Evidence submitted by the Society and
College of Radiographers (ISTC 16)
1. The Society and College of Radiographers
(SCOR) represents more than 18,000 Radiographers and Assistants
employed in all forms of imaging, including ultrasound, MRI and
in Radiotherapy. As a trade union and professional body our aims
are to protect the interests of our members and to promote high
standards of professional practice and safety for patients and
public. We are not opposed to any initiative to improve the service
delivery to patients; however, we question the effectiveness of
the ISTC programme which we feel was introduced without a full
examination of alternative means to improve services within current
health care provision and without full consultation with our members,
many of whom are leaders in their respective fields. Further,
it is our view that whilst there is evidence that waiting times
have improved there has been insufficient examination of the knock
on effect on NHS workloads in support of the ISTCs.
2. MRI facilities provide a key role in
the diagnosis and management of cancer care and without sufficient
or robust planning any reduction or failure of this service will
have an immediate impact on the delivery of other policy initiatives.
We are concerned that the forecast for MRI provision by 2007-08
expects that the Independent Sector (IS) will provide 20% activity
and as such we would query the intention for service provision
once the life of the current contracts expire. It appears that
a dependency upon private sector provision is being deliberately
and unnecessarily created at the expense of investment in NHS
services.
Not all of the terms of reference of the inquiry
are of direct relevance to the SCoR and only items of primary
relevance will be addressed in this submission. Our submission
focuses upon radiography services conducted within ISTCs.
Q3. What contribution have ISTCs made to
the reduction of waiting times and waiting lists?
3.1 The ISTCs have undoubtedly impacted
upon waiting times but it is our belief that any reduction would
have occurred if the same level of investment (finance and infrastructure)
had been channelled directly in to NHS facilities. Our view is
that the benchmark was superficial in that a reduction in waiting
times was the measurement of success but there was no account
taken of the wider impact of the introduction of ISTC, such as
the knock on effects within the NHS.
3.2 The ISTCs are not innovative they have
merely increased capacity and therefore helped to reduce waiting
times for specific procedures. Undoubtedly, had capacity, staff
numbers and equipment within the NHS been increased waiting times
would have been similarly reduced and consistency of care and
treatment maintained. In 2005 the SCoR conducted research into
the impact upon NHS units of IS MRI provision. The consensus was
that that the work of the ISTC could have been done more efficiently
by the NHS units.
Quote: "We have the ability to perform these
scans by extending the working at a much lesser cost. The figures
were submitted to the SHA but the decision to use mobiles was
made."
Quote: "We costed it to do some Saturday
lists, less than half the price, including all radiologist fees
etc"
Quote: "For the cost of no more than 10
hours per week support staff (Health Care Assistant) wages, we
could eliminate our waiting list completely."
Quote: "The patients would have been fed
through the system in a more controlled manner, resulting in less
administration time by the NHS being spent on the organisation
of the scans and the reports getting to clinicians."
Q4. Are ISTCs providing value for money?
4.1 Whether or not the ISTC programme is
value for money is unclear. Most requests for clarification as
to the costs associated with ISTCs (including saving per procedure
compared to within the NHS) are declined due to "commercial
confidentiality". However, in the MRI survey 85% of respondents
agreed that the IS arrangements had resulted in a direct additional
cost to their Trust.
Quote: "Many hours of administrative work
are required from clinical staff prior to each visit, that would
not be required if the work was done in-house. Not to mention
costs of linen, lockers, reception staffing—all extra to
normal practice"
Q5. Does the operation of ISTCs have an adverse
effect on NHS services in their areas?
5.1 Our research found that NHS radiographers
believed that IS provision has an adverse effect upon local NHS
services. For example, it was found that NHS staff and capacity
was diverted to the time consuming task of identifying suitable
cases for the IS. Additional NHS time was then spent on follow
up work where the IS failed to conduct the relevant examination
or was unable to produce sufficient clarity of image to produce
a satisfactory medical report. Members further advise us that
some examinations had to be repeated in the NHS because overseas
radiologists employed by the IS and ISTCs to report images from
a remote location, failed to produce reports with sufficient clarity
to determine further treatment. Many of these problems could have
been resolved had the entire procedure been conducted within the
NHS unit with the reporting radiologist on hand to resolve any
ambiguities.
