NHS England
NHS / Health Body
Noted
NHS England acknowledges the concerns raised and explains the national context of radiologist shortages and the role of the GIRFT program and National Imaging Strategy. They highlight ongoing work to share learnings from PFD reports nationally. (AI summary)
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Dear Coroner,
Re: Regulation 28 Report to Prevent Future Deaths – Iona Grace Buckingham who died on 4 December 2022.
Thank you for your Report to Prevent Future Deaths (hereafter “Report”) dated 12 January 2024 concerning the death of Iona Grace Buckingham on 4 December 2022. In advance of responding to the specific concerns raised in your Report, I would like to express my deep condolences to Iona’s parents and family. NHS England are keen to assure the family and the coroner that the concerns raised about Iona’s care have been listened to and reflected upon.
Your Report raises the concern that over access to paediatric radiologists outside of 9am to 5pm on Mondays and Fridays and that this may be due to available funding.
The Getting It Right First Time (GIRFT) Radiology programme provided input into this response. GIRFT is a national programme designed to improve the treatment and care of patients through in-depth reviews of services, benchmarking and presenting a data- driven evidence base to support change.
The GIRFT radiology National Report was published in November 2020 and contains twenty recommendations for NHS radiology services. While these aren’t specific to paediatric radiology facilities, the imaging of children and young adults was reviewed during the programme of visits to all NHS organisations providing radiology services in England. There is a national shortage of radiologists of all specialisms. Sir Mike Richards’ independent report “Diagnostics recovery and renewal” published in October 2020 identified a need for 2000 additional consultant radiologists. Workforce data is collected by the Royal College of Radiologists (RCR) and published in an annual census report. The most recent report demonstrates a 29% shortfall in consultant radiologists across the UK. Regional analysis suggests that this shortfall is up to 35% in the East Midlands. This is not due to a lack of interested applicants but to a historic shortage of funded training places. NHS England are supporting Trusts to increase reporting capacity by increasing the number of reporting radiographers and radiologist trainees per financial year, via international recruitment initiatives and workforce National Medical Director NHS England Wellington House 133-155 Waterloo Road London SE1 8UG
4 March 2024
demand and capacity planning tools. NHS England are supporting Trusts to increase reporting capacity by increasing the number of reporting radiographers and radiologist trainees per financial year, via international recruitment initiatives and workforce demand and capacity planning tools. In June 2023, NHS England also published the NHS Long Term Workforce Plan, in response to the current lack of sufficient workforce. The plan sets out how we will train, retain and reform healthcare staff across the NHS over the next fifteen years, and is underpinned by the biggest recruitment drive in NHS history. Against this backdrop, 24/7 provision of specialist paediatric radiology services is currently only available in specialist children’s hospitals and other tertiary centres. It is rare for a district hospital to have more than one or two radiologists with an interest in paediatric imaging and comprehensive cover is therefore not currently possible. With reference to thoracic ultrasound in children for the purpose of identifying a pleural fluid collection such as empyema, this is a technique performed not only by specialist paediatric radiologists but also by some general radiologists, some advanced practice sonographers and by some paediatric intensivists with appropriate training. NHS England would not expect hospitals to have a formal rota for the provision of this service, but to be able to seek help from a tertiary centre on the occasions on which an ultrasound was needed and not available locally in a timely fashion. NHS England’s National Imaging Strategy, published in November 2019, set out a proposal to create collaborative imaging networks across England which is now in the process of being implemented. One of the stated purposes of imaging networks is to improve equity of access to specialist services which would include paediatric radiology. Collaboration between paediatric radiologists in different hospitals already exists, for example in the provision of reporting services for imaging studies conducted in cases of Suspected Physical Abuse. The GIRFT programme will be visiting all 22 imaging networks during the course of 2024 and the provision of paediatric imaging and reporting services will be on the list of topics to be reviewed. I would also like to provide further assurances on national NHS England work taking place around the Reports to Prevent Future Deaths. All reports received are discussed by the Regulation 28 Working Group, comprising Regional Medical Directors, and other clinical and quality colleagues from across the regions. This ensures that key learnings and insights around preventable deaths are shared across the NHS at both a national and regional level and helps us pay close attention to any emerging trends that may require further review and action.
