Approved Business Cases for Consultant Radiologist from 2019 to 2023

Summary

The requester sought details of approved business cases for Consultant Radiologists between 2019 and 2022, and the authority provided a partial response containing a business case document dated February 2020 regarding a Breast Radiologist role.

Key Facts

• The response includes a business case document from the Department of Health & Social Care dated February 2020.
• The proposal aims to address a 71% increase in ultrasound interventional workload over five years.
• The role is intended to support compliance with NICE guidelines and Cancer Network targets.
• The business case highlights the need for a Director of Breast Screening following a 2017 incident.
• The outcome was classified as 'Some information sent but not all held'.

Data Disclosed

• 71%
• 2019
• 2022
• 2020
• 2017
• Feb 2020
• 2 WW
• B3 lesions

Original Request

Details and dates of any approved business cases for either a Consultant Breast Radiologist or a Consultant General Radiology with an interest in Breast Radiology between the dates 1/1/2019 and 31/12/22 please.

Data Tables (3)

Full Response Text

Department of Health & Social Care Rheynn Slaynyt as Kiarail y Theay

Consultant Breast Radiologist or Specialist Interest Radiologist

Author:

Sponsor:

Version 1

Version Control Issue Date Author Reason 1 Feb 2020

Distribution List

Name Department / Division

Department of Health & Social Care
Rheynn Slaynyt as Kiarail y Theay

Page: 2

Contents 1. Executive Summary ..................... Error! Bookmark not defined. 2. Strategic Case ............................. Error! Bookmark not defined. 3. Economic Case ............................ Error! Bookmark not defined. 4. Financial Case ............................. Error! Bookmark not defined. 5. Funding Source ........................... Error! Bookmark not defined. 6. Approvals ..................................... Error! Bookmark not defined.

Department of Health & Social Care
Rheynn Slaynyt as Kiarail y Theay

Page: 3 1. Strategic Case

This initiative fundamentally supports the Programme for Government’s National Outcome of ‘We live longer, healthier lives’. The DHSC Strategy outlines the need for increased support for screening programs so that patients are prevented from entering the acute setting, and Radiology has a key role to play in supporting this. At a Department level the request underpins two of the strategic pillars within the Health and Social Care Strategy, namely:

• To improve services for people who really do need care in hospital
• To ensure that people receive good value health and social care services

The recommended proposal would not only benefit patients, but will also enable the department to comply with NICE guidelines and Cancer Network targets for appropriate and efficient clinical care.

Given the Island’s isolated locality it is necessary for our Hospital to offer services which a similar sized hospital in the UK would not provide due to their relative vicinity to specialist centres. Being the only Hospital on the Island, and considering the economic burden of transferring patients to Tertiary centres, the Radiology department on the Island needs to offer more services than would be expected, and thus the activity of the Specialists is influenced by the diversification of roles needed within the service.

Workload
The breast service demand has increased steadily over the last 5 years. The radiologist’s ultrasound interventional workload has increased by approximately 71% over the last 5 years. These examinations are typically used to diagnose cancers.
In addition to the ultrasound workload the radiographic modality interventional workload has increased.

0 20 40 60 80 100 120 140 160 Core Biopsy breast Core biopsy axilla FNA biopsy breast FNA axilla Localisation Skin marking Marker Insertion Drainage Aspiration Vac Ass Biopsy Ultrasound Radiologist Interventions 2018 2016 2014 Department of Health & Social Care
Rheynn Slaynyt as Kiarail y Theay

Page: 4

This being the case the single handed radiologist has increased sessions in the breast unit to cover the clinics required. This has left a deficit within the general radiology department, causing increased workload pressure on the remaining radiologists.

In addition the symptomatic breast service demand continues to rise and extra clinics are required on an ad hoc basis to maintain the 2 WW cancer pathway Trend figures predict that at least one extra clinic is required each month to accommodate the demand.

