Health CommitteeWritten evidence from the Society and College of Radiographers (ETWP 60)

1. The Society and College of Radiographers is pleased to be able to submit written evidence to the above enquiry, in addition to contributing to that submitted by the Allied Health Professions Federation. In the interest of brevity, we have confined ourselves to our major concerns aligning these to relevant themes of the inquiry.

2. The right numbers of appropriately qualified and trained healthcare staff (as well as clinical academics and researchers) at national, regional and local levels

(a) Radiographers and the wider radiographer workforce are vital front line clinical staff in the delivery of effective and timely cancer treatment (radiotherapy); and clinical imaging to enable important health screening (breast, fetal anomaly, aortic aneurysm), early diagnosis (for cancer and other significant conditions such as heart disease and stroke), disease and condition monitoring, and interventional image guided procedures.

(b) Early treatment and diagnosis is cost effective in terms of provision of health care services, and beneficial to the population in that it reduces both mortality and morbidity so enhancing both length and quality of life.

(c) We agree that it is essential to ensure that there are appropriately qualified and trained healthcare staff including academic and research staff but we have real concerns that this is in jeopardy at present for a number of reasons.

(d) Inadequacy of workforce planning; despite considerable investment in the Centre for Workforce Intelligence this, as yet, has not delivered the new/better approach that is needed. In particular, it has not sought to derive workforce need from service delivery and healthcare need (which seemed to us to be the right starting points), but has used current workforce numbers and affordability as the main influences. This perpetuates the short-term approach to workforce planning which drives a boom/bust (or glut/famine) cycle in relation to workforce supply, and fails to help deliver long-term skills-mix based solutions to cost and quality effective health care delivery.

(e) The establishment of Local Education and Training Boards (LETBs) ahead of Health Education England (HEE) is unhelpful and has the potential to destabilise education and training commissioning further, especially in the area of the support and assistant level workforce (bands 1–4) and in post-registration education and training. We have concerns that the already small amount of investment in the bands 1–4 workforce will decrease further, leading to a reduction in the necessary development of assistant practitioners in, for example, radiotherapy, breast screening and clinical imaging. These staff are essential to enable the skills of radiographers to be utilised more effectively such that radiographers are able to support medical staff to spend proportionally more of their time with patients with complex radiotherapy and clinical imaging or intervention needs.

(f) There is also a disconnect between the roles of LETBs and HEE, and the funding flows. Collectively and historically, employers have not shown themselves to be responsible in terms of education and training as is evidenced by the very low investment in the bands 1–4 workforce, the failure to invest in developing advanced and consultant practitioners to deliver both “routine” service needs (there is a severe and chronic shortage of sonographers, a band 7 workforce, to deliver ultrasound imaging services, yet plenty of staff wanting to train in ultrasound and plenty of education places available—the gap is a failure by employers to invest in the required training posts), and to deliver service innovations that have been shown to improve quality and effectiveness (for example, cancer site specialist radiographers, reporting radiographers). Radiographers and sonographers remain on the Migrations Advisory Committee (MAC) list of shortage professions and we do not see this changing in the foreseeable future.

3. All providers and commissioners of healthcare (both NHS and non-NHS) play an appropriate part in developing the future workforce

(a) This is essential in our view, and its vital that they play appropriate and full parts in developing the whole workforce (ie bands 1–9 inclusive), and including the research and academic workforce. Without these latter groups there would not be the continuing development of an evidence base for practice, and the continuing development of a sufficiently educated and trained clinical workforce.

(b) Our experience is that both NHS and non-NHS providers have been low investors in developing the healthcare workforce but the non-NHS healthcare provider sector has overly relied on recruiting NHS funded and trained staff at all levels, especially at post registration advanced and specialist practice staff, for example, sonographers and magnetic resonance imaging radiographers. We believe this has contributed to NHS employers being reluctant to train these groups. Unless there is obligation placed on non-NHS employers to contribute to education and training in clear, meaningful and regular ways (by payment of a levy and/or by providing high quality clinical placements), we feel this inequity will continue. Indeed, it is likely to worsen as the “any qualified provider” (AQP) policy takes root (this is intended to take effect in the first wave in relation to provision of ultrasound and magnetic resonance imaging services ).

(c) Education and training requires high quality clinical placements, and an expectation that all service providers accept that they have vital roles as education providers alongside their healthcare services provider roles. We have noted an increase in “complaints” from student radiographers about their clinical placements, with students stating that there is little or no time for clinical staff to help them with their clinical learning objectives and needs as there is a constant stream of patients and fewer trained staff available to deal with them. In our view, the quality of clinical education and the expectation that this is a role that healthcare service providers must deliver has never been addressed satisfactorily, especially in relation to the non-medical workforce. We welcome the idea that the new architecture will deliver this and trust that HEE will be able to use funding flows to bring about the much needed improvements and to introduce equity across the whole system. Attempts to do this in the past have always been thwarted by the large (medical) teaching NHS healthcare providers as for such organisations the funding support is significant, and funding that has gone to NHS organisations to support clinical education and training has almost wholly been directed at medical education and training.

4. The existing workforce can be developed and re-skilled for the future (through means including post-registration training and continuing professional development)

(a) This is essential in our view but we are not confident that the new architecture will deliver this. We have already voiced our concerns about the development of LETBs ahead of HEE, and our concern that LETBs will be the bodies determining all but the pre-registration workforce education and training, and re-state these here. Investment in the bands 1–4 workforce and in the post-registration workforce is essential if cost effective, high quality healthcare is to be delivered. At present, there are some very good examples in individual NHS Trusts of innovations that deliver the highest quality of care through excellent development of its whole radiographic workforce (eg Pinderfields and Pontefract NHS Trust’s trauma and emergency care imaging services, Countess of Chester Hospital’s breast imaging service, United Bristol Hospital’s radiotherapy service, North Bristol Hospital’s gastro-intestinal imaging services, Addenbrooke’s Hospital’s radiotherapy service, Medway Maritime Hospital’s magnetic resonance imaging service) but there is little to encourage widespread take-up of these innovations, and the new architecture could make this situation even worse if there is to be no real oversight of LETBs by HEE across the whole of education and training development and provision.

December 2011

Prepared 22nd May 2012