X-rays sent abroad amid acute UK shortage of radiologists

The NHS is sending an increasing number of patient scans for analysis by radiologists on the other side of the world as the taxpayer-funded health service seeks to overcome staff shortages and clear record-long post-pandemic waiting lists for hospital care.

About 14 per cent of the reporting of scans — such as X-rays, CT and MRI — is being outsourced, including to experts in Australia and New Zealand, up from just 5 per cent six years ago. This rises to more than 80 per cent for out-of-hours services, according to data from LEK Consulting, which advises teleradiology providers.

Scans are vital in diagnosing and treating cancer, strokes, heart disease and many other devastating diseases but demand is outpacing capacity.

The Royal College of Radiologists (RCR) estimates there are 1,939 full-time consultant clinical radiologist posts unfilled across the UK, a shortfall of 33 per cent. It is warning that patients will pay the price unless the shortage of imaging and cancer doctors is addressed.

According to Cancer Research UK, the country entered the pandemic “at or near the bottom” of a league table of comparable countries in relation to one-year and five-year survival rates for multiple cancers, including those of the stomach, colon, rectum, pancreas and lung.

There is a global shortage of radiologists, but the situation in the UK is especially acute. It has nine radiologists per 100,000 people, compared with the EU average of 12. Greece tops the league table with 31 per 100,000.

Even before the pandemic, 10 per cent of people waited more than six weeks for an MRI but in December 2020, the figure stood at 21 per cent. Staff shortages have been identified as a key reason that 115,000 cancer patients in England are “diagnosed too late to give them the best chance of survival”, the RCR said.

According to the college, 91 per cent of trusts and health boards sent a proportion of their scan workload to teleradiology companies in 2020, spending £206m. The lobby group argues that outsourcing is expensive and that the government could save £190m a year, or £420m by 2030, over the next decade if it invested in its own training and overseas recruitment.

The “current system creates financial inefficiencies in the system and is only effective in the short-term”, it warned. Additional costs from outsourcing include fees paid to overseas recruitment agencies.

Dr William Ramsden, vice-president for clinical radiology at the RCR, said that although private-sector involvement was vital to managing immediate demand “more and more outsourcing to external suppliers is not the cure for insufficient radiologists on the ground”.

In-house hospital radiologists did far more than just read scans on computers, he said. They worked with other doctors to manage cases and run clinics, “as well as performing life-saving interventions using real-time scans”.

However, Eilert Hinrichs, partner at LEK Consulting, said teleradiology could help address the capacity shortfall and provide more specialised expertise because patients and radiologists no longer needed to be in the same location. “It provides speed and quality and could address the capacity shortage,” he said.

There are about 10 teleradiology providers in the UK including Everlight Radiology, Medica and 4ways Healthcare, most of whom use trained radiologists who work part-time for the NHS or have retired. They are sent the scans and provided with the technology to complete analysis from home.

Stuart Quin, chief executive of Medica, which employs about 300 staff, including UK qualified radiologists in Europe, New Zealand and Australia, said one advantage of working with doctors on the other side of the world was that they could quickly report, during daytime hours, digital scans from patients attending accident and emergency departments in the UK at night.

The government on Monday announced a £248m investment in technology to digitise the NHS and speed up the way tests, images and results are shared between hospitals, labs and GP surgeries over the next year.

Sajid Javid, health and social care secretary, said the money — part of a settlement agreed in last year’s spending review — “will help ensure our NHS has access to the latest digital technology to drive up efficiency”.