Radiology services in the NHS in recent years have seen significant investment and advancement – particularly in interventional radiology. Yet, it’s well documented that our services still compare poorly with many other OECD countries when looking at metrics such as waiting times, the ratio of scanners per 100,000 population, the age of equipment and staffing levels. For example:
The NHS has the lowest number of CT per head of population and third lowest number of MRI per head in the OECD.
Our equipment is old; with nearly 50 percent of MRI machines operating beyond their recommended life.
There is a chronic shortage of radiologists and radiographers with 10 percent of all consultant radiologist roles (n=433) vacant before the pandemic. Two-thirds of these having been vacant for over a year, double the number in 2015.
The Richards report (NHS England » Diagnostics: Recovery and Renewal – Report of the Independent Review of Diagnostic Services for NHS England) calls for 2,000 new radiologists and 4,000 new radiographers. COVID-19 has only exacerbated these issues.
At a practical level, the shortage of staff and equipment – particularly in diagnostic radiology – contributes to poor access and clinical outcomes. For example, the current five-year survival rate for colon cancer puts the NHS in 18th place across the OECD — significantly below Australia, Japan, Belgium, and Canada.
The NHS Long Term Plan provides an opportunity for improvement
The development of diagnostic networks, first proposed in the NHS Long Term Plan and described more fully in recent implementation guidance published by NHS England and Improvement, offers a once in a generation opportunity to transform services, stimulate innovation and attract investment in staff and equipment.
The development of Provider Networks should make this easier than when similar networks for pathology services were proposed and failed in many areas due to organisational self-interest and poor relationships.
The transformation required needs collaboration across multiple players
However, the transformation required will only be achieved if clinicians and executives work together alongside their partners from Health Education England and Higher Education to employ pioneering workforce solutions, embrace technology and consider the role of the independent sector. This may involve exploring operating models that encourage collaboration between NHS bodies and/or, accommodating the role of the independent sector to help transform the service.
These options also have the potential to derive tax efficiencies in terms of infrastructure, equipment, and operating costs as a bi-product, which can help affordability.
The legislation does not make this easy, however. It limits options by prohibiting NHS Trusts that do not have ‘Foundation’ status (approximately one third of all Trusts) from entering corporate joint ventures unlike their foundation trust neighbours and partners.
Those who do seek to innovate will also need to find by themselves the capacity to do so, and the resources to procure the specialist advice required. This advice is likely to include, but not be limited to commercial, governance, tax, and legal advice.
Providers could choose to do one of the three “do minimum” options
We may see however that providers elect one of the three “do minimum” options offered in recent guidance from NHS England and Improvement on commercial structures and governance (April 2021).
The options are:
- a simple collaboration between trusts,
- alliance contracting or,
- a unit organisation hosted by one trust
This would be a missed opportunity and will fail to deliver the transformation required. Whilst these options offer a model to share capacity (staff and resources) better than at present, there is more that needs to be done to address the chronic issues described above.
For those with the vision and ambition to follow the joint venture options, employed well, these offer the potential to transform the way services are provided, update aged equipment, increase capacity, move services into local communities and provide vastly superior services.
What option do you think works best for you? We would be interested in your thoughts.