June 2021. Over the longer term, the portfolio has delivered +40.50/0 and +740/0 on a three-year and five-year timeframe respectively Financlal revlew The Sncome of the Col￿ge amounted to £6.7 million, w7th expenditure of £5.9 million, and a resultant surplus of £803k. During the previous financial year. the College was unable to run the spring 202.0 diet of examinations due lo thé Covid-19 pandèmic which wero d6ferr6d until this financlal year. The fees payable by candid8tes. although received in the bank account of the College. could not be brought into the accounts until the point in tim8 that examinations had actually taken place, hence the reason why Income from postgraduate education and examinations has increased to £2.2 million compared with £895k last year. Income from the trading activities of the College through the Events@No6 conferenc8 centre had to cease operation in March 2020 and have operated on an extremely limited basis for allowabl8 educatK)nal events as and ￿en permitted to do $0. Some stsff from the commercial of the College, unfortunately, had lo be made redundant because of the severe reductlon in Income. Some other slaff for this activty and generally across the College were fudoughed under the Coronavirus Job Retention Scheme. All such staff have retumed from furlough at the 30 June. Costs forthe trading area of activity were reduced and managed wherever possible. with a conscrous decision to retain the sales and marketing function in place to ensur& that the College Is on the front foot as this aclivity recommences. Further savings have txen made against the salaries budget due to vacant position8 whlch were not filled during the year, or which were delayed before being recruited to. The College has been holding virtual committee meetings rather than face to face meetings throughout the year. so there have been savings on travel and related cost8 8nd the provision of refreshments at meetings. Most meetirKJs will continue virtually for the ensuing financial year. Savings in building related Costs (including cleaning, energy consumption, building maintenance) have been identified as a result of closing the building on 24th March 2020. All staff have been working remotely since that date. The dale for reopenlng the office will be tha 13 September 2021, with the conference centre opening fully from 19 July. Pago S

The Royal College of Pathologists Report of the trustees for the year ended 30 June 2021 Reserves The Twstee Board has established a r8S8rv8s pollcy, whereby the unrestricted funds not committed or invested in tangible fixed assets, or designated for speGtfiG purposes (the 'free reserves'l held by the Colleg&, should nomially be sufficient lo allow the Colleg8 to operate without income for up to 15 months. This18vel of resetves is essentigl. because our income is not guaranteed and can be subject to significant fluctuations year on year. The College's reserves ensure that short temi changes In revenue will not materially affecl the College's activities, secures the long temi funding of the College and enables th8 College to meet its dulles under statute and ils Royal Charter to promote starKlards of education and practice of pathology. This level of reserves would also enable the College to address any unforeseeable ad- hoc expenditure arising from topical issues in pathology, which the College feels should addressed. At 30th June 2021 the level of free reseryes of £7.0 million equated to 14.75 months of un￿StriCted expenditure. The total amount of restricted funds at 30 June 20214mounted to £1.45 Million. Golng ¢on¢om The tnJstee8 have ￿vIewed the financial position and Tin8ncial forec8Sts, taking into account the levels of investment reserves and cash. and the systems of financial control and risk management. As a result of this review. the trustees believe that they are well placed to manage operational and financial risks successfully. Accordingly, the trustees consid6r that the College has adequate resources to continue In operational existence for the foreseeable futu￿. They Continue to support the golng conc8m basis In accounting and in preparing the annual financial accounts. Doslgnatod funds Designated funds aro funds set aslde by the Trustee Board out of unrestricted general funds for spectfic flrture purposes or projects, and are excluded from the value of the College's free reseNes. An explanation of the college's désignated funds is given in note 20 to these accounts. Investment poll¢y and objectlves Thè Trusteé Board's investment policy is to maximise the return on investments taking the medium to long-temi view with a moderate level of risk. The capital value of the portfolio should be protected in line wth the objecllve of generating an annual rate of retum of inftation, as defined by the Consumer pri￿ Index ICPI), plus 4 % over 8 5-year basis after eX￿nSes. The Trustee Board may invest funds of the College in such stocks, funds, shares, or securities and other investments wlthin the United Kingdom or elsewhere as the Board sees fit, provided that the Board is satisfied that such inveglment is nol speculative, and will not expose such monies and other inv8Stments to uTrJue risk. The Tntstee Board has adopted an ethical investment poliGy precluding direct investment in fossil fu81, tobacco or armament companies. The total retum approach is adopted, including for those investments relating to restricted funds. Page 6

The Royal College of Pathologists Report of the trustees for the year ended 30 June 2021 Rlsk management The principal risks faced by the College relate to- (al Covid-19, as this has affected most areas of operation of the College and the finances Substantially, Including the loss of revenue from the conference cenlre and how this will develop as the economy opens up as the Covid-19 restrictions are lifted,- {b) examination risks, including errors in the processing of examinations and whether or not the face to face $Sttings can run during periods of the pandemic and {c} IT risks, including breach of security on systems. the failure to update or innovate IT systems, and reliance on the College database. The risks associated wlth Covid-19 being mitigated by continuing to deliver seNices to the membership. examination candidates and trainees whilst working remotely. continuing lo run committee meetlngs and other events virtually, regular review by the trustee board, and by monitoring actual financial performance closely against the budget. The risks assochqted with the conference ￿ntre are being mitigated by regular meetings with the ¢ontt3ct caterers who are responsible for the sales and mark&ting of Ihe spa￿. The directors of the trading subsidiary company are meelSng wSth ihem monthly, and the operational staff meet weekly. This will highlight any issues as they occur. The IT risks are mitigated by conducting regular revlews of equlpment and sofhmare. A review of the requlrements for the College including the database is plann8d during the ensuing financial year. The examination risks are being mitigated by continuing the use of speckqlist examinations management software, introducing n&w examlnation m8thodologies and in a review of procedures and controls. Auditors A r8solutron will be proposed at the Annual G8neral Meeting that Begbies be re-appointed as auditors to the College for the ensuing year. Plans for future periods Trustees have agreed a new strategy for 2021-24 that has 5 strategic aims. Strategic aim 1- to suppjrt all members through th8 delivery of high-quality member SeN1￿8. This will be achieved by: Supporting current members in their contlnulng educatlon by offerfng guidance and support. Encouraging future members by foslering their Interest in a Ca￿er in pathology and supporting career development. Promoting and encouraging inclusivity and diversty throughout our membership, the wkler professlon and our work. Advancing knowledge in pathology through the delivery of a rdnge of ￿SOUrCeS to support continuing professional development for all our members. Implementing the use of technology that wdens and improves conslstency of access to servlces for members. Strategic aim 2 - develop and malntain high standards of education, training and research across all pathology speclaltie8. Thls wlll be achleved by: Providing cuThlcula, assessmenls and examinations for professional groups, ensurlng that they meet Ihe future requirements for the profession. Optimising the efficiency of the examination process by developing centralised systems and providing enhanced support lo examiners. Page 7

The Royal College of Pathologists Report of the trustees for the year ended 30 June 2021 Plans forfuture periods (continued) Increasing intemational participation in College examinations. Encouraging and supporting our members and trainees to undertake and publish high-quallty research to advan￿ the practice of pathology. Strategic aim 3 promote excellen￿ and advanGe knowledge in pathology pra￿l¢e across all SP8cialtleS. This will be achieved by= Advocating for 8 propedy resoUr￿d, supported and sustainable pathology workfor￿. Conllnuing tr) develop excellent continuous pmfessional development recording and support servic8S. Delivering high-quality resources to benefit pathology practice. Developing a robust framework for governance and oversight of exlemal quality assurance to ensure hlgh standards. Promoting environmental sustainability in pathology and the ways in thich we work. Supporting future innovalion and dolivery of digital resources in pathology. Str8tsgic aim 4- increase the College's influence through a clear, coherent, professional voice. This will be achieved by: Promoting the Col￿ge as a vital Cont￿bUtOr to health pollcy and decision making. Influencing policy to advance patient care and safety. Champloning the College as the18ading medical royal o)118g8 in genomics servlces. Promoting pathology to the wider heath professionals and the public to enhance our capacity and influence policy. Strategic alrn 5- resource the future devèlopment of th8 College. We wlll achieve this by: Increasing and developing new sources of income to support the work of the College. Delivering effective m8nagement of member services and prnviding an exc£llent place to work. Building corporats membershlp that I￿nefItS the College and Its member pathers. Structure, Governance & Management The College of Pathologlsts was founded on 21 June 1962 and was incotporated und6r Royal Charter on 28 February 1970, and regist8red as a Charitable Trust on 28 April 1970. The College is govemed by its Royal Charter. Ordinances and By4aws, the 'governing documents.. The Trustee Board is responsible for the structure. governance and management of the College, including financial matters. Members of the Board are the trustees of the College. Committees r8POrting to the Trustee 808rd include the Council, Govemance Committee, Nominations Committee and Remuneration Committee. Council is responsible for the clinical, educ81ional and professional functions of the College. Council has sub committees, including standing advisory committees, examinations and trainlng committees, and regional counclls. The Irustee8 served during the year set out below. They comprise the 7 honorary officers, the chairs of each of the regional councils for Northem Iréland, Scotland and Wales, and 3 lay trustees. Trustees are elected or appointed for 8 Ihre8-year tem of office afterwhich they may serve again only after a one-year gap. unless elected to another honorary officer role. The Treasurer, Registrar cind l<ay Irubleeb Ldri fur Iwu wri¥ttLulive Ilireg-y¥ar leriii¥ vf vrrits¥. Page 8