Thank you for bringing these important patient safety issues to my attention and please do not hesitate to contact me should you need any further information.
Re: Regulation 28 Report to Prevent Future Deaths – Iona Grace Buckingham who died on 4 December 2022.
Thank you for your Report to Prevent Future Deaths (hereafter “Report”) dated 12 January 2024 concerning the death of Iona Grace Buckingham on 4 December 2022. In advance of responding to the specific concerns raised in your Report, I would like to express my deep condolences to Iona’s parents and family. NHS England are keen to assure the family and the coroner that the concerns raised about Iona’s care have been listened to and reflected upon.
Your Report raises the concern that over access to paediatric radiologists outside of 9am to 5pm on Mondays and Fridays and that this may be due to available funding.
The Getting It Right First Time (GIRFT) Radiology programme provided input into this response. GIRFT is a national programme designed to improve the treatment and care of patients through in-depth reviews of services, benchmarking and presenting a data- driven evidence base to support change.
The GIRFT radiology National Report was published in November 2020 and contains twenty recommendations for NHS radiology services. While these aren’t specific to paediatric radiology facilities, the imaging of children and young adults was reviewed during the programme of visits to all NHS organisations providing radiology services in England. There is a national shortage of radiologists of all specialisms. Sir Mike Richards’ independent report “Diagnostics recovery and renewal” published in October 2020 identified a need for 2000 additional consultant radiologists. Workforce data is collected by the Royal College of Radiologists (RCR) and published in an annual census report. The most recent report demonstrates a 29% shortfall in consultant radiologists across the UK. Regional analysis suggests that this shortfall is up to 35% in the East Midlands. This is not due to a lack of interested applicants but to a historic shortage of funded training places. NHS England are supporting Trusts to increase reporting capacity by increasing the number of reporting radiographers and radiologist trainees per financial year, via international recruitment initiatives and workforce National Medical Director NHS England Wellington House 133-155 Waterloo Road London SE1 8UG
4 March 2024
demand and capacity planning tools. NHS England are supporting Trusts to increase reporting capacity by increasing the number of reporting radiographers and radiologist trainees per financial year, via international recruitment initiatives and workforce demand and capacity planning tools. In June 2023, NHS England also published the NHS Long Term Workforce Plan, in response to the current lack of sufficient workforce. The plan sets out how we will train, retain and reform healthcare staff across the NHS over the next fifteen years, and is underpinned by the biggest recruitment drive in NHS history. Against this backdrop, 24/7 provision of specialist paediatric radiology services is currently only available in specialist children’s hospitals and other tertiary centres. It is rare for a district hospital to have more than one or two radiologists with an interest in paediatric imaging and comprehensive cover is therefore not currently possible. With reference to thoracic ultrasound in children for the purpose of identifying a pleural fluid collection such as empyema, this is a technique performed not only by specialist paediatric radiologists but also by some general radiologists, some advanced practice sonographers and by some paediatric intensivists with appropriate training. NHS England would not expect hospitals to have a formal rota for the provision of this service, but to be able to seek help from a tertiary centre on the occasions on which an ultrasound was needed and not available locally in a timely fashion. NHS England’s National Imaging Strategy, published in November 2019, set out a proposal to create collaborative imaging networks across England which is now in the process of being implemented. One of the stated purposes of imaging networks is to improve equity of access to specialist services which would include paediatric radiology. Collaboration between paediatric radiologists in different hospitals already exists, for example in the provision of reporting services for imaging studies conducted in cases of Suspected Physical Abuse. The GIRFT programme will be visiting all 22 imaging networks during the course of 2024 and the provision of paediatric imaging and reporting services will be on the list of topics to be reviewed. I would also like to provide further assurances on national NHS England work taking place around the Reports to Prevent Future Deaths. All reports received are discussed by the Regulation 28 Working Group, comprising Regional Medical Directors, and other clinical and quality colleagues from across the regions. This ensures that key learnings and insights around preventable deaths are shared across the NHS at both a national and regional level and helps us pay close attention to any emerging trends that may require further review and action.
Thank you for bringing these important patient safety issues to my attention and please do not hesitate to contact me should you need any further information.