By Dr Grant Baxter, Chair, Standing Scottish Committee of The Royal College of Radiologists
LAST week, this newspaper highlighted our hospitals’ growing expenditure on outsourced scans, as a result of Scotland’s very real, ongoing crisis in radiologist staffing. Official figures showed that NHS Scotland spent £3.8 million between April 2017 and February 2018 sending X-rays, CT and MRI scans to commercial imaging companies in the UK and overseas – in some cases in India and Australia – because there are simply too few radiologists to cope with the workload. This was up from £2.8m in 2016/17.
Sadly, the front page headline was not news to radiologists or to The Royal College of Radiologists. Radiology services in Scotland are in need of resuscitation: increasingly complex workloads, lack of investment in trainee and consultant doctors over many years, and retirement levels increasing at rates that are not being addressed, are historic issues. These are now culminating in us witnessing a national radiology service that is starting to crumble. This matters because when radiology fails, the health service fails – modern healthcare is based on us being able to detect injury and disease and to manage care from patient scans.
Millions of pounds are being spent on outsourcing radiology work to private companies due to our dire need for more consultant radiologist staff, but the situation worsens daily. Waiting times continually increase – largely due to imaging backlogs – cancers go undiagnosed, patients cannot be treated as their scans are not reported on time, patients’ anxiety and worry over pending scan reports can last for weeks and months, and it goes on. Life-saving interventional radiology procedures, cancer treatments and palliative cancer procedures almost function on a postcode lottery due to lack of imaging experts. How much longer can this be tolerated?
The Scottish Government and health boards have recently tried recruiting radiology consultants from abroad, but despite many people’s best efforts which I would like to acknowledge, this initiative has failed.
NHS Scotland is rolling out a new IT system to try to help address reporting delays across Scotland. This is a fantastic idea with a lot of support from clinicians but at best it will only improve the situation at the margins – it will not generate more radiologists. As healthcare provision falters in a region due to its lack of radiologists, the issue becomes harder to address.
The Royal College of Radiologists and Scotland’s doctors know there is no quick fix. The Government has made a start to tap our best resource – home-grown trainee radiologists – promising us 10 extra trainees per year, with the first crop of extra trainee consultants going into training this summer. It’s a start, but it’s not enough. We need at least 25 extra trainees every year. The extra 10 doctors will barely cover expected retirements, never mind the posts currently sitting empty.
We see four applicants for every trainee radiology job – surely it makes more sense to use this resource and train our own radiologists? In the long-term this will save the country money as the millions spent on outsourcing work from hospitals drops.
Artificial intelligence will help with workloads but hospital-ready AI is still a long way off. By the time it arrives we could have trained more than 100 additional radiologists and have a Scottish radiologist workforce fit for the 21st century.
As a country with a rich history in medicine it is sad that we seem unable to properly invest in our own talent. We know the Scottish Government and Health Secretary understand the situation – it is now imperative they be bold and expand on their promises for more trainees. If not, this healthcare crisis will be too late to reverse.
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