>>Dr Tim Taylor: Hello, thank you very much for staying around.
Do please take your seats again already.
My challenge now is to keep you awake after lunch, and to stop you looking that way at
the cricket which I can see from a great view here.
So here we go.
My name's Dr Tim Taylor, I'm a practicing consultant radiologist, I'm also the EMRAD
medical director.
This is Andrew Fern who's the senior responsible owner for the EMRAD consortium, and this is
Dr Mike Brookes who's our business analyst.
So first off, we're a clinical radiology consortium, our whole purpose is centred around the patient,
that's what we exist for, is patient care.
So for the next five minutes I'm going to describe a little bit about what we've learned
so far and how we think we could share some of that stuff nationally for the benefit of
the NHS should we get through vanguard.
So we've spent the last two years designing building and now deploying an exceptional
- though I say so myself - imaging technology across a big collaboration of seven Trusts.
We're serving in the East Midlands about six and a half million people, and Mike over here
as a clinician money is strange, but Mike says that it will save us as a consortium
about £10 to £15 million over the next ten years compared to what we're currently paying.
From my point of view it brings immediate benefits for the patients, to carers and to
clinicians - but that's not enough, we can do more.
>>Unidentified male speaker: So what have we done so far, we've persuaded seven acute
Trusts who needed to replace their imaging technology to work collaboratively to design,
procure, and then enter a ten year fully funded contract to build a single shared repository
of all images across the East Midlands.
That's quite big really.
Those seven Trusts and their 12 hospitals, their ATDs and their myriad of clinical networks
will be able to do what we've all wanted to do ever since the national programme for IT
developed PAX, and that is share images quickly and easily with any other clinician with a
shared interest in the patient.
Through a no due competitive dialogue procurement we selected cutting edge technologies that
will not only provide any image anywhere, but it will provide the core building block
for us to be seen as a national benchmark for new models of NHS clinical collaboration
within radiology.
The first steps we've already taken.
We've created an NHS framework contract for other consortia across England to help avoid
procurement costs.
We've developed a consortia model that others can pick up and use.
We've created a governance model that will ensure safe and legitimate clinical sharing.
We've done that by having the chief executives of the seven organisations fully behind our
programme of work.
We've also been working with the Royal College of Radiologists, with Health Education, England,
the Academic Health Science Networks locally, our local clinical networks, our commissioners,
our staff, and most importantly the people that we serve to help us shape what might
be possible.
But why work collaboratively?
>>Unidentified male speaker: So I'm not going to tell you anything that you don't know but
radiology services in the UK are in trouble.
Over the last decade we've had loads of clinical networks spring up and flourishing, absolutely
rightly, cancer, stroke, major trauma, paediatrics, these are all absolutely crucial clinical
networks providing service to the patient at their point of need.
The problem is radiology has really struggled to keep pace and we're now in the paradoxical
situation where you can have a patient move across a region or across a network faster
than their images can.
That makes no sense.
Despite massive investment in scanners the additional piece that goes with those scanners
is someone to interpret those images.
And that investment hasn't been able to keep pace either.
So national data from the Royal College of Radiologists backed up with data from Health
Education, England, shows that in the certainly in the East Midlands we have a massive recruitment
problem and I'm sure some of you do too.
We're really down on the number of whole time consultants that we have in radiology.
We have a massive problem with retention as well in terms of retirement over the next
ten years.
And this affects all Trusts, big and small, in different ways.
So the big Trusts are pushing really hard to match their emergency department and urgent
care targets, and they struggle with the elective work.
The smaller Trusts don't have capacity to provide that work so they end up outsourcing
which costs a load of money to be honest.
And it's reported by the same people, NHS consultants.
So the more we've worked on this the more we believe we've got another way of working
potentially that works in collaboration, not in competition with the things that are currently
working.
So for example, by developing a regional family of radiology Trusts using the important but
actually quite a small part of technology that sits underneath that, and building with
a massive amount of clinical engagement we think we can provide expert care closer to
the patient regardless of the location with really solid clinical and information governance
support, and with patient involvement at the ground level because issues like information
governance and clinical governance are really, really important to people.
We think we can possibly provide an in-house NHS alternative to outsourcing.