Tho Royal College of Pathologists Report of the trustees for the year ended 30 June 2021 Structure. Governance & Management (Contlnued) The honorary officers 8re elected by the fellowship as a whole from amongst the felk)ws. The chairs of the regional councils are ele¢ted by the fellows in that region from amongst the fellows resident thin the partlcular region. The Ihree lay trust88s are appointed following a process which includes advertising these positions, completion of an application form, shortlistlng against the requlrements contslned in the role description and person specification, and a panel intetview. Trust88S take decisions in the best interests of the Colleg8 as a whole. They operate in accordance with a code of conduct that makes explicll reference to objectivity in decision-making. A register of int8rests is maintained in respect of each member of the Truste6 Board and Council. On appointment to office trustees receive an Induction pack and 8re invited to attend the annu81 induction training meeting. The Trustee Board approves the College's annual budget and forward plan. Once approved, the implementation of the plan is deiegaled to the staff, who have the authority to work within the parameters s6t by the Boa￿. Decisions of a strateglc nature, or Items othith the agreed budget and plan, must be referred to the Board. The College ￿ollY owns a subsldlary ￿mpanY, RCPath Trading Limited, which undert8k88 certain trading activitie8. The directors of the company are the College's President, Treasurer. Chief Executive, and an Sndependent d1￿Ctor appointed by the College's Trustee Board. The Trustee Board requir8S that the taxable profits of th8 company be paid to the College under gift aid. R•sponslbllllies of the trustees The truslees are responsible for preparlng the report of the trustees and the financhgl statements in accordance with applicable law and United Kingdom Accounting Standards (United Kingdom Generally Accepled Accounting PraGtice). Th6 law appllcable to charities in England and Wales requires the trustees lo prepara financial statements for each financlal year which give a true and fair view of the state of affairs of the College and of the incoming resources arKJ application of resources of the Colleg6 for that period. In preparing these financial statements, Ihe trustees are required to.. Select suitabl8 accounting policies and then apply Iham consistently.. Observe the methods a￿1 principals of the Statement of Recommended Practlce IChariti8s Made judgements and estimales that are reasonable and prudent: State whether appli¢able accounting standards have been followed, subject lo any material departures dlsclosed and explalned in the financial slatemenls,- and Prepare the financlal ststemenls on the going concern basis unless it is inappropriate to presume that the College wll continue in operation. The truslees ar8 restxjnsible for keeping proper accounting records that disclose with reasonable accuracy at any time the financial position of the College and enable them to ensure that the financial statemenls comply with the Charities Act 2011, the Charities SORP (FRS 1021 and the provisions of the Royal Charter. Ordinances 8nd By-Laws. They are also responsible for safeguarding the assets of the College and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities. The trustees are responsible for the maintenance and Integrity of the College and financial infonnation Included on the College's website. Legislation in the United Kingdom goveming the preparation and dissemination of financial ststemenls may dlffer from legislatlon in other jurisdictions. Page g

The Royal College of Pathologisls Report of the trustees for the year ended 30 June 2021 Structure, Governance & Managomont (continued) Koy management personnel remuneratlon The trustees consider the Trustee Board and the sen￿r management team comprfse the key management personnel of the charity in charge of direcling and conlrolling, running and operating the College on a day to day basis. All trustees give of their time freely and no truste8 received remuneration in the year. Details of t￿steeS. expenses are disclosed in note 6 to the accounts. The pay of all stsff, including the senior stsff. is reviewed annually by the remuneration Committee. Pay is benchmarked against the median of the rdnge for similar roles in simi18r sized organisations in the London not for profit sector. Remuneration is based upon eight pay bands each with slx pay points. Staff progress up the pay scale on successful o)mpletion of an annual ￿rforManCe reV￿w. The senior management team meet annually to review and agree p8rfomiance review summaries for all staff, and the remuneration committee reV￿w8 and r8tifies this decision. The remuneration committee reviews the perfomiance revlews for all of the members of the senior management team and agrees Iheir progression up the pay scale. No employee of the College or of its contractors is paid below the London living wage. Slatoment of dl$closur0 to audltor So far as the trustees are aware, there is no relevanl audit infomiation of which the College's auditors ar8 unaware. Additionally, the trustees have taken all the steps they ought to have taken as trustees in order lo make themselves aware of any relevant audit information and to establish that the College's auditors are aware of that information. Reference & adminlstratlve d•tails Trusteos Those wh) served as trustees during the year were as follows: Dr Andy Boon Prof Sarah Coup18nd Dr Bemie Croal Dr Angharad Dav56S Ms Jill Gaunllett Prof Shelley Heard Prof Peter Johnston Treasurer Vice Presidenl laprK)inted 26 November 2020) Chair Scotland regional council lappoinled 26 November 2020) Vice President (appointed 26 November 2020) Lay Trustee Vi¢e President {demitted off5￿ 26 November 2020) Ch8ir Scotland regional council (demitted office 26 November 2020) WI￿ President (appointed 26 November 2020) Chair Wales regional council Vice President Idemitted Offi￿ 26 November 2020) Vice Presidenl Idemltted office 26 November 20201 President & Chair of Truste8 Board (demitted office 26 November 2020) Chair Northern IreLqnd regional ￿UnCIl Presldent (appointed 26 November 2020} President Elect (to 26 November 2020) Registrar Lay Trustee & from 26 November 2020 Chair of Trustee Board Lay Trustee (appoinled 13 May 2021 } Asslstanl Registrar Dr Jonathan Kell Dr RaGha81 Liebmann Dr Tim Littlewood Prof Jo Martin Prof Ken Mills Dr Mike Osborn Dr Lance Sandle Mr Robert Smhh Mr Vincent Voon Dr Eslher Youd Page 10

The Royal Coll•ge of Pathologists Report of the trustees for the year ended 30 June 2021 Reference & administrative details (continuod) Senior Staff Daniel Ross Joanne Brinklow Diane Gaston Nigel Pollard Katherine Timms Chief Executive Director of Leaming Director of Communications Dlrector of Cotporate Services Director of P￿fessIonall$M (from 7 July 2021) Prlnclpal Office The Royal College of Pathologist8, 6 Alie Street, London E1 8QT. Telephone.. 020 74516700 E-mail.. info@rcpath.org Website.. ￿.rcpath.org Regislered charity nUM￿r 261035 in England & Wales Professlonal advlsors to the College Auditors: Begbles, 9 Bonhlll Street. London EC2A 4DJ. Taxatlon advlsors: Crowe, 55 Ludgate Hill, London EC4M 7JW. Property advisors". CBRE, Henrietta House. Henriett8 Place, London W1G ONB. Solicltors". Womble BotKi Dlckinson. 4 More London Rlverside. London SE12AU. Investment managers: Canaccord Genuity, 41 Lolhbury, London EC2R 7AE. Bankers: HSBC, 69 Pall Mall, St. James's, London SW1Y 5EY. Approved by the Trus186 Board signed on their behalf by.. Dr Mlko Osbom President 5 August 2021 Page 11

Indgpendent auditor's report to the trustees of The Royal College of Pathologists Oplnion We have audited the financial ststements of The Royal College of Pathologlsls (the 'charity') for the year ended 30 June 2021 which comprise th8 Consolidated Statement of Financial Activities, the Consolidated and Ccillege Balance Sheets. the Consolidaled Stat8ment of Cash Flows and notes to the financial slatements, Including a 8ummary of significant accounting policies. The financial reportlng framework that has been applled In their preparalk)n Is applic8ble law and United Kingdom Accountlng Standards, Including Financial Reporting Stsndard 102 The Financial Reporting Standard applicable in the UK Republic of IreLqnd (United Kingdom Generally Accepted Accounting Practice). In our opinion the finan¢i81 statements: Give a true and fair view of the state of the parent charity and its subsidiary undertaking's affairs as at 30 June 2021 and of their incoming resourGe5 and application of resources, for the year then ended,. have been property prepar8d in accordance wrf(h United Kingdom G8n8rally Acc8Pted Accounting Practice.. have been prepared in accordance with the requirements of the Charities Act 2011. Basls for oplnlon We conducted our audlt Sn accordance wlth Inlemational Standards on Auditlng IUKI (ISAS IUKII and applScable law. Our responsibilities under those Standards are further discussed in the audilorfs responsibilities for the financial stalom8ntS S8Ction of our report. W8 are indepèndent of th& charfty in accordance with the ethical requirements that are relovanl lo our audit of the financial statements in the UK. including the FRC'S Elhical Standard, and w8 have fulfilled our other ethical re8pon8ibilities in accordance with these requirements. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion. ConGlusions relating to golng ¢on¢orn In auditing the financial statements, we have concluded that the directors, use of the going cOn￿rn basls of accounting in thg preparation of the financial stat8m8nts is appropriate. Based on the work we have perfomied, we hava not identtfied any material uncertalntles relatlng io events or conditlons Ihat, individualty or collectively, may cast significant doubt on the company's ability to continuè as a going concem for a period of at least twelve monlhs from when the financial statements are authorised for issue. Our r8sponsibiliti&s and the responsibilities of the d1￿ctOrS with respect lo going ￿n￿rn are de8¢ribed in the relevant sections of this report. Other Informatlon The tTUSte8s ar8 responsible forthe other Infomation. The other Infomiallon comprlses th8 report of the trustees. Our opinion on the financial statements does not cover th8 other information and, excepl to the exlenl othe￿ise explicitly ststed in our report. we do not express any fomi of assurance Gonclusion thereon. In Connection with our audit of th8 financial statem8nts, our responsibility is to read th8 Other inf0m1at￿n and, in doing so, consider whether the other infomation is materially inGonsistenl with the financi81 statements or our knowledge obtained in the audit or othe￿ise appears to be materially misstated. 11 we identify such material inconslstencies or apparent matertal mlsstatements. we 8re required to delemine whether there is a malerial mlsslatement in the financial ststsments or materlal misststement of the other infomiation. If based on the work we have perfomied, we conclude that there is a material misslalement of this other infomiallon, we are required to report that faGt. We have nothing to report in this regard. Page 12

