Traditionally the United Kingdom, with its nationalized health service, has relied on its network of public and private hospitals to provide medical imaging facilities. More recently, private organizations have provided both static and mobile facilities for scanning procedures, some of these in partnership with the local health authorities.
These privately operated imaging facilities have tended to concentrate on the high-end procedures such as CT, MRI, and PET, as well as some interventional examinations, with very few, if any, offering conventional plain-film examinations. The large private hospital chains, such as BUPA, Nuffield, General Healthcare (BMI), and Capio (formerly Community Hospitals) have run their facilities along similar lines.
"The market conditions for developing privately owned and managed imaging centers have never been better," said Paul Hobson, head of diagnostics for Capio Healthcare U.K.
"Clinicians, patients, and entrepreneurial businesses have welcomed this shift in attitude, allowing a different approach to service provision in the U.K.," he said. "It seems to me that the more radical the idea, (compared to the existing model of U.K. healthcare delivery), the more interesting it is to the Department of Health. They are looking for solutions."
Iain Main, regional director of BMI Healthcare, agreed. However, he warned that reimbursement is an issue.
"Who pays the bills? The imaging service works well within the private hospital; fees are wrapped up with our general pricing negotiations. Imaging equipment is expensive -- to buy or lease and maintain -- so what equipment would a private imaging center contain? What return would an investor expect?"
Public service, private ventures
For many years individual or small groups of radiologists have run private consulting rooms, where some have purchased their own x-ray and ultrasound equipment, to provide a lucrative service to wealthy private patients. Several examples of these facilities still exist in London’s Harley Street medical district.
It is easy to forget that a modern imaging department does not require a large building with thick walls and small windows. It is now more important to provide a comfortable environment for patients and clinical personnel, and enough parking for patients and staff. The facility must attract consulting physicians. It can be located out of town or in a shopping center.
However, the situation -- and many of the parameters -- have changed, with funding now readily available for the right proposal in the right area. According to Stuart Murray, managing director of Close Asset Finance, part of the Close Brothers Merchant Banking Group, "We are very keen to become involved in the financing of medical equipment for these private medical outpatient diagnostic centers."
There has also been interest expressed by some overseas groups in developing imaging facilities, usually targeting a specific gap that they see in the current provision of centers in the U.K.
Government support
In a recent meeting with members of parliament (MP) in the House of Commons, it was noticeable that even the more left-wing MPs seemed to realize that involvement from the private sector was the only way to reduce waiting lists, and that there has to be an improvement in efficiency in the National Health Service (NHS).
At this meeting, Lord Philip Hunt, Parliamentary under-secretary of state for health, spoke about the need to use current information technology to provide better and speedier service to patients. Hunt said that the formation of strategic health authorities, with the mission to improve patient care and the ability to make their own decisions on how and where to spend their allocations, must be the way forward.
The NHS is planning to spend an extra £5 billion ($7.7 billion U.S.) to improve its IT systems over the next six years, in order to set up electronic patient records and electronic subscribing. The patient should expect his or her medical records to be available to any clinician having the authority to view them. Hunt added that the private sector is being asked to provide a high level of commitment to this venture, and certainly any innovative approaches that appear to deal with the problems of the NHS would be considered.
Technologies are now available to acquire an image digitally, archive it, view and report on it, and then distribute it to whoever needs to view it throughout the healthcare enterprise. Software is available to remove the majority of paper from the system and store the information from these documents with the patient’s images.
Medical image management systems, such as PACS and RIS, can provide the capabilities -- and operate on even the poorest networks -- to distribute images and reports from consultant radiologists to primary care centers in the community. Even though there is a worrisome lack of radiologists in the U.K., I believe that all clinicians will eventually have to come on board, and get involved in a more modern approach to delivering healthcare to the community.
In theory, digital technology could make many radiologists redundant, at least at a local level, as images can be sent anywhere in the world to be reported. However, with the advent of the new consultant climate and radiologists’ change in status from being independent contractors, they seem to be more flexible in their approach to new ideas.
Private-initiative trepidation
So why have private medical imaging centers just not happened in the U.K.? After all, the concept works well elsewhere in the world, and with the shift in funding and therefore control of where the patient gets sent for the examination, there does not appear to be a logical reason why dedicated centers should not be implemented in the U.K.
Is it because the Department of Health would rather not think about the patient? What about the patient who waits three months for a CT of the chest, when a private-sector imaging facility could carry out a CT or DR chest examination (probably even at a lower cost to the British taxpayer), while the patient waits?
One possible explanation is that with the current bad press concerning the cost of the government’s Private Finance Initiatives (also known as PPPs -- private/public partnerships), perhaps private-sector organizations fear that the current government will renege on its commitment to supply £5 billion ($7.7 billion U.S.) in extra funding to the NHS over the next five years.
Despite this understandable worry, the British government seems eager to pursue anything that offers a feasible and cost-effective solution. (Click here to view the U.K. Department of Health’s white paper, Growing Capacity: A new role for external healthcare providers in England).
The Department of Health is already seriously considering setting up its own diagnostic and treatment centers, which will contain imaging facilities. The intention is for these to be financed and run by the private sector.
"I think that independent imaging centers in the U.K. are inevitable and probably desirable," said Dr. Simon Blease, a radiologist and director of Med-Tel U.K., a private MRI scanning firm in Harley Street, London. "The capital costs of imaging are huge and have a major impact on NHS resource provision. The U.K. government would probably leap at the chance to transfer the risk to the independent sector, so long as patient care is not compromised."
Blease added that "it is only those examinations with reasonable reimbursement rates and high demand, such as MR and PET, that allow a decent business plan to work."
"Reimbursement for plain film is so low that profits are marginal after operating costs are met," he added. "The NCSA (National Computer Security Association) and the HQS (Health Quality Service) accreditation schemes are probably as good as any other measure to ensure that appropriate standards are put in place for independent medical resources. However, there is still the problem of radiology manpower shortage, and someone is going to have to plow through the work, whether it is on a viewbox in an NHS Trust or on a monitor in a private office."
By Peter StaffAuntMinnie.com contributing writer
August 15, 2002
Peter Staff is managing director of Xograph Imaging Systems, a privately owned medical imaging company in the U.K. He has more than 30 years experience in the radiology industry. Staff is also a member of the U.K. Parliament’s Associate Parliamentary Health Forum, and sits on the British Institute of Radiology’s Industry Committee.
Related Reading
Radiology service not keeping up with routine demand in U.K., August 8, 2002
U.K.'s imaging demands exceed capacity of personnel, September 12, 2001
U.K. radiologists grapple with privacy act, August 13, 2001
Europe still lags in communication technology, May 24, 2001
Copyright © 2002 AuntMinnie.com