It's the same people doing the work after all.
We can't, and we're not going to be able to fix the problem of over demand and under capacity.
We can't magic people out of thin air.
But what we can do is make our region an attractive place to work and an attractive place to stay
working, and an attractive place to work even after retirement if you want to.
And that model is cascadeable across the whole NHS we think.
So what do we need to make this happen?
>>Unidentified male speaker: So by this time next year all seven Trusts will have deployed
a successful technical solution.
The concept of a single patient imaging record across the East Midlands will have started
to transform the way in which we deliver clinical care.
A regional clinical governance network to support the new ways of clinical collaboration
will have been set up with patient involvement from the ground.
We will be reporting and supporting collaboratively across the East Midlands.
We will develop an East Midlands wide radiology service.
The first of numerous cross Trust clinical appointments will have been advertised, and
further Trusts and other consortia will be exploiting the work that we've done in EMRAD.
>>Dr Tim Taylor: So finally how can vanguard help?
It sounds really exciting but what do we need from vanguard, thanks.
There are several specific areas which we would really value vanguard support.
Firstly actually helping us get the word out, there's strength in collaboration.
The practicalities of setting up a collaborative network aren't as scary as certainly I thought
they might be as a clinician.
It is practically doable.
You just have to get the right people doing the right things with the right input.
Secondly I would really love some help to develop NHS contracts that accommodate new
ways of working across Trusts that don't rely on myriad different honorary clinical contracts.
Different ways of payment models, that don't currently exist to support our aims.
I'd also love national support for a kind of working together clinical governance framework.
We have an EMRAD clinical governance framework, we're setting it up, it's really important
to us.
But we need support, we need national involvement and heads up with that.
We also would like deployment support and development support between EMRAD and our
other technical partners, so that we can develop and create an NHScentric brokerage system
with appropriate business intelligence, clinical governance and information governance, so
that we can really make a world class system in the East Midlands.
>>Unidentified male speaker: So in summary we've built a solution that we passionately
believe, you'll get the passion.
That we can help the NHS help itself by working differently because we can't continue to work
in the way that we have been doing.
Thank you very much for listening, we're happy to answer any questions that you might have.
>>Unidentified female speaker: Thank you very much.
No questions?
A lady here in the blue.
>>Kathy Pritchard-Jones: I'm Kathy Pritchard-Jones from UCL Partners.
I'm interested in your governance model about how you've set it up to react to unexpected
abnormal findings.
>>Unidentified male speaker: Yes, that's a really, really interesting question, but one
I'm very happy to answer.
So unexpected findings are a problem.
Just getting for example if I find a lump on a chest x-ray how do I make sure that the
clinician and ultimately the patient gets that report as quickly as they possibly can?
Many of us have real problems with that.
It was one of the fundamental cornerstones of actually our procurement was to make sure
we have something and we've actually got a very, very good technical something to make
that work.
But as with everything else the technical something isn't the important bit.
The important bit is making sure that the clinical governance around what you do in
your organisation, and more importantly what you do across the EMRAD organisation is 1,
rock solid and 2, absolutely reproducible.
And that's why the clinical governance is so important which is why it's set up.
And you end up with in broad terms, you end up with SOPs and high level agreements and
patient involvement very, very early on.
But it is manageable and we've managed it.
>>Unidentified male speaker: I think it's important to realise we're not just talking
about a technical solution here, people make things happen.
So part of that drive is to have someone like Tim with the passion, with the drive to engage
with clinicians across the consortia, to make sure those clinicians feel part of the process
and have been over the last two years to help design and build the solution that they're
going to be using, and they're going to feel strongly about when they go forward.
>>Unidentified female speaker: Question from table nine.
>>Shelley Dolan: Thank you.
Shelley Dolan from the Royal Marsden London Cancer Alliance.
Fantastic idea, really, really important.
Have you thought about how you're going to bring on, if you like, the next generation
of radiographers but also perhaps apprentices and new models of growth, because as you say
the workforce is a key issue.
>>Unidentified male speaker: Yes, so this is really interesting.
Health Education East Midlands have very clearly shown us and Health Education England, that
it's not just consultants radiologists, it's radiographers, it's ancillary staff.