Independent auditor's report to the trustees of The Royal College of Pathologists Matters on which wo are roquired to roport by frx¢oPtlon In the light of the knowledge and understanding of the charity and its environment obtalned Sn the course of the athyit, we have not identif￿d any material misstatements in the report of trustees. We have nothing to report in respect of the following matters in relation to whSch the Charftles (Accounts and Reports) Regulations 2008 require u5 to report to you if, in our opinion.. The infomation given in the trustees, report is inconsistent in any malerial respect with the financial slalement8', or Sufficient accounting records have not been k8Pt', or The flnancial statements are not in agreement wilh the accounting records: or W6 have not received all the Information and explanations we require for our audit. Responslbllltlas of Irustees As explained more fully in the trustees, responsibilities statement, Ihe trustees are responsible for the preparation of the financial statements and for being satisfied that they give a tru8 and fair view. and for such intemal control as the Iruslees d8t8rmine is necessary to enab￿ the preparatlon of financial statements that 8re free from material misstatement, whether due lo fr8ud or error. In preparing th8 financial statements, the trustees are r8sponsible for assessing the charity's ability to ¢ontinue as a going concern. disclosing, as applicable. matters relating to going concern and using th& going concem basis of accounting unless the trustees either intend to cease operations, or have no realistic aM8matlve but to do so. Auditor's responsibilities for the audit of the financial statemonts We have been appointed as auditors under seclon 151 of the Charftles Act 2011 and report in accordance with the Act and relevant regulations made or having effect thereunder. Our objectives are lo obtain reasonab￿ assurance about whether the financial statements as a whole are free from materlal misstatement, whether due to fraud or error, and to issuè an auditorfs report that Includes our opinion. Reasonable assurance is a high lev81 of 8ssur8nce, but is not a guaranlee that an audrf( conducted in accordan￿ wtth ISAS (UK) will aNvays detect a mat8rial misststement when il exists. Misststements can arise from fraud or error and are considered material if, individually or in the aggregate. they could reasonably be expected to Infiuence the economic decisions of users taken on the basis of these financial statements. Irregularities, including fraud, are instances of mn•complianc6 wth laws and régulations. We design procedures in line with our responsibilities, outlined above. lo dete¢t material misstatements in respect of I￿egular1tie$, Including fraud. The extent to which our procedures are capable of detecting irregularities, in¢luding fraud is detailed below., Extent to whlch the audll VOPS ¢apablo of dgtecting irregularities, including fraud Irregularlties, including fraud, are instances of noncomplianGe wlth laws and regulations. We design procedures in lin8 Wlth our responsibilities, outlined above, to detect materlal misstatements in respect of irregularities, including fraud. Th8 8Xt6nt to whlch our procedures ar6 capabl8 of detecting ir￿gUIarit1es, including fraud is d8tailed below. Agreement of the flnanclal statement disclosures to underlying supporting documentation., Enqulries and confirmation of management and the trustees as to their identification of any non-compliance with laws or regulations, or any aclual or potsntial claims; Revlew of minutes of Boarrj meetings throughout th8 period,. Incorporating unpredictabllliy into the nature, Ilming andlor extent of testing., EvaluatSon of the selection and application of the accounting policies chosen by the charity; Pag8 13

Ind•pend8nt auditor's report to the Irustees of The Royal College of Pathologists In relation to the risk of management override of intemal controls, by undertaklng procedures to reviewjoumal entries and evaluating whether there was evidence of bias that represented risk of material misstat8menl due to fraud. and We assess8d the Su$￿ptIbl1itY of the charity's financial statements lo m81erial misstalement, Including how f￿lKI might occur by considering the key rSsks imp8cling the financial statements. Our audit procedures were deslgned to respond to risks of material misstateTnent in the financial 8tatemenl8. recognising that the risk of not detecting a material misstatement du8 to fraud is higher than the risk of not detecting one resulting from e￿Or, as fraud may involve delib8rate concEalment by, for example, forgery, misrepresentstions or through collusion. There 8r8 inherent limitations in the audit prOGedU￿S performed and the further remov8d non- compliance with laws and regulations is from the evènts and transactM)ns reflected in the fin8ncial statements, the less likely we are to become aware of it. A further description of our responsibilities for the audit of the financial statements is located on the Financial Reporting Council'5 website at: www.frG.org.uklauditorsresponsibilities. This de￿rIptIOn forms part of our auditor's repo Use of our report This report is made solely lo the College's Irustees. as a body, in accordance with part 4 of the Charities {Accounts and Rerx)rt8) Regulations 2008. Our audit work has been undertaken so Ihal we might state to the College's trustees those matters we are required lo state to them in an auditor's report and for no other purpose. To the fullest extent permitted by law. we do not accept or assume responsibility to anyone other than the College and its trustees as a body, for our audit wort(. for this report. or for the opinions we have formed. Begbies Chartered Accountants St8tutory Auditors 9 Bonhill Street London EC2A 4DJ 1912021 Begbies Is ellglble to act as an auditr)r in temis of section 1212 of the Companres Act 2006. Pag8 14

The Royal College of Pathologists Consolidated Statement of Financial Activitles for Ihe year ended 30 June 2021 Unreslrirted Unrestricted General Designated Funds Funds Total Funds 2021 Total Funds 2020 Restricted Funds Incomè from: Nol& Donations & legacies Charitable activities 1,483 1,483 3,892 Subscriptions Poslgraduale educatlon & examinations Pathology portal Inl8mational d&vdopmenl Conferences & academic activities Professional standards Communications & public engagement Trading activities Investments 3.785.867 2,194,501 3,785,867 2,199,501 175,000 14,316 262,107 52,626 423 3,622.145 894,774 1￿,127 108,787 187,950 59,788 5,000 743,280 147,619 79,751 5,000 175,¢J)O 14,316 262,107 52,626 423 68,324 91,757 79,820 68,324 93,946 79,820 2,189 Other Total In¢om 6,551,224 182,189 6,733.413 5.953,113 Exponditure on: Ralsing funds Trading aGtivlties & eduGalion Gentre Investment management faes Charllable activities 945.670 23,557 600 946,270 23,557 1.408,765 14,472 Po8lgradu8le education & examinatlons Pathology portal Inlemational development Conferences & academic advi118S Research Professional standards Clinlcal effecliven85S Workforce Communications & public engag6ment Advisory committees Total oxpendlture Net Income l {gxponditurg} boforo net galn8 on Investments 1,737,826 13,0(K) 138,871 5,000 91,943 3,462 1,750,826 138,871 360,670 364,816 3.462 269,543 259,300 313,000 1,096,090 413,749 1,672,503 26,153 420,827 385,451 3,884 332,372 299,697 337,097 1,235,916 478,274 355.670 262,873 269,543 251.717 313,0ty) 1.095,270 391,165 7,583 820 22,584 5,646,291 30,767 253,096 5,930,154 6,615,411 904,933 (30,76n {70,907) 803.259 (662,2981 Nel gains on investments Net Income l (expèndlture} 14 871,548 164,075 1,035,623 150,475 1,776,481 {30.7671 93,168 1,838,882 1511,823} Transfers be￿een funds 19 1604,420) 603,420 1,000 Net movoment in funds 1,172,061 572,653 94,168 1,838,882 1511,823) Reconcillatlon of funds: Toial funds brought forward 6,424,037 28.864,164 1.364,466 36,652,667 37,164,490 Total funds carrled forward 19 7,596.098 29.436,817 1.458,634 38.491,549 36,652,667 All of the above results are derived from continuing actlvilles. There were no other recognised gains or losses other than those staled above. The notes on pages 18 10 32 fomi part of these accounts. P8ge 15

