PAEDS IMAGING IN SCOTLAND: WHERE ARE WE AND WHERE DO

WE WANT TO BE?

Dr Andrew Watt

PERSONAL TIMELINE

• Consultant 2000 (n=6) • Yorkhill Trust

• Clinical Director 2003 (n=3) • Yorkhill Division

• Paeds Lead Clinician 2006 (n=5) • Diagnostics Directorate

• Deputy CD Imaging GGC 2014 (n=7)

• NCH 2015 (n=9)

• Survived 3\4 corporate reorganisations in 18 years

GROWTH IN IMAGING

PLANNING FOR 2015

ModalityNumber of rooms

Patients per session

Total per session

Capacity 2 session day 5 days 50 weeks

Capacity 3 session day x 5 + 2 sessions x 2 50 weeks

12/13 activity plus 12 & under other sites & RAH & 13-15yrs all GGC

Projected 13/14 activity

Plain Film 3 24 72 36000 68400 39103 45751Ultrasound 3 10 30 15000 28500 11869 11869CT 2 6 12 6000 11400 1743 1987Fluoro 1 6 6 3000 5700 2657 2657MR 1 5 5 2500 4750MR GA 1 3 3 1500 2850MR Total 4000 7600 4191 4317TOTAL 68000 129200 59563 66580

NCH Capacity V Projected activity (Exams)

2018

• Continued growth in MRI, USS & CT

• Plain film growth limited due to other GGC activity

• No let up in 18 year trend despite: • Awareness of radiation dose

• Waiting times

• Full Consultant vetting

ModalityMonthly Avg for 2017/2018 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 AVG p.m.

Predicted annual total 18-19

CT 213 281 236 183 146 212 2538MR 472 515 579 513 436 511 6129US 1039 967 1087 1036 934 1006 12072Plain Film 2843 2703 3390 3298 2790 3045 36543Grand Tot 4567 4466 5292 5030 4306 0 0 0 0 0 0 0 0 4774 57282

WHAT ARE THE PROBLEMS

• Lack of Radiologists with a paediatric interest

• Loss of DGH specialists e.g. FVRH

• Limited local access to imaging

• e.g. Lanarkshire, paediatric CT & MRI contracted to NSHGGC

• Lack of reporting capacity

• Increasing Specialist imaging volumes

• CTA, MRS, PET-CT, WB-MRI

• Travel distance for patients

REASONS

• Improved technology & treatment options

• Requirement for confirmed diagnosis

• Centralisation of services:

• CT\MRI Lanarkshire

• Nuc Med\Fluoro Dumfries

• MRI\Fluoro Forth Valley

• Neuro reporting Ayshire

• NHSGGC under 16s policy

• Child protection imaging

STAG REPORT 2016

WHAT DOES THIS MEAN?

• Paediatric services are commissioned on a regional\national basis

• Paediatric imaging services are provided on a local basis

• Ad hoc agreements

• Inconsistent\lack of access

• Financial issues relating to cross border flows

WHAT CAN BE DONE?

• Manage paediatric imaging services the same way

• How?

• Inreach

• Outreach

• Hub and spoke

IN REACH VS OUTREACH

• Radiologist based locally

• Spends weekly time in centre

• Issues:

• Competing generalist\specialist demands

• Single point of failure

• Cover for leave

• On call not feasible

• Recruitment difficult

• Radiologist based at the sentre

• Weekly local sessions

• Issues:

• Whole time specialist clinical work

• Cross cover from colleagues

• On call possible

• Recruitment likely

• No continuous on site presence

HUB & SPOKE

ISSUES

• Paediatric Radiology staff workload at the centre

• Local vs non local work

• Capacity local vs central

• IT reliability for remote reporting

• Travel distance & support of on site services • CT\MRI

• Fluoro

• Ultrasound

• Buy in required

SOLUTIONS

• Agree clear referral pathways at regional level

• Resource & staff pathways correctly

• Enable remote reporting as part of pathways

• Improve regional accessibility

• Duty Radiologists in the paediatric centres

• Consider regional on call

• ? Feasibility

• Outsourcing

• High % of fluoro\uss OOH

CONCLUSIONS

• Local provision of imaging services

• Regional\national provision of clinical services

• This has led to: • Ad hoc access agreements

• Geographic lottery on access

• Inadequate resourcing & unsustainable service provision

• Regional\national commissioning in a hub\spoke model is the logical solution. • Promotes recruitment & resilience

• Maintains local services