Now I am not one to moan and I know that the most dangerous place in a hospital is reputed to be the door to the X-ray department at 5.00pm (you may get run over by the rush of radiologists leaving)!
But I had noticed that my work load seemed to be steadily rising despite my best attempts to prevent it.
So we decided to review the radiology work load figures for the last three years and the increases were quite unbelievable. CT had increased by 61%, ultrasound by 71% and MRI by a staggering 101% (and I am talking thousands of scans, not hundreds). This huge rise in demand for imaging investigations is reflected nationally, but I suspect we are at the extreme end of the curve.
The reasons for this surge are fairly straightforward. Firstly, we have abolished significant waits for investigations, an achievement for which we are justifiably proud. But this has effectively taken the lid off Pandora’s box - long waiting times were an efficient means of controlling demand.
Secondly, the combined effect of MMC and the WTD has resulted in junior doctors with far less experience and confidence than in former times. Consequently they have a much lower threshold for requesting imaging investigations. This is not a criticism, merely a statement of fact.
Thirdly, public expectations of what the health service can deliver continue to be inflated by politicians. I am reminded of a headline in the Daily Garbage some time ago: “Death rates continue to fall”!
It is true that a significant number of these requests are utterly inappropriate. Earlier today I scanned the kidneys of a frail confused elderly lady with deteriorating renal function. My report stated: “Bilateral 91-year-old kidneys”. We then shipped her off to have a CT scan of her brain (same age). I am not ageist and believe that appropriate investigations should be done at any age, but it’s difficult to know how the results would have altered her management.
You would expect that the response of the trust management would be to rapidly recruit additional general radiologists to deal with the increasing work load. Did they heck! We calculated the shortfall as between eight and 12 WTE consultants. Eight months after we raised our concerns they offered us four, then immediately reduced to three.
It is not as if we are not earning the cash. Last year, based on tariff, we brought in about £20m of business. However our actual annual budget is about £7.5m and we are expected to make a 5% cost improvement this year. We must be the most cost-efficient department in the whole hospital. Yet where has the cash gone? To support the most inefficient parts of the service who still fail to hit the targets despite having millions thrown at them (I mention no names).
So a pretty depressing story. We have managed the work load by ditching the easy things like IP reporting (perversely usually the sickest patients) and by generally reducing the quality of the work we do. Sadly this has resulted in clinical errors, some serious. The clinical governance issues do not need to be spelled out.
Our trust is travelling down the road towards foundation status, yet sadly it seems that nothing has been learned from the Mid Staffs debacle.
Tags: Foundation trusts, Mid Staffordshire, MMC, Radiology, WTD