The Royal College of Pathologi$ls Consolldated and Collage Balanc8 Sheets as at 30 June 2021 Consolidated College 2021 2020 2021 2020 Nol8 Flxed Assets: Tangible assets Investm&nls 13 14 38,403,585 6,294.113 39,036,481 5.281,517 38,403.585 6,294,213 39,036,481 5,281,617 Total flxed a5￿ts 44,697,698 44,317,998 44,697.798 44,318,098 Current assets: Stocks Debtors Cash at bank and in hand 15 16 4.900 477,465 6,143,921 11.231 564,210 5,202,564 4,91)) 844,610 6,138,929 11,231 837,148 5,104,139 Total current a88èts 6,626,286 5,778,005 6,988,439 5,952.518 Liabllltles.. Creditors.. Amounts falling due within one year 17 14.040,0791 14,332,997) 13,958,939) (4,270,803} Not Curront assets 2,586.207 1.445.1X)8 3,029,500 1,681,715 Totsl assets less current liabllltles 47,283,905 45,763,006 47,727,298 45,999,813 Creditors.. Amounts falling due after more than one year 17 18,792,356} (9,110,339) {8,792.3561 19,110,339) Total not assets 38,491,549 36,652,667 38.934,942 36.889,474 Thè funds of the Collego: Unreslricl8d funds - general funds Unr8slrlcted funds- designated funds Reslricled fvnds 21 21 21 7,596,098 29,436,817 1.458,634 6.424.037 28,864,164 1,364,466 8,039,491 29.436,817 1,458,634 6,660.843 28,864.164 1,364,467 Total Coll•go fund¥ 38,491,$49 36,652,667 38,934,942 36,889,474 The notes on pages 18 10 32 fomi part of these accounts. The financial slatemants wer8 approved by the Trustee Board on 5th August 2021 and slgned on behalf of the Trustee Board by Dr Mike Osl)om President Dr Andrew Boon Treasurer Page 16

The Royal College of Pathologlsts Consolidated statement of cash flows for the year ended 30 June 2021 2021 2020 Cash Ilovrn from operating activltlos: Nel cash provided by l {used in) operating activities (note 1 below) 1,1￿,575 267,188 Cash flows from investing aCt[￿tIes,. Dlvidends and interest received Purchase of property, plant and equipment Proceeds from the sale of investments Purchase of Inv8slmenls 93.946 (39,6881 1,529,147 (1,680.003) 147,619 1107.4071 1,768,666 1821,9361 Net cash provlded by l (used In) Investlng actlvltles 196,5981 986,942 Cash flow8 from flnan¢ing actlvities Repayment of borrowng Cash inflows from new borrowlng Ngt Gash provldod by l {u8èd In) financlng aGtlvltie8 1326,503) (2,963,311) 172,530 1326,503) (2.790,7811 Chang8 in cash and cash equivalents in the year 767,474 {1,136,650) Cash and cash eoulvalents at the beginning of the year Cash and cash gquivalents at the end of the year (note 2 below) 5,380,746 6,517,396 6,148,220 5.380,746 Notes to the statement of cash flows 1. Reconclliatlon of net ineomo1{gxpgndlture} to net cash flow from operatlng actlvltles 2021 2020 Net incomellaxpgnditurv) for the yoar (as per tho statemgnt of financial activities) 1.838,882 {511,823) Adjustments for: Depreciation charge8 {Gainsylosses on investments Dividends and interest (InGreasgydecr8ase in stocks {Increaseydecrease in debtors Increaselldecreasel in creditors 672,584 {1.035,623} 193,946} 6,331 86,745 1284,398} 675,668 {150,475) 1147,619) 2,S01 120,066 278,870 Not cash provlded by l {usgd inl oporatlng aGtlviti?$ 1,190,575 267,188 2. Analysls of cash and cash equlvalents 2021 2020 Change in year Cash at bank Cash al brok8r 6,143,921 4,299 5,202,564 178,182 941,357 1173,8831 Tot?1 Gash and Gash equivalents 6,148,220 5,380,746 767,474 Analysls of changes In net dgbt 2021 Cash flows 2020 Cash Cash at brokgr Loans falling due ￿thin one year Loans falling due more than one year 6,143,921 4,299 1317,830) {8,792,356} 12,961,966) 941,357 1173.883> 8,520 317,983 1,093,977 5,202,564 178,182 {326,350) 19,110,339} 14,055,943 Pagg 17

The Royal College of Pathologlsts Notes to the Financial Statements as at 30 June 2021 1. Accounting policies (818asls of preparatlon The financlal slalements have been prepared In accordance the Statement of Recommend8d Practice: Awounling and Reporting by Charllies preparing their accounts In accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland IFRS 102) issued on 16 July 2014 and the Financial Reporting Standard appliGablg in the UK and Republic of Ireland {FRS 102} and the Charities Act 2011 and UK Generally Acc6pl8d PraGtiG8 as it applies from 1 January 2019. (bl Publlc bgneflt ontSty The College meets the definition of a public benefit entity under FRS 102. {c) Golng concem The trustees conslder that thgrg are no material uncertainlies about the College's ability lo ¢[￿tInu? a5 a going concem. The tru81ees do not wnsider that there are any souwks of aslimation uncertalnly al the reporting dale Ihal have a significant risk of causing a malerlal adjustment lo the carrying amounts of assets and liabilities wthin the next reporting perfod. Id) Group flnanclal statements The financial slalem8nts consolidate the re$ull$ of tho Collop and Ils whdly owned subsidiary, RCPath Trading Limited, on a line by line basis. le) Incomg In￿me 18 included on a recavable ba8Is. Income from subscriptions. trainee registration and fe@s for participatlon in the conts'nuing professlon81 dfjvelopment scheme are recognised in the accounting period lo which the services V8r8d by Ihoso fees relate. Fees received in advance are accounted for as deferred income wlhin credilors. In4J)me from examinations and conferences & academic activities are induded in the accounting Ood in which the examination or conference tskes place. (Q Expendlture and Irrecoverable VAT Expenditure is re￿gnised once there is a18gal or constructive obligation lo make a payment lo a third party, it is probable that selll8menl ￿11 be required and the amount of the obligation can be measured reliably. Expgnditure on charitable activities includes the costs of delivering examinations, training and educational activities undertaken lo further Ihg purposes of the College and Ih8ir associated support costs. 1Th8coverable VAT is charged 88 a cost against the activity for which th& expenditure was incurred. Igl Allocation of support costs Resources expended ar8 allocated lo the particular activity where the Gosl relates direcdy lo that activity. Fbwever, the cost of overall direction and administration of each activity, comprising the salary and overhead costs of the enlral function, is apportioned, based on staff numbers engaged in each activity. Govemance costs are apportioned on the sam8 bas18. Ihl Foroign currencles Transactions denominated in foreign currencies are tran8latad Into Sterling at the rale of exchange prgvailing al the lime of the transaction. Pogg 18

The Royal College of Pathologlsts Noles to the Flnanclal Statements as at 30 June 2021 lil Tangible fixed assets and depreclatlon Tangible fixed assets Gosling more than £1,000 are capilalised. Depreciallon is charged on fixed assets at rates calculated to write off their cost evenly as follows.. Freehold bulldings over 50 years lo residual value Land not depreciated Flxluros. fittings and office equlpment over 310 5 years Computer system5 and software Over 2 to 5 years The College has adopted an accounting pollcy of capllallsing borrowing costs that are directly atlribulable to the construction of the new building. Frorn the dale of o¢¢upation of the premises in November 2019 inl8resl has beon charged lo the Statement of Financial Activitie8. As explained in note 14, herflage 8ss&ls have not been capltallsed or depre￿ated as no rellable value can bg attributed. til Oporating lea595 Instalmenls under operating lease commiknents arising in the year are included In the Statement of Financial Activities for the y8ar in which they arise. Ik) Stocks These are slated at tha lower of cost and net rea118able value. {1} Funds accountlng Funds held by the College are: Unrestrlotgd ggner81 funds - th8se are fvnds whlch Can be used in accordance with the tharilable objects al the discretion of the Trustee Board. UnresthGted Deslgnated funds - these are funds set aside by the Trustee Board out of unrestricted general funds for specific future purposes or projeGts. Reslrl¢ted funds - these are funds that can only be used for parlicular restricted purposes wlhin the objects of the College. Restrictions arise when specified by the donor or where funds are raised for particular reslricled purposes. Further explanation of the nature and purpose of each fund is included in the notes to the acGounts. {m} Ponslon schemes The College participates in 2 pension schemes.. the defined benefit scheme, operated by SAUL Isuperannuatic Arrang9menls of the University of London) and the defined contribution scheme operated by Royal London. For SAUL, the aduarial valuation applies lo SAUL as a whole and does not identify surpluses or deficits applicable lo Individual employers. As a whole, the market value of SAUL'S assets at 31 March 2020 was £3,612 million representing 940A of the liabilities. The market value of SAUL'S assets at 30 April 2021 was £4,369 million representing 109°h of the eslimaled liabilities. It is not possiblg to identify an individual Employer's share of the underlwng assets and liabililles of SAUL. The Collgge accounts for ils participation in SAUL as if il were a defined contribution schome and pension costs are based on the amounts actually paid li.e. Gash amounlsl in accordanca with paragraphs 28.11 of FRS102. Although there was a Technical Provisions deflcit at 31 March 2020. allo￿ng for post valuation experlence lo 30 April 2020, Saul had a Technical Provisions surplus. Therefore no deficit contributions were required followng the 2020 valuation and thar8 is no defined b8nefit liability {i.8. the present value of any deficit ¢onlribulions due lo SAUL) lo be recognlsed by the College. For the Royal London scheme, the pension charge represents the conlrlbulions payable by the Cdlgge. In) Rg$garch grants Grants payable and rer￿1vabIe are recognised in the statement of finan¢ial activities in the period to whl¢h the grant relates and where conditions relating lo the grant have been fulfilled. lol Terrnlnatlon paymonts Torminalion payments are recognised in the Slalement of Financial Activitles then incurred. Page19

