Imaging Department Board Presentation 8 th January 2018 Presented by Dr Hefin Jones, Deonne Lee and Jonathan Barnett

Imaging Department Board Presentation 8 th January 2018 Presented by Dr Hefin Jones, Deonne Lee and Jonathan Barnett

Background and Context Imaging lies at the heart of the NHS s work. NHS Imaging services in England deliver approximately 42 million imaging tests a year, representing involvement in over 50% of patient interactions with the NHS Demand for tests has risen consistently as the NHS has understood the contribution that Imaging can make to better outcomes and longer lives and patients and clinicians have consistently high levels of confidence in the service provided. 60,000 58,000 56,000 54,000 52,000 50,000 48,000 46,000 44,000 42,000 Number of Exams Performed April 2015 - December 2017 All current planning points to front loading of diagnostics and one-stop clinics 489 525 518

Our Department The Imaging Directorate encompasses a wide range of modalities across our two hospital and 4 community sites including: General X-Ray RSUH Hub, Lyme and County Haywood Leek Theatres SMT Dr Hefin Jones, Clinical Director Deonne Lee, Professional Head of Imaging Jonathan Barnett, Directorate Manager of Imaging Ultrasound RSUH Hub, Lyme and County Obstetrics and Community Haywood Leek Bentilee MRI 7 scanners, 4 x 3T and 3 x 1.5T RSUH Hub and Valley County Nuclear Medicine 3 SPECT-CT Scanners PET-CT CT 6 scanners, 1 x Flash Scanner, 1 x 256 slice, 3 x 128 slice RSUH Hub and County A&E Interventional Radiology 2 Siemens IR Rooms and Room 5 Radiology Day Case Unit Breast 7 RSUH Hub and Valley 5 community screening locations Advanced Practice 25 wte The most for any Teaching Hospital nationally We are the 4 th biggest Imaging Department in the Country

The department in Numbers 2017/2018 Budget 30m Pay 24m Non Pay 6m Of external Income Tests per year wte. Delivered a TAT for GPDA Current cancer TAT days test to report Radiologists Radiographers and Prof &Tech Adv. Practitioners Registrars Nurses IDA s A&C We gave And Patients had an MRI had a CT people an x-ray an ultrasound Performed over Interventional Radiology Over Breast Screening population Trust 6 week diagnostic target delivered for Nuclear Medicine Studies People through the RDCU Screening per year ladies out of the last 20 months

Achievements in 2017 Projects Opened RDCU Opening MRI scanner at County in 6 months! Registrar Room 200k grant from HEE Launched the School of Radiography 4 US machines replaced in Hub South Staffordshire Breast Screening re-configuration completed South Staffs ICE started rolled out on track for completion this week Workforce Won a UHNM Staff award for Staff Engagement Recruited 13 people to our Aspiring Programme Consultant Workforce carrying 1 vacancy! Woman s Imaging Radiologist, Consultant Radiographer, GI Radiologist and 2 GI Fellow s recruited and now in post Cardiothoracic Radiologist starting in February Nuclear Medicine Consultant, Nuclear Medicine Spec. Doctor, appointed due to start in March 18. Ultrasound Team reduced locum requirement to 0 in September 2017 Successfully recruited 26 student Radiographers Sept 18

Achievements in 2017 Service Developments TACE service development approved and awaiting first patient Head and Neck pilot to provide all faster access to diagnostics live from November Same day walk in CT scans for endoscopy positive patients introduced from October 2017 Finance Green CIP plans of 1.19m Other County MOC complete to centralise scheduling team at Stoke Radiology Consultant Leadership Course delivered in April and November with cohort 3 due in March 2018 Recruitment campaign on Facebook for Student and Qualified Radiographer s hits 100k views World Radiography Day gained great plaudits in the department and on Social Media. Recruited 1 sonographer and 1 qualified General Radiographer. 130 Research trials supported

