A massive shortage of consultant histopathologists means that trusts are forced to rely on a hard core of sub-standard locums who are putting patient care at risk, senior pathologists have revealed.

Last week the Commission for Health Improvement issued a 'wake-up call' to trusts across the country which are failing to institute proper checks when they appoint locum consultants.

CHI's comments came in a 'shocking' report into 78-year-old histopathologist Dr James Elwood which found that he had worked in at least four hospitals over several years without proper checks on his references, employment history or competence.

But Professor John Lilleyman, chair of the Royal College of Pathologists, told HSJ that the Elwood case was the tip of the iceberg: 'We have a number of ongoing cases of journeyman locums that are running around the country causing far more problems than Elwood. They can get work because trusts are desperate - you can't get off the starting blocks with a national cancer plan if you haven't got anyone to diagnose the cancer in the first place.'

CHI's investigation into Dr Elwood found that trusts relied on 'word-of-mouth' endorsements from consultant colleagues rather than formal references when they employed Dr Elwood, who has since voluntarily withdrawn from the medical register.

When it was revealed there were question marks over his work, Swindon and Malborough trust, where he worked 22 times, instigated a review of 10,000 slides and found 223 cases of misdiagnosis with serious consequences for several patients.

Dr John Christie, consultant histopathologist at Russells Hall Hospital, Dudley, and until recently chair of the British Medical Association pathology sub-committee, said current workloads and high vacancy rates meant that 'pathology is seen as a sweatshop'.He said there were 140 vacancies among 900 consultant or consultant equivalent posts across England.

Official guidance states that consultants should examine no more than 4,000 samples a year. The Royal College of Pathologists says it would be safer to do 2,500 a year.

The CHI report found Dr Elwood was doing the equivalent of 7,000 a year. 'That is sheer managerial irresponsibility, 'Dr Christie added.

Swindon and Malborough trust chief executive Sonia Mills, who was not in place when Dr Elwood was employed, said the trust accepted that its employment practices 'could have been better' and 'deeply regrets' the need for a review of his work.

CHI chief executive Dr Peter Homa told HSJ: 'Every trust chief executive should make it a priority this week to satisfy themselves that employment checks are put into place to ensure locum medical staff are competent and that they have suitable equipment to carry out their work.'

CHI also recommends an end to the 'over-reliance' on locum consultants and more robust procedures for monitoring their work, and that the Department of Health should set up a national database which would allow trusts to check doctors' qualifications and employment history.

The Department of Health looks set to scale down the number of performance indicators made publicly available each autumn.

In a consultation paper launched on Tuesday, the DoH outlined proposals to develop three different forms of indicators. For the first time, patient satisfaction, clinical quality and employment practices will form part of the statistics.

But only a 'relatively small' selection of headline measures would be published annually. A further set would be disseminated among the NHS as a benchmarking exercise, and a 'wider' set of indicators for which data is not currently collected could be developed in time.

The division of indicators into headline and benchmarking statistics may take the heat off the yearly autumn row over the publication of data perceived by the media and public as quality 'league tables'.

Under the proposals, headline indicators describing all-round performance would be accompanied by independent commentaries from the Audit Commission and the Commission for Health Improvement.

More detailed information, containing a wider range of background and supporting information which will indicate good or bad performance in all areas, will be disseminated internally within the NHS.

Clinical areas covered by national service frameworks will also be measured, as well as areas such as access, workforce, efficiency, and health inequalities and public health. For the first time the new indicators will attempt to measure patient satisfaction.

University College London Hospitals trust chief executive Robert Naylor, who sits on the NHS performance working group, said: 'Up until recently the views of consumers have not been heard loudly enough. Clearly, one of the things we need to do is to bring more consistency into it.'