The Royal College of Pathologlsts Notes to the Flnan¢ial Stalements as al 30 Jun8 2021 (pl Fix•d asset inve$tm8nts Fixed asset Investments are included al their fair values Imarkel value) at the baiance sheet dale. Any gain or loss on revaluation is taken to the Slalemenl of Flnancial ActSvities. {q) Dobtors Trade and other debtors are recognised 81 the settlement amount due after any trad8 discount offered. Prepayments ar8 valued at the amount prepaid nel of any trade discounts due. (rl Cash at bank and in hand Cash at bank and cash in hand indudes cash and short term highly liquid invegtm6nl8 ￿th a short maturity of three months or l&ss from the date of acquisition or opening of the deposit or similar ￿lunt. Cash balances exdude any funds held on behalf of service users. (s) Crodltors and provisions Creditors and provision8 are recognised where the charty has 8 present obligallon result+ng from a past event that will probably result in the Iransfer of funds lo a third party and the amount due lo sollle the obligation can be measured or estimated reliably. Creditors and provisions aro nomally re¢ognised at their settlement amount after allowing for any trade discounts due. The charity only ha8 financial assets and finantxal Ilabillues of a kind that quallfy as basic financial inslrumenl5. 2. Tradlng Income and expendltura RCPath Trading Limited The College owns 1CKJQ/o of RCPalh Trading Limited Icompany number 045352961. The main activities of the company are to undertake various trading activitiès of the College. The company supplies consultancy seniices under the loding name of RCPalh consulting, and operates a commercial Conferen￿ centre cailed Evenls@No6 al the College's Alie Street premlses. The latter operation commenced in January 2019 and is currently in a planned loss making start-up siluats'on. 11 will donate future laxabl8 profits lo the College under gift aid. Trading results extracted from ils audited accounts are as follows.. 2021 2020 Profit & L088 account Tumover 68,325 852,289 Cost of sales and admlnistralive expans8s Net profil Payable urMl&r gift aid lo The Royal College of Pathologists (Loss) I Profil retained in RCPalh Trading Limlted 1274,909) 1206,584) {823,033} 29,256 {206,5841 29.256 Balanco shoèt 2021 2020 Debtors Cash al bank 19.402 4,993 50.031 98,425 24,395 (81.139} 156.7441 (386,5471 (443,2911 148,456 162,193} Creditors.. amounts falling dug ￿thIn one year Net Gurrenl assets Credllors: amounts falling due after more than one ye Nel assets I Iliabililiesl 86,263 1322,9701 1236,707 Share capital Profit and19ss aGGount 100 100 1443,3911 {236,8071 Capllal and reserves al 30 June 1443,2911 1236,7071 Th8 Collegè has agreed a fomial loan lo finanaally support its trading subsidiary Gompanls losses during the start-up phase of ils conference Ggntre operations, and due lo the effects of Covid-19. The loan is for a period of up lo 10 years. The College purchased £Nil {2020- £109,009) of services from rts wholty owned subsidiary during the year and received a payment of £Nil12020 - £22,500) towards the cost of shared overheads. In a¢cordance with the SORP, these transactions have been removed on con801idalion. Page 20

The Royal College of Pathologists Notes to the Flnancial Statements as at 30 June 2021 3, Detalled comparatlves for thg statoment of flnanclal actlvltlos in 2020 Unrestricted Unrestricted Ger78ral Dèsignated Funds Funds Total Restricted Funds Funds 30 June 2020 Incomg from: Donations & legacies Charitsble activities 3,892 3.892 Subscriptions Postgraduate edl￿tiOn & gxaminations Digltal education project Intemalional development Conferences & academic activities Professional standards Communications & public engagement Trading activities 3,622,145 831.274 3,622,145 894,774 100.127 108,787 187,950 59,788 5.O¢X) 63.500 100,127 58,450 87,838 50.337 100,112 59,788 5,000 743,280 743.280 Investments 139.066 8.553 147,619 Other 79.751 79,751 Total in¢omo 5,629,645 323,468 5.953,113 Exponditure on: Raising fiJnd8 Trading ￿tIVitIeS Investment management fees Charitable aGtivilies 1,396.959 14,472 11,806 1,408,765 14.472 Poslgradualg education & examinations Digital education project International development Conferences & academi¢ a¢livilios Research professi￿81 standards Clinical effeGtivgngss Workforce Communications & public engagement Advisory committees 1,661,517 10,986 26,153 1,079 20,636 3,884 1.656 1.672.503 26,153 420.827 385,451 3,884 332,372 299.697 337.097 1.235,916 478,274 419,748 364,815 330.716 291,658 337,097 1,232,585 478,274 8,039 3,331 Totsl expenditurè 6,527,841 19,845 67,725 6,615,411 Nel Income l (expenditurè} baforfj n•t gains on Investmonts Net gains on investments (898,1961 94,274 119,8451 255,743 (662,2981 150,475 56,201 Nat Income l (oxpendlture) Transfers between funds {803,9221 466,447 119,845} (419,9511 311,944 1511,823) {46,4961 Net movement In funds 1337,4751 1439,796) 265,448 1511,823> Raconclllatlon of funds: Total funds brought forward 6.761,512 29.303,960 1,099.018 37,164,490 Total funds carrled ft>rward 6,424.037 28.864,164 1,364,466 36,652,667 Page 21

The Royal College of Pathologists Notes to the Financlal Statements as at 30 June 2021 4. Income from investments 2021 2020 Bank deposit Inlere8t Income from UK lisled investments Income from overseas listed investments Income from invesiment properties 6,164 51.077 7,410 29,295 33,873 75,618 12,053 26.075 93,946 147,619 S. Donatlons & Legacles 2021 2020 College members Othgr dI￿atiONS 850 633 1,244 1,483 3,892 6. Stsff ¢¢yJts. trustee remuneratlon and expenses. and the cost of kay managoment personnel 2021 2020 The total cost of salaries and wages were Salaries and wages Redundancy and lemiination costs Soryal security costs Pension conlrSbulions 2.391,857 2,491,341 32,600 252,271 324,735 238,755 328,813 2,959,425 3.100.947 The redundancy and temiinalion costs were 8ellled and paid al th$ balance sheet dale. The number of employees whose emoluments exceeded £60,000 in the year was as follows.. 2021 No. 2020 No. £60,001- £70,000 £70.001- £80,000 £120,001-£130,000 Contributions were made lo a defined benefit pension scheme amounting to £57,96812020- £65,080) in regpect of the staff noted above. The key management personnel of the charity comprise the Injslees. the Chief Executive and the 312020- 41 other senior managers. The total employee Temuneralion of the key management personn81 amounted lo £465,66612020- £577,255). The charity trLIst￿8 wer8 not paid or received any other benefits from employment the charity in the year 12020 - £Nill. No charity trustee received payment for professional or other services supplied lo the charity (2020- £Nill. Travel, subsistence and accommodation costs incuried amounting to £209 (2020 - £27,179) were reimbursed to 2 {2020- 13} members of the Trustee Board. During the year there were no other related party Iransaclions12020- £Nil). P8ge 22

