Too many images but not enough pairs of eyes
Written by Natasha Perkins, Solicitor at Fletchers.
It has been reported in the news over the last couple of months, more recently over the last fortnight, that there is a shortage of radiologists across the country.
Ultimately, this means there are less people available to review radiological images. Whether it is a fracture, tumour, cyst or a fluid collection, there are simply not enough people to prepare a report on what an image shows.
Essentially radiologists and what they do underpins all clinical decisions. A radiologist reports on what the image shows and the specialist in whichever field decides what this means and what treatment is required.
If one considers how most medical conditions are diagnosed, a majority of them require some form of scan or x-ray which produce images. It is these images which are used to diagnose a condition and dictate the course of treatment required.
It is well known that radiology is crucial to the diagnosis and treatment of cancer. I have had clients who are cancer patients and have either had a CT, PET, or MRI scan before every follow-up with their oncologist, which shows how crucial it is to their treatment.
In its July 2018 report named ‘Radiology Review’, the Care Quality Commission (CQC) reviewed a number of trusts and their radiology practices. The report focussed mainly on the time taken to prepare a report on an image once it is taken.
Due to recognised delays in reporting images, the CQC has suggested introducing tighter timescales. The difficulty with tighter timescales is that the number of radiological images taken would not change and so the demand upon each radiologist would ultimately be higher in order to turn reports around more swiftly.
The CQC found specifically at Worcester Royal Hospital, Kettering General Hospital and Queen Alexandra Hospital that there were issues with staff shortages and so a clinician qualified to review images would also be asked to carry out other duties despite there being a dedicated rota.
This suggests a shortage of staff across the board and not just specific to radiologists. It was also found that there were a high number of vacancies unfilled which again flags up the issue of shortages in people undertaking training.
Without the appropriate number of radiologists available, Trusts are also having to resort to outsourcing images to private companies which ultimately leads to additional costs and more scope for errors or delays to be made.
As well as this being a problem in England, a red alert warning has been issued in Scotland as the Royal College of Radiologists has warned that more training places are urgently required. Similar issues have also been reported in Northern Ireland.
The issue is also not unique to radiologists. In June 2018, the president of the Royal College of Physicians, Jane Dacre, advised that more medical school places are required in order to cope with NHS demand, indicating that this is a problem in more NHS positions and not just specific to radiologists. However, it is clear that radiologists hold a crucial role when treating patients, particularly those suffering from cancer and so this issue presently seems most concerning.
As a medical negligence solicitor, I have dealt with multiple cases where something has been missed, misreported or an image of poor quality has dictated a patient’s diagnosis. This can be in any discipline whether it be orthopaedics, oncology, colorectal, cardiology and the like. Errors with radiology can have grave consequences for a patient, particularly if their condition is life threatening.
Often when reviewing medical records it is evident that there has been a staff shortage and this is something which often crops up in Defences. I have also been involved with cases where reports have not been completed until weeks later and it has been acknowledged that it has “slipped through the net”. Alternatively, and perhaps more encouragingly when faced with high demand, I have seen cases where despite a lack of report, findings have been discussed verbally and clinical decisions have been made on that basis.
It is imperative that there remains a focus on patient safety and the increased media reports of insufficient staff numbers and delays in patients receiving treatment is concerning. It is not easy to simply recruit more radiologists – the investment needs to start early on.
Although the distribution of NHS funding is often a juggling exercise, a focus on increased training, an increased intake of medical students and an increase of awareness across the board would help the situation. However, having been a student myself, I also know how expensive university is and I was one of the ‘lucky’ ones who missed the £9,000 annual tuition fees. The expense of this can be off-putting for any prospective medical student. I would like to see a more open approach to studying medicine, but with the same high standards still applied.
Further, from a medical negligence perspective, without there being a sufficient number of practitioners, one would also question whether there would be enough to establish a ‘reasonable body of practitioners’ under Bolam. Further, if there are delays and staff shortages across the board, would this affect what would be considered reasonable? It will be interesting to see how this is addressed over the next few years.