Plans for 2018 Deliver ISAS Accreditation March 2018 Deliver PACS replacement - due on line March 2018 Work more closely with SSOTP and maintain Community Work Build links with CCG colleagues to get 100% of GPDA work Work with Leighton to strengthen patient pathways Replacement of 3 x MRI and 3 x CT scanners in the Hub and A&E Continue to develop hot reporting, walk in and one stops services Write and deliver the business cases for Cardiac CT expansion, Interventional Radiology Theatre 3 and additional staffing

Portsmouth Hospitals NHS Trust Review backlog of x-rays CQC Inspectors identified at Queen Alexandra Hospital a backlog of 23,000 images of chest x-rays from the preceding 12 month, which had not been formally reviewed by a radiologist or appropriately-trained clinician. Three serious incidents where patients with lung cancer had suffered significant harm because their chest x-rays had not been properly assessed with a formal radiological report. The Chief Inspector of Hospitals, Professor Ted Baker - now reviewing radiology reporting across the NHS in England. Dr Nicola Strickland, President of The Royal College of Radiologists, said: Patient x-rays must be viewed as quickly as possible by a radiologist or appropriately trained clinician. We very much welcome Professor Baker s survey of radiology reporting services across England, which should give further transparency on the serious issue of radiology reporting backlogs. The RCR published Standards on the reporting of imaging by non-radiologist medically trained practitioners in 2016 as an update to the previous standards in 2011. It stated: Reporting is best carried out by radiologists or, where appropriate, by delegation to role-extended practitioners working in teams with radiologists

UHNM Current Position A&E Attender Hot Reporting of all MSK plain x-ray imaging Monday-Friday 9-5 (Formal report within 20 minutes) Current backlog 1245 plain x-rays (chest ) Oldest wait 12 days (70% within 7 days) Current Pathway outside core hours (non hot-reporting) ED Patient attends ED Patient clinically assessed - ENP or clinician - x-ray referral completed X-Ray ED X-Ray X-ray performed and diagnostic quality checked Images viewed by ED staff - ENP/clinician Provisional conclusion/patient pathway decided and actioned ( no formal report at this stage) X-ray images viewed and formally reported after patient left department (could be reported days later) ED informed of any potential misses report/requiring action (R3 coded) ED ED Consultant reviews R3 coded reports and recalls / actions as a result of formal x-ray report verification/publication by reporting radiographer

Potential Added Value Next Steps To introduce a second layer of advanced practice hot-reporting service on Sat/Sun 9-5 to support ED To include MSK and appendicular reporting as per the weekday service currently, chest performed if scope of practice allows. Potential radiographer working alongside ED team during triage. Advanced practice radiographer will be available to advise nurse on most suitable x-ray views for clinical suspicion if needed. Supports immediate formal reporting enabling clinical decisions to be made with formal x-ray report rather than decision based on provisional assessment of plain images or waiting for ED clinician assessment. Outcomes: Improved quality of care at time of attendance. Most appropriate x-ray view for clinical presentation first time. Repeats advised at time if necessary reducing time Reduces recalls and numbers of inappropriate referrals to # clinic ED Patient attends ED Patient clinically assessed ENP - x-ray referral completed ( discussion with radiographer if required / radiographer based in ED) X-Ray X-ray performed and diagnostic quality checked ED Images 'Hot Reported' by AP Image reporter based in Imaging or ED Review of formal report +/- discussion with radiographer as appropriate with conclusion about patient outcome pathway made using formal report and clinical correlation Patient discharged /admitted /referred on to fracture clinic on if necessary confirmed on formal report

Staff Engagement

World Radiography Day 8 th November 2017

Insights One stop Lung cancer pathway Realities of one-stop GPDA Trust position AQP

Opportunities and Challenges Opportunities Work more closely with SSOTP and maintain Community Work Build links with CCG colleagues to get 100% of GPDA work Look at in-sourcing opportunities Challenges Leighton and SaTH are in a very precarious position and we are at risk of them cherry-picking of services and the alignment of OOH and in-hours pathways. Demand Management - primary care getting annoyed at us for saving the CCGs money with US vetting and the amount of criticism we are getting for it, with none of the plaudits Real-estate is becoming a big issue to demand and successful recruitment we are expanding reporting at both sites and at home but need IT support and capital investment

Thanks for listening