The Royal College of Pathologists Notes to the Financial Statements as at 30 June 2021 7. Staff numbers The average number of employ89s (head count based on numbor of staff employed) during the year was as follows.. 2021 2020 No. No. 20.0 19.5 Poslgraduale education & examinations Conferences & academic activities Professional standards Clinical effectiveness Advisory commilleos Communications & public relations Workforce Educats'on centre International development 13.4 13.6 60.2 62.3 The average number of full lime equivalent employee8 during the year was 54.8 8. Total expondituré {Currenl year) Direct Costs Staff Costs Support Costs Total 2021 Total 2020 Trading activities & education centre Investment management fee Postgraduate education & examinations Pathology Portal International development Conferences & aoademic activities Research Professional standards Clinical Effectiveness Workforce Communications & public engagement Advisory commillees 210,623 23,557 402.381 64.099 10,211 (7,101) 3,462 3,713 10,248 888 128,893 55.626 65,194 670,453 946,270 23.557 1,750,826 138,871 360,670 354.816 3,462 269,543 259.300 313,000 1,096,090 413.749 1,408,765 14,472 1,672,503 26.153 420,827 385.451 3,884 332,372 299,697 337,097 1.235,916 478,274 908,043 74.772 213,985 246,775 440,402 136,474 115,142 155,596 176,257 203,570 687,045 228,188 110,234 72,795 108,542 280,152 129,935 Total for the year ￿ded 30 June 2020 906,600 2,959,425 2,064,129 5,930.154 6,615,411 8. Total expenditure (Prior yearl Dire¢t Costs Staff Costs Support Costs Total 2020 Trading activities & education centre Investment managamenl fee Poslgradu8le education & examinations Pathology Portal Inlemational development Conferences & academlc aclivllies Research Professional sland8rds Clinical Effedveness Worf(force Communicats'ons & public engagement Advisory Gommittees 749,178 14.472 213,681 17.069 13,720 58,532 3,884 6,444 11.343 1.086 277,870 64,104 79,510 580,077 1,406,765 14.472 1,672,503 26.153 420,827 385.451 3,884 332,372 299,697 337.097 1,235,916 478.274 923,346 9.084 276,133 225.820 535,476 130,974 101,099 215,971 219,034 231.283 682,734 238.032 109,957 69,320 104,728 275,312 176,138 Total for the y8ar ended 30 June 2019 1,431,383 3,100,947 2,083,081 6,615,411 Governance costs are contslnad ￿thin support costs and are not Shown saparately. They comprise the expenditure in relation lo the trustee board of £Nil12020- £16,978), Iruslee recruitment ¢osts of £8,617 {2020 - £Nill, legal costs of £20,832 {2020- £45,862) and the auditors remuneration as detailed in note 9. Page 23

The Royal College of Pathologists Notes to the Financial Statements as at 30 June 2021 9. Net Incomlng resources for the year 2021 2020 This is staled after charging: Depreaalion Auditor's remuneration - extemal audit Auditor's remuneration - payroll bureau services Trustee Ilabilily Indemnlty insurance 672,584 9,500 5,429 831 675,668 9,394 6,141 1.024 10. Ponsions The Cdlege participal8s in 2 pension schemes.. the defined benefit scheme. operated by SAUL ISup8rannualion Arrangements of the University of London) and the defined conlributson scheme. operated by Royal London. SAUL The College participates in the Superannuation Arrangements of the University of London {'SAUL'I, which is a (xntralised defined benefit schemè wlhin the United Kingdom and was conlracled-oth of the Second Slate Pension (prior lo April 20161. SAUL is an independently-manag8d pension scheme for the non-academic staff of over 50 colleges and institutions with links lo higher education. Penslon benefits accnjed wthin SAUL cutrently build up on 8 Career Average R8valued E8ming8 {"CARE"I ba818. The College is not expected lo be liable to SAUL for any other curr8nt participab'ng employer's obligations under the Rules of SAUL, but in the event of an insolvency of any parbcipaling employer within SAUL, an amount of any pension shortfall lthich cannot otherwise ba recovèred) In respect of that employer, may be spread across the remaining participating employers and r&flected in the next aGluarial valuation. Funding Policy SAUL'S statutory funding objective is lo have sufficient and appropriate assets lo meet the costs incurred by the Trustee in paying SAUL'S benefits as they fall due {Ihe'Technical Provislons'}. The Trustee adopts assumptions which, tsken as a whole. are Intended lo be sufficiently prudent for pensions and benefits already in payment lo contlnu8 lo be paid and for the commitments which arise from Memb8rs' accrued penSiC￿ rights lo be met. The Technical Provisions assumptions indud8 appropriate margins to allow for the possibility of events luming out worse than exp9Gted. However. tho fundlng Meth(￿ and assumptions do not completoly remove the risk Ihal the TeGhniGo1 Provisions could be insufficient to provide benefits in the future. A ft)mial actuarial valuation of SAUL is carried out every three years by a professionally qualified and independent actuary. The last actuarial valuation was carried out wlh an effeGlive date of 31 March 2020. Informal reviews of SAUL'S position, reflecting changes in market condillons. cash flow Information and new accrual of benefits, are carried out be￿￿en formal Valuations. The funding principl8s were agreed by the Trustee and Employers in June 2021 and are due lo be wewed again at SAUL'S next formal valuation in 2023. At the 31 March 2020 valuation SAUL was 94Vo funded on 118 Technical Provisions basis. However, market movements following the valuation dale were positive and the Trustees and the Employers agreed to allow for post-valua￿On experienc8 up lo 30 April 2021. As SAUL was in surplus on its Technical Provisions basis at that dale, no deficit contributions were requirèd. However. the Truste8 and Employers have agreed that the ongoing Employers, Gonlributions will increase from a rale of 16,10 of CARE salaries lo 1901¢ of CARE salaries from 1 April 2022 and lo 210/0 of CARE salari8s frown 1 January 2023. Royal London scheme The College op8rat8s a defined contribution scheme for staff other than senior managers who joined the Collega after 1 April 2021. The assets of the scheme arè held separately from those of the College in an independently administered fund with Royal London. The pension cost charged repr8s8nls the contributions payable under the scheme by the College lo the fund. The Colleg8 h99 no liA￿lIty under thè schome other than for paymonl of thoso contributSons. Page 24

The Royal College of Pathologists Notes to tho Financial Statements as at 30 June 2020 11. Allocatlon of c08ts Support costs as per note 8 abovg, can be broken down by activity, as follows: Information technology (Current year) Finance S8crelarial Premises Total Poslgraduale education & examinations International dovelopmant Conferences & academic a¢tivilies Professional standards Clinlcal effecliven95S Workforca Communlcations & public engagement Trading acliviligs & education Genlrg Advisory committeas 186,005 54.509 46,183 45,477 29,996 41.607 136,046 20,959 48,702 99,942 32,796 28,139 27,363 18,048 25,034 70,250 12.614 29,303 25,943 8,513 148,512 40.6S6 33,516 30,291 20,066 35,403 55,620 633,606 44,323 440,402 136.474 115,142 110,234 72,795 108,542 280,152 670,453 129,935 7,103 4,685 6,498 18,236 3.274 7,607 Total support ¢osls year ended 30 June 2021 2,064,129 Information technology (Prior year) Finan¢e S￿retariat Premises Total Poslgraduale educallon & examinations International (Jevelopment Conferences & academic activitie5 Professlonal standards Clinical eff8ctivene88 Wot1(force C¢)mmunicalions & public engagement Trading activities & eduGalion centre Advisory commillees 106,696 31,989 17,814 27,009 17,814 24,711 69,343 11,684 36,587 128.090 38,404 21,387 32,425 21.387 29,665 83,247 14,028 43.923 33.179 9,948 5,540 8,399 5.540 7,684 21.563 3,186 9.974 267,511 50.633 56,358 42,124 24,579 42.668 101,159 551,179 85,654 535,476 130,974 101.099 109,957 69.320 104,728 275,312 580,077 176.138 Total suppcAt costs year ended 30 June 2020 2,083.081 The basis of allocation of support costs Is as fdlows.. Infomialion technology costs have been allo&?18d on the basis of the number of computers used by each dgpartmenl. Finance costs and secretariat costs have been allocated on the basis of the head¢ounl. Premises c4)sts have been allocated on the basis of the usage of fl¢2or ar8a8. Salary costs as per note 8 above can be further analysed as follows.. Directly HR, Payroll Attributable &IT (Current year) Finance Socretarial Premises Totsl Po8lor8duale education & examlnalSons Digital educauon prole International development Conferences & academic 8Ctivities Professional standards Clinical effectiveness Workforce Communications & public en9agèmènl Trading aotivilies & education centr8 Advisory committees 632,280 74,772 130,554 174,648 86.088 129,944 139,519 506,657 33,208 152,839 78,602 95,604 61.542 40,015 908.043 74,772 213.985 246,775 155,596 176,257 203,570 687,045 65,194 228,188 23,529 20,595 19.524 13,282 18,228 51,752 8.953 21,454 28,977 24,999 24.183 16,013 22,218 62,395 11,139 26.264 18,740 16.079 15,635 10,313 14.304 40,141 7,208 16,744 12,185 10,454 10,166 6,705 9,301 26,100 4.686 10,887 Totsl salary c08t8 year end￿ 30 June 2021 2.959.425 Pagtr 25

