NHS trusts are not getting the most out of their MRI scanners

MRI scanners should be used seven days a week for at least 10 hours a day. Photograph: Mark Kostich/Getty Images

Extending the range of hospital services provided at weekends is becoming an increasingly important health policy. Having identified this as a priority, NHS England medical director Bruce Keogh has set up a forum focusing on creating a seven-days-a-week NHS, with its findings due to be published later this year. This review comes after a welter of professional advice, and studies in recent years have identified that patients admitted to hospital at weekends have significantly worse outcomes than those admitted during the week.

In 2011, a Royal College of Surgeons study into emergency surgical patients and the Dr Foster Hospital Guide both highlighted how the closure of services at weekends was a significant factor in patient outcomes. A lack of routine diagnostic services was specifically highlighted as having an adverse effect, creating a bottleneck for getting patients to effective treatment.

Currently in some trusts, scanning services are still run as a weekday limited-hours service, and the implication of this is that capacity is not keeping pace with demand. Alliance Medical's research and analysis of available data across the NHS shows that more than a quarter of NHS trusts (37 of 135) have a very low utilisation rate of below 5,000 MRI scans per machine per year. By contrast, across the 20 NHS static imaging centres run by Alliance Medical, 14 operate seven days a week for at least 10 hours a day. On sites with high throughput, these are staffed at two radiographers per scanning hour to maximise patient throughput. The services are integrated with being able to offer clinical reporting services, which can provide access to clinicians in the UK and other time zones for urgent reports.

With volumes of MRI scans increasing by around 10% a year, there is a strong financial case for extending hours and improving productivity through the most efficient utilisation of scanning services.

There is nothing revolutionary in achieving this and trusts should look at extending hours in scanning as an "easy win" towards the achievement of a seven-days-a-week NHS.

Flexible staff contracts that routinely consider scanning as a seven-day service are fundamental, and this is an area where the Agenda for Change may have inadvertently created disincentives for some trusts. The rates of unsociable hours salary premiums, as well as the difficulty of dovetailing with consultant and junior doctor job planning, can mean a sharp escalation in staff costs. But, with demand for scans rising, ensuring full utilisation of the established units has to be a more efficient option than simply setting up new scanning centres, each running below capacity.

This is an area where independent healthcare providers such as Alliance Medical have a distinct advantage because their staff contracts assume a routine operation across a seven-day rota with standardised working hours.

Absolutely key to the productivity of radiographers is the team of administrative staff that supports them. A good support team manages the back-office tasks, freeing radiographers to deliver frontline patient care, and works to maximise utilisation by proactively filling appointment slots.

Good performance data and support systems also play an important role in the management of diagnostic lists and are currently lacking in many areas. Through its partnering arrangements with the NHS, Alliance Medical measures patient throughput and has introduced key performance indicators, including hours of uptime and patients scanned per hour. These are measured and reported daily right up to board level. By sharing knowledge in this way, workflows can be standardised, minimising duplication of effort and data entry to ensure a consistently high level of patient care and throughput. Systematically reviewing capacity versus demand enables staffing to be balanced to mirror the hospital's wider needs. 

Another important factor is negotiating hard on maintenance and service contracts. Alliance Medical negotiates for routine maintenance work to be undertaken out-of-hours (which, under seven-day working, means overnight) and as a result they have MRI scanners operating at 99.42% of opening hours.

Improving access to scanning services makes sense both financially and in terms of meeting the expectations that will be placed on providers over the coming year. It entails a relatively simple set of processes and should be one of the first areas looked at by acute trusts.

David Loasby a former NHS acute trust chief executive and UK business development director for Alliance Medical Limited.

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