Also, in line with screening guidelines for the vacuum excision of B3 lesions (and with scope for the excision of benign lesions), further radiologist sessions are required. Vacuum excision by the radiologist negates the need for the patient to go to theatre.

Governance Following the breast incident in 2017 the below recommendations were proposed to senior management. The proposed radiologist role will encompass the Director of Breast screening within the job plan. Recommendations

Additional support for the program by the UK Screening centre, currently the Nightingale, Manchester;- 1. The Nightingale Centre to potentially join MDM’s via teleconference for the input into screening cases.

1. Implement a review of all routine recall cases at assessment in line with recent UK guidelines.

0 20 40 60 80 100 Vac Ass Biopsy Stereo Core Biopsy Tomo Guided Biopsy Stereo localisation Stereo marker insertion Radiographic Radiologist Interventions 2018 2016 2014 Department of Health & Social Care
Rheynn Slaynyt as Kiarail y Theay

Page: 5 3. Improved networks and support with local radiologist attendance at NW Regional (UK) Quality Assurance Radiology meetings.

1. Regular local Radiologist attendance at UK screening centre to maintain links and networks, in keeping with best practice for single handed practitioners.

2. Cover for local Radiologist leave by staff from the Nightingale or equivalent, rather than unknown locums.

3. Consider the appointment of a Breast Screening Programme Director to monitor the performance of the IOM BSP and bench mark that performance with the North-west region as part of regional QA radiology meetings, with a regular independent objective review of service performance.

4. To demonstrate that the IOM Breast Screening Service is operating in line with best practice the unit should be supported in engaging in regular Quality Assurance visits (at least 3 yearly) in line with the UK NHS BSP guidelines. Efforts should be made link the Isle of Man Breast Screening Programme QA with Nightingale Centre scheduled QA visit October 2018, so that this process can be undertaken in a cost effective and timely manner.

5. Economic Case Option 1.Do nothing None of the recommendations would be implemented following the breast incident. We would continue to utilise high cost locums to cover the existing single handed radiologist.
   The department would not be able to expand to meet the current demand and follow the new guidelines on lesion retraction.

Option 2. Recruit an additional Consultant Breast Radiologist.

This would enable the breast work to be covered and provide cover for leave periods without the need for costly locum cover. In addition capacity would be increased to meet demand and develop the service to meet current service guidelines.

Recommended option Option 2
To recruit a consultant breast radiologist.

1. Financial Case

Option 1. Do nothing Continue to spend on high cost locum cover for the single handed current post holders leave periods. The nature of the role and the lack of breast radiologists nationally deems that the cover attracts a premium rate consistently above the island capped rate scheme. Last year’s locum cover for cost £ 89,108.00 approximately. Department of Health & Social Care
Rheynn Slaynyt as Kiarail y Theay

Page: 6

Option 2. Recruit to a breast radiologist

The proposed job would be a 10 PA contract. The cost would be £ 165,555.00 inclusive of contributory on costs per annum.

1. Funding Source Cost avoidance by utilising the Agency and bank funding of £89,108.00, leaving a deficit of £76, 449.00 to be funded by another source.

2. Approvals Position Name Signature Date

Senior Responsible Officer

Designated Finance Officer

Accounting Officer

Manx Care Noble’s Hospital, Strang Braddan, Isle of Man IM4 4R (01624) 650 000

Our ref: 4545402 7 May 2025

Dear

We write further to your request, received 28 March 2025, which states:

"Details and dates of any approved business cases for either a Consultant Breast Radiologist or a Consultant General Radiology with an interest in Breast Radiology between the dates 1/1/2019 and 31/12/22 please."

Response
While our aim is to provide information whenever possible, in this instance the public authority does not hold or cannot, after taking reasonable steps to do so, find some of the information that you have requested. The Business case available was established in 2020.

I have enclosed copies of the information that is held.

Please quote the reference number 4545402 in any future communications.

Your right to request a review

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I will now close your request as of this date.

Yours sincerely