The Sunday Times loves to run health campaigns, spearheaded by their two health correspondents. But unfortunately they seem to have a bit of an issue with regard to radiology.
Last summer their story was the inability to get ’scans’ during weekends implying that come lunchtime Friday the entire radiology department does a ‘POETS‘ leaving the MRI and CT scanners to gather dust until Monday morning. The story was illustrated by accounts of medical disasters due to patients not being scanned promptly enough.
Now obviously we already know that patients may be managed inappropriately with poorer outcomes at weekends and no one wants to see this. But in my department scanning takes place 24/7 for urgent cases and it is actually easier to get a not-very urgent scan at the weekend than during the week. This is because the weekday lists are totally overbooked with non-urgent patients to ensure they don’t breach the wretched six week scanning target. We also regularly run routine weekend lists to cope with the backlog.
The ST published a letter which I wrote at that time. I pointed out that while radiology departments are under relentless pressure Joe public perceives the service as free and consequently put huge pressure on their GPs for unnecessary and irrelevant scans and X-rays. The “banged finger/toe/knee six weeks ago, still sore, please X-ray” and myriads of similar requests are well known to all radiologists and must cost the NHS £millions per year. If the public want prompt appropriate access diagnostics then they need to use the service more responsibly.
The latest ST campaign relates to poor cancer outcomes in the UK as compared to elsewhere in Europe. The aims of this are laudable and would certainly merit the support of anyone. However yet again they have targeted radiology and the ability of GPs to get rapid access to diagnostics for their patients.
Many trusts, they told us, are breaching the six week target.
So again I wrote to the ST (published 23 March) and pointed out two things. The first is that the problem is not due to inefficient radiology departments. Most will be able to demonstrate significant increases in productivity over the last decade. But we are simply unable to cope with the inexorable rise in demand for diagnostic imaging. The complexity of scans is also increasing as technology improves.
When I was a lad a cranial CT scan would consist of about ten slices, and it would take about 20 minutes to produce the images. Nowadays you can scan from nipples to knees in one breath-hold and hundreds, if not thousands, of images are generated.
However more important is the fact that even if a patient is scanned within the six week target and the box ticked the scan may well sit in a digital queue for a further six weeks waiting to be reported. There is no target for this, consequently it is not measured and is not therefore regarded as a priority by trust managers.
This came as a bit of an eye-opener to the ST journalists who, in line with the majority of the population, think that the output from a scan is a picture whereas it is, in fact, a considered report from an experienced radiologist. But modern scanners can produce images far faster than we can report them.
I was phoned by each of them following my letter. One relayed a conversation she had had with “an exasperated” but anonymous London radiologist who told her that there was also a significant backlog of unreported plain X-ray images, some of which might show significant pathology. She wanted to know if this could possibly be true. And of course it is! In PACS systems up and down the country there are probably now millions of images which have not been formally reported. A recent unofficial straw poll revealed significant reporting backlogs in 81% of trusts.
On Sunday 6 April the ST published a letter from the President of the Royal College of Radiologists, Dr Giles Maskell (a mate of mine) basically confirming what I had said (phew) and pointing out that the UK has one of the lowest ratios of radiologists per head of population in the developed world. There is little point in the ST campaigning for “more scans” when there are simply not enough people to report them as it is.
We have been highlighting this problem for years but the Department of Health has simply stuck its proverbial head up its proverbial backside. Seventy per cent of all patients accessing healthcare need to pass through a radiology department and we are now a significant blockage in the drive for NHS improvement.
I am now off to my PACS workstation for a gruelling reporting session. And what work will I be prioritising - paediatrics or acutely ill medical patients? No I will be reporting the sore fingers/toes/knees because the GPs are now our paymasters and the trust management requires us to prioritise this otherwise they might send their patients elsewhere and our income would plummet.
It’s a funny old world!