Just getting radiology departments running and keeping them running is really tricky.
So part of the reason for going through the vanguard process is to say, well how can we
make radiology a really attractive thing to work in?
And actually speaking personally it's not an attractive thing to work in when you're
being smashed with targets and two week waits going to one week waits and your work list
just goes up and up and up.
And that's the same for radiographers as well.
However, in our region you've got some really big busy hospitals which frankly are quite
hard to work in.
And you've got some much smaller hospitals which offer a different model.
They work in a different way.
I think there's a lot of scope for people, because the network becomes a family of Trusts.
Why stay in one?
You can work in all of them.
That's what we need the vanguard for.
>>Unidentified male speaker: We've learned actually across the consortia and there's
a mix of district general hospitals and large acute teaching hospitals in the consortia.
We've learned that the best practice isn't always from those large acute teaching hospitals.
And actually the most efficient practice has come from the DGHs.
By learning we can actually share that working practice across the consortia first and then
hopefully much more widely.
>>Unidentified female speaker: Can we just take a question here from the lady on table
four.
>>Unidentified female speaker: [Inaudible]
>>Unidentified male speaker: There is no such thing as a bog standard DGH, they are all
fantastic places.
>>Unidentified female speaker: Very interesting in terms of what you say because I do think
that radiology represents one of the biggest workforce challenges we have.
But I wondered if you'd [Inaudible] I mean we're busy buying imaging expertise from private
companies and what have you, but I wondered if you have had any difficulty getting the
consultants to sell their discretionary time to you as opposed to a private provider?
I mean have they welcomed it?
How have they really taken to it?
>>Unidentified male speaker: The clinical answer is, I would much rather work for my
organisation and for my NHS colleagues.
I'm an NHS clinician; I want to provide this service.
Third party organisations have created a way of providing a service outside of the NHS
because our models weren't sufficiently mature.
I think this has a really good chance of creating a mature safe model with clinical governance
that means it just becomes seamless with part of our normal day to day working.
>>Unidentified female speaker: Sounds like a win, win, win, really.
>>Unidentified male speaker: I'm hoping so.
>>Unidentified female speaker: I just want to take one question from[Inaudible] there's
two people here desperate to ask questions, so do you want to take the second one in the
front and then we'll then try and quickly[Inaudible] if you ask very quick questions we'll try
and take them both.
>>Geoff Belling: Geoff Belling, UCLH.
I'm just interested how much this model could roll out across other things.
You must have thought about pathology and various other support services.
>>Unidentified male speaker: Yes, we have.
So in the original contract that we put out other ologies were part of it.
Not everything in medicine is quite as tecchie savvy as radiology might be, and believe me
some of the my colleagues are not tecchie savvy.
We're used to working in front of screens, we're used to the concept of shared workloads.
In fact some of us working in the private sector are quite familiar with this sort of
model anyway.
In terms of other ologies well you've immediately got pathology, you've got ophthalmology, in
fact you've got anything that has an imaging resource that becomes a single, kind of, weak
point, and yes it's roll out [unclear 00:13:59].
We've had discussions with radiotherapy and pathology already.
>>Unidentified female speaker: I'll just take the gentleman[Inaudible] the very last question.
>>Steve: Steve, one very quick one.
The buzz word seems to be patient involvement, you've mentioned it twice, can you tell me
something about it?
>>Unidentified male speaker: Yes, very easy, very quick.
So for example let's take clinical governance, I mean radiology is one of those secondary
specialities, you've probably never seen a radiologist unless they've put a needle in
your neck or something like that.
But in terms of getting them involved, we create a regional patient record, there is
no chance we can create a safe regional patient record unless patients and carers have been
thoroughly involved right at the beginning of writing the information governance for
that, it just won't work.
So we've had patient representatives actually critiquing and drafting our first drafts of
every document in the IG space.
Similarly in the clinical governance space we've got patient representatives sitting
as a member of the clinical governance board for the region.
It's fundamental that this works.
>>Unidentified male speaker: The people we serve need to trust us and that means that
we've got to engage with people that we serve.
>>Unidentified female speaker: Thank you very much, that's East Midlands Radiology Consortium.