The Royal College of Pathologlsts Notes to the Financial Statements as at 30 June 2021 11. Allocation of costs {contlnued) Dlreclly HR. Payroll Attributable &IT (Prior year) Finance Secretarial Premises Total Postgraduate education & examinalioi Digital education project International development cOnferen￿S & academic activities Professional standards Cllnical effectiveness Workforc8 Communications & public engagemen Trading activities & education c8ntrg Aévisory committees 626,979 9,084 186,035 168,251 141,224 167.486 161,909 487,067 55,344 157,786 98,472 100,990 55,792 41.113 923,346 9,084 276,133 225.820 215,971 219,034 231,283 682,734 79,510 238,032 29,867 19,836 24,578 18.018 23,281 66,128 8,094 30,723 19.400 25,550 17,292 23,569 66,333 8,215 27.401 16,989 10,555 14.174 9,349 12.968 36,390 4.524 15,179 12.519 7,778 10,445 6,889 9.556 26,816 3,333 11,186 Total salary costs year ended 30 June 2020 3,100,947 The basis of all(Kation of salary costs is 88 follows.. Information technology costs have been allocated on the basis of the number of Computers used by each department. Finance costs, secretarial Gosls, p￿miseS costs and HR & payroll costs have been alloGal8d on th6 basis of the headcounl. 12. Taxation As a r8gislergd tharily th8 College is exempt from corporation tax since all income is applied for charitable purposes. 13. Tanglble fixod assets Consolidated and College Computer Systems & Software Fixtures, Fittiros & Equlpmant Frgghold Property Totsl Cost or valuation At 1 July 2020 Addi1Sons Oispo$81s 38,625.892 9,628 1.199,696 14,602 902,149 40.727.737 15.458 39,688 AI 30 June 2021 38,635.S20 1.214,298 917.fj07 40,767,425 Depreciation Al 1 July 2020 Provided In year Di8PQ$81$ 459.883 372,710 795,322 143,064 436,051 156.810 1,691,2S8 672.584 At 30 Jung 2021 832,593 938,386 592,861 2,363,840 Nel book value 8130 June 2021 37,802,927 275,912 324,746 38.403.585 Net book value at 30 June 2020 38,166.009 404,374 466,098 39,036.481 In addition lo the capilalised fixed assets held for the Charity's own use. the College also has a number of assets on trust for retention In perpetuity as a permanent record of the College's history. These comprisè a unique collection of paintings depicting the College's 19 Presidents since ils founding in 1962, togelhor wth a library collection and other artefacls whose intrinsic value Ss also bound up wlh the College's history. These are irrepl8ceable 0ri9inals to whlch no reliabl& ¢osl or value can be attributed and accordlngly these assets have not been capllalised in the financial slalement8. Page 26

The Royal College of Pathologists Notes to the Financial Statements as at 30 June 2021 14. Investments Consolidated 2021 2020 Cc41ege 2021 2020 Market value a11 July 2020 Additions al cost Redassificalion from Tangibl& Fixed Assets Disposals al market value Nel gain on revaluation Market value al 30 June 2021 5,281,517 5,164,735 5,281,617 5,164,835 1,680,003 1,000,118 1,680,003 1,CK)0,118 734,855 734.855 11.703,0301 (1.768,666) {1,703,0301 11,768,666) 1,035,623 150.475 1,035,623 150,475 6,294,113 5.281.517 6,294,213 5,281,617 Hlslorical cost al 30 June 2021 4,350,188 3.698,133 4,350,288 3.698,233 Investments al market value comprised.. UK listed fixed interest securities UK listed equity shares UK listed Investment trusts ?nd unil trusts Overseas listed fixed interest securib'es Overseas listed investment trusts and unlt trusts Cash held by investrnenl manager awaiting r￿nVestment Investment property Unlisted investments 126,488 1.294,232 1,718,912 107,460 1.298,628 4,299 698,112 131,565 553,856 1,381,856 100.430 2,194,538 184,417 734,855 126,488 131,565 1,294,232 553,856 1,718,912 1,381,856 107,460 100,430 1.298.628 2.194,538 4,299 184,417 698,112 734,855 100 100 Market value as at 30 Jun8 2021 6,294,113 5,281,517 6,294,213 5,281,617 The investment property is valued by roference lo tha market value of simllar properties in the development, which, in the opinion of the Trustees, 18 the fair value 8130 June 2021. Unlisted Investments al cost comprise.. 2021 2020 RCPalh Trading Limited - 100 ordinary shares of £1 each 100 1C 111) 100 The Cdlege owns 1CN)tykn of the ordinary share capital of RCPalh Trading Limited, company number 4535296. which has been consolidated as a subsidiary undertaking throughout. Thg rggislgred address of the company is 6 Alig Street, London E18QT. 15. Stocks Consolidated and College 2021 2020 Memorabili8 for resal8 Wines 4,9C4) 10.381 850 4,900 11,231 Page 27

The Royal College of Pathologists Notes to Ihe Financial Statements as at 30 June 2021 16. D•btors Consolidated 2021 2020 Co119ge 2021 2020 Trade debtors Prepayinenls and accrued income Other debtors Amounts due from subsidiary undertaking 27.327 137,470 312.668 68,798 187,956 307,456 7,925 137.470 312,668 386.547 18,766 187,956 307,456 322,970 477,465 564.210 844,610 837,148 The arnountdue from tho subsidlary undertaking of £386,547 Is due after rTh)re than one year. 17. Credltors Consolidated 2021 2020 College 2021 2020 Amounts falling due within one year Deferred income {note 181 Trade Creditors Bank loan Other creditors Taxation and social security Accnjals 2.777,290 183,253 317,830 92,992 63.685 605,029 3.129.527 217,182 326,350 131,123 61,595 467,220 2.746.855 138,698 317,830 92,992 63.685 598,879 3,129,527 190,262 326,350 98,249 61,595 464,820 4,040,079 4,332,997 3.958,939 4.270.803 Amounts falling due after more than one year Consdidated and College Bank loan- amount due between 2 and 5 years Bank loan - amount due after 5 years 2021 2020 1.323.430 7,468,926 1,302,329 7,808,010 8,792.356 9.110.339 The loan is a commer¢ial m¢)rtgage loan $eW￿d by a first legal charge over the land and building owned by the College al 6 Alie St￿et. The original lolal loan amount was £12 million. Of this, £2.5 million of capital was repaid in January 2020. Interest is charged al 1.5.10 above base rate. 18. Def•rr•d income Consolldated 2021 2020 Cdlegg 2021 2020 Balance al l July 2020 Amount releas8d to incoming resource5 Amount defe￿ed in the year 3,129,527 2,286,976 3,129,527 2,225,506 {3,129,5271 {2,286.976} {3,129,527} 12,225.5061 2,777,290 3.129.527 2.746,855 3,129,527 Balance as at 30 June 2021 2,777.290 3,129,527 2,746,855 3,129,527 Deferred income compris@s income from sub5criplions, trainee r8gislralion, examinations. conferences and continuing professional development. received in advance, that will form part of incoming resources during the followng financial year. The College was in receipt of £198,570 of stalulory funding for the year12020 - £139.5221 by way of grants for $peGific projects and the Coronavinjs Job R8lenlion Scheme. All conditions rdaling lo these grants have been mel in full. Page 28

The Royal College of Pathologists Notes to the Financial Statements as at 30 June 2021 19. Movements In Funds (Current year} Balanc8 81 Incoming 1 July 2020 Resources Outgoing Resources Transfers Gains and Losses Balan￿ al 30 Jun8 2021 Restricted fiinds Research Pool Fund Oliver Memorial Fund Bhagwan Singh Fund Flynn Lecture & Bursary Fund Kohn Memorial Fund Developmental Pathology Fund Medical Examiner Training Fund E-learning Project Fund Inlemth'onal Challenge Events Fund Public Engagement Fund Furness Prize Fund Summer School Fund William Tong Mèrnorial Fund Pathology Portal Fund MTI Fund Aris8 Project Fund Gale8 Prize Fund Undargraduate Pathology Fund 25,725 145,895 62.853 153,733 28,707 18,814 101,491 50,243 27,705 2,529 559 14,521 2,686 566,112 50,243 57,650 5,000 50,000 1,364,466 15 596 212 829 {3,4621 {15,6211 22,278 164,215 88,486 240,056 41,2 26,050 24,617 50,271 22.721 2,530 359 20,529 2,688 602,560 50,271 57,682 5.003 37,028 1,458.634 33,345 25,421 85.494 12,581 7,234 68 28 16 176.9421 15,000) 1200) 5,008 1,(XJO 175,319 28 32 (138.8711 28 182,189 113,000} {253,0961 164,075 Unr•strict8d Funds Designated funds Property Fund Cancer Reporting Fund EQA Funé Premlses Marketlng Fund 60th Anniversary Fund Examinations Development Fund TeGhnology Replacement Fund Major Repairs Fund Corporate Membership Fund General unrgslricted fund 28,729,321 46.649 50,000 38,194 (36,580) 28,692.741 39.066 so,000 37,594 10,000 100.000 400,OC(J 1(X),000 7,416 7,596,098 (7,583) 16001 10,000 100,000 400,000 100,000 30,000 1604,420} (22,584) 6.551,224 (5,646,291) 6.424.037 871,548 Total Fund5 36,652,667 6,733,413 (5,930,154) 1,035,623 38,491,549 The transfer lo the summer schools fund represents the College's share of funding for this activity lo match that made by other individual pathology asswiations ¥tho jointly run this event. The transfer from the designated property fund 18 so a8 to maintain the balan￿ on the fund being equal to the net bcL)k value of the land and buildings less the capital oulslanding on the mortgage loan. The transfer to the dgsignaled 60th anniversary fund is lo sel aside monies to support the 60th anniversary of th8 Collega which will be on 21 June 2022, and for events to commemorate Ihls ￿CaSion. The transfer to the examinations dgvglopmenl fund is to sel aside money in support of the digilisalion of examinations. The transfer lo thg major repairs fund is to establish a sinking fund for replacement of plant and equipment 81 Alie Street. The transfer lo the Cofporale membership fund is lo pump prime the project to allract a number of corporates into membership of the Collegg. Page 29