Q6. What arrangements are made for patient
follow-up and the management of complications?
6.1 The lack of evidence to assess the impact
of the scheme has hindered any realistic or in depth examination
of how the programme has been effective or not. We would welcome
some information to assess the effectiveness of treatment to examination
and the degree of follow up imaging required.
Q7. What role have ISTCs played and should
they play in training medical staff?
7.1 We are concerned that there has been
an emphasis on the training of medical staff. ISTCs employ a range
of staff including our members. It is our view that an assessment
of the effectiveness on role development and training should apply
to all sections of the workforce.
7.2 A number of universities already use
private providers for clinical placements of pre-registration
level radiography students. Additionally, for post-registration
competence based programmes, there is already private sector provision,
either because they provide the placements required to support
necessary post-registration education and training programmes
for their own employees undergoing development, or because they
provide specific experience that isn't readily available in the
NHS (an example is where an NHS organisation has outsourced its
`routine' MRI but has a radiographer undertaking an MRI PgDip/MSc—that
radiographer may well be seconded out to the private provider
to enable him/her to gain the required experience and undergo
the relevant clinical assessments). The SCoR is in the process
of developing a good practice guide, which sets out our expectations
of ISTC/private sector placement providers.
7.3 One important issue highlighted in our
MRI unit survey was the negative impact upon Continuing Professional
Development time for NHS staff. By having to deal with urgent
and complex cases, since the ISTC siphon the routine cases, means
that staff has less time to train new entrants.
Quote: "Pressure on unit is so great that
although we train new members of staff we cannot allow more scanning
time on patients to teach these individuals. There is no extra
time allocated to CPD"
Q8. Are the accreditation and appointment
procedures for ISTC medical staff appropriate?
8.1 We are concerned that the role of the
AHP is consistently overlooked in favour of medical staff. In
recognition of the fact that radiography is a shortage profession,
and is likely to remain so for the foreseeable future, the Government
has restricted employment of radiographers in ISTCs and the Society
supports this policy of additionality. Any radiographer practicising
within the UK, wherever they gained their qualification, must
comply with the Health Professions Council standards and therefore
this must be the minimum requirement for employment in or for
an ISTC. To date few of our members have been in direct employment
in ISTCs. It is our view that the focus for all employment must
be the NHS to encourage new recruits retain key skills and to
access national terms and conditions and national pension entitlement.
It is our view that the failures in workforce planning will only
serve to deepen divisions within the health care environment.
Q9. What implications does commercial confidentiality
have for access to information and public accountability with
regard to ISTCs?
9.1 Commercial confidentiality has been
a barrier to understanding the true cost benefit of ISTCs and
so they have been judged on the impact upon waiting times and
thereby judged a success. A fuller assessment needs to be undertaken.
Q10. What changes should the Government make
to its policy towards ISTCs in the light of experience to date?
10.1:
— The government should require that
all image reporting in ISTCs be done on site or in real time so
that any ambiguity can be swiftly resolved and does not become
a burden subsequently shifted to NHS sites for resolution.
— We would expect that any ISTC would
employ staff on terms no less than AFC and provide access to the
NHS pension scheme.
— All ISTC providers should have, as
a condition of engagement, recognition of trade union and professional
bodies. There should be a requirement to support and actively
work with the appropriate professional body to introduce role
extension and development.
— We recognise that increasingly there
will be a reliance on teleradiology as a standard practice for
reporting on images. Until then we would advocate caution. Certainly
before there is further implementation, there must be full evaluation
of the effectiveness and consistency with this form of reporting.
— There should be a full assessment
of workforce needs for the foreseeable future with full engagement
with all stakeholders.
Q11. What criteria should be used in evaluating
the bids for the Second Wave of ISTCs?
11.1 We would expect that at the very least,
there would be evaluation of effectiveness of service provision
and standards, evaluation of the levels of training and development
and the effectiveness of patient access and standards of care.
Q12. What factors have been and should be
taken into account when deciding the location of ISTCs?
12.1 There must be an evaluation of the
current provision and transparent evidence to justify the use
of an ISTC or IS facility to provide additional capacity or choice.
Yvonne Reihill
The Society of Radiographers
10 February 2006
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