The Royal College of Pathologlsts Notes to the Financial Statemenls as at 30 June 2021 19. Movemènts In Funds (Prior period) Balanc8 at Incoming 1 July 2019 Resources Outgoing Resou￿$ Transfers Gains and Lossos Balance al 30 June 2020 Restrlcted funds Research Pool Fund Oliver Memorial Funé Bhagwan Singh Fijnd Flynn Lecture Fund Kohn Memorial Fund Developmental Pathology Fund m￿1¢81 Examiner Training Fund Quality in Pathology Fund E-leaming Project Fund Internalion?I Challenge Events Fund Public Engagement Fund Furness Prfze Fund Neera Patel Fund Summer School Fund William Tong Memorial Fund Digital Now Fund MTI Fund Arise Project Fund Galea Prizè Fund Undergraduate Palholcpjy Fund 29.468 130,540 55,222 103,938 39,472 22,449 80,366 1,656 50,0(J) 27,567 2.931 755 141 1,792 597 805 1,080 621 88,257 13,884) 11,1151 25,725 145,895 62,853 153,733 28,707 18.814 101,491 14.678 7,034 49,590 (10,845} 14,2561 16¢XJ) 11,000} {20,6361 {1,6561 {46,496) 243 138 14 50,243 27,705 2,529 559 1416) 1200) 11,981 2,673 490,000 50.000 13,526 13 102,265 243 58,729 5.000 50.000 {10,9861 14,521 2,686 566.112 50,243 57,650 5,000 50,000 {26,1531 11,0791 1.099,018 323,468 {67,7251 146,4961 56.201 1,364,466 Unrestrlcted Funds Designated Property Fund Designated Cancer Reporting Fund Designated EQA Fund Deslgnated Premises Marf(ellng Fund 29,149,272 54,688 50,000 50,000 1419,951) 28,729,321 46.649 50,000 38,194 (8,039) 111,8061 Ganeral unreslricled fund 6,761,512 5,629,645 16,527,841) 466.447 94,274 6,424,037 Total Funds 37.164,490 5,953,113 16,615,411) 150,475 36,652.667 20. Restrlcted and designatgd funds The Research Pool Fund was established in 1995 to promote resgarch in pathology. The Oliver Memorial Fund was established lo perpetuate the name of Percy Lane Oliver, by providing an annual national award for service lo blood transfusion, and for the furtherance of k￿￿edge relating lo the princAples and practices of blood transfusion. The Bhagwan Singh Fund was established in 198210 sponsor occasional visits be￿n the UK and Malaysia. lo promote Malayslan pathology. The Flynn Lecture Fund was established in 1998 to fund an annual lecture in dinical biochemistry. Additionally, a number of bursaries are awarded to trainees to attend the scientific meeting where the lecture is delivered. The Kohn Memorial Fund was established in 1987 to fund an annual lecture mainly in clinical biochemistry. The Developmerbtal Pathology Fund was established in July 2004 as a grfl from the Developmental Pathology Society to fund an occasional named 'Emery' lecture in paediatric pathology. The Medical Examiner Tralning Fund was established by grant in ald from the Departrnenl of Health (England) lo support th8 development of e4earnlng materials and face lo face training for medical examiners of the cause of death. The E4eaming Project Fund was established lo fund the provision of eleclronic16aming for pathology collsullanls and trainees, and is supported by grant in aid from e-Learning for Healthcare, part of Health Education England. Pag& 30

Th8 Royal College of Pathologists Notes to the Financial Statements as at 30 June 2021 20. Restrlcted and d•slgnated funds (continugdl The Pathology Portal Fund was established by grant in aid from Health Education England to develop and Implement competence based model of leaming support on a digital platform for pathology which would include digitisation of examination8. The Inlemational Challenge Evenl$ Fund was established lo raise funds for the College's Intemational development projects. The Publlc Engagement fund was establlsh8d by way of a prize awarded by The Royal Society lo Dr Suzy Lishman for her Work on beh81f of the College on public engagement and is available for the College's public engagement work. The Furness Prize fund was established in 2010 to fund an annugl prize in scien¢9 Gomrnunication in relation lo palholo9y. The Neera Pald Memorfal Fund was established by way of gift from the family of the late Neera Patel lo provide funds to support a named College lecture in Neera's name and also a Iravdling bursary award for Iraine6s in head, neck or breast pathology. The Summer School Fund was eslabllshed to collect and adminisl8r the funds lo run the annual pathology summer school, which is funded and run in assDGiation with a number of pathol¢)gy specialist socl81ies. The William Tong Memorial Fund was established by way of donations from the family and fri8nds of tho late William Tong lo provide an annual prize lo a trainee in vlrology on the basis of a piec8 of worf( submilled as a poster. The MTI Fund was established by grant in aid from the West London Cancer Allianee lo deliver training opportunlli&s across London for intemalional medical graduates in histopalhology as part of the medical training initiative. The Arise Proj8Ct Fund was established by Grant in Aid fr(Mm the European Union to fund the College's involvement in a multi-partner research project lo share and spread best pracllce In ne￿￿0M screenlng, dlagnosls and Irealmenl of Sickle Cell Disease, leading to improvemgnls in overall disease ¢yJtcome. The undergraduate pathology fund was established by Grant in Aid from Health Education England lo ¢reale undergraduate and foundation taster events and materials lo support recruilmenl In patho109y. The Galea Prize Fund was established by way of gift from Metabolic Support UK lo fund 8n annual prize lo encourage research into a therapy that will ameliorate and in future help find a Gure for metsboliG disorders and inherilgd rarg conditions. The design2led propety fund was aslablished following the disposal of the College's previous functional propth to hdd the funds that will be required (excluding the amount lo be borrowgd by way of mortgage loan) for the acquisition and r8developmenl of the Alie Street premises. The designated cancer reportlng fund w8S 8stsblished to fund the College's share of the commitment lo the Inlemalional Collaboration on Cancer Reporting, whose aims are lo pursue global h8rmonisation of cancer datasets for pathology reporting. The ICCR has been incorporated as a not for profit organisalion and the Collgge is a foundation member. The designated EQA fund was esl8bli8hed lo fund initlal expenditur6 on interpretive EQA and lechnlGal EQA monitoring systems. The deslgnaled premises markeb'ng fund was estsblished for exp9ndilure on the markeling of the facilities al Alie Slregt Ihal will generate revenue for the Colleg8 in subsequent years. The designated 60th anniversary fund was established to fund activities assoc4aled WTlh the 60th anniversary of the founding of the Colleg8, which will be on 21 st June 2022. The designated examinations developm6nl fund was estsblished to fund the development of the diglts'salion of College Èxaminations. The deslgnaled lethnolo9y replaGemenl fund was e8tabli$hed to fund the replacgmonl of Ihe Coilege's central database system. which is an enterprise wide system incorporating membership, finance, examinations, training. CPD, academic SyTnposia, and 8 dynamlc link that inlegrales lo the College website. The designated major repairs fund was established to create a sinking fund for the repair and replacement of majLY pieces of plant and gquipmenl wlhin the College's premises al Ali& Slreal. The deslgnated corporalo membership fijnd was established lo fund the development and expansion of the College's corporate membership scheme. Page 31

The Royal College of Pathologlsts Notes to the Financial Statements as at 30 June 2021 21. Analysls of group net assets bgtwoen funds {Current yoar)- Consolidatod Tanglble flxeé assets Investments Nel current assets Long term Total General unr¢striGled Designated Restricted 600,658 37,802,927 5,736,776 1,258,664 426,246 901,297 7.596,098 18,792,356) 29,436,817 1,458,834 557,337 Nel ass81s as at 30 June 2021 38,403,585 6.294.113 2.586.207 18.792,3561 38,491,549 21. Anatysis of group net assets bgtwegn funds (Current year)- College Tangible fixed 8SS818 Investments Nel current assets Long term Total Ggneral unrestricted DesSgnaled Reslricled 600,658 37,802,927 5,736,876 1,701,957 426,246 901,297 8.039,491 {8.792.356129,436,817 1,458,634 557,337 Net assets as al 30 June 2021 38,403,585 6,294,213 3,029,500 (8,792,356) 38,934,942 21. Analysls of group net assets betwoen funds (Prlor y•ar)- Consolldated Tangible fixed assets Inveslmonts N81 current assets Loftg tom Tol81 General unreslriGted Dgsignale Reslricl8d 870,472 38,166,009 4,888,255 665,310 6.424,037 (191,5061 (9,110,339) 28,864,164 971.204 1,364,466 393,262 Nel assets as al 30 Jun8 2020 39,036,481 5,281,517 1,445,008 19,110.3391 36,652,667 21. Analysls of group net assets bètweèn funds (Prior year)- Collogo Tangible r￿e￿ assets Investments Nel current Long term assets Total General unrestricted Designated Reslrict8d 870,472 38,166,009 4,888,355 902,016 6,660,843 1191,506) (9,110.339) 28,864,164 971,205 1,364.467 393.262 Nel assets as al 30 Jung 2020 39,036,481 5,281,617 1,681,715 19,110,339) 36.889,474 22. Presontatlonal currency The presenlalional Gurr8ncy is Sleding. Page 32