As the NHS celebrates 60 years of caring for the nation’s health and well-being, Richard Evans, the SoR’s chief executive, looks back on his time in the NHS and talks about how radiographers have contributed to the success of the service, as well as how their roles could develop over the next sixty years.

Q From your point of view as a radiographer, what have been the most significant developments in the NHS over the last 60 years?

A There are the obvious leaps in technology, which have little to do with the NHS itself but have transformed radiography. In fact, the NHS has on the whole been quite slow to take up technological advances.

One exception to that is CT scanning, probably the most significant development in the whole of medicine, not just radiography. CT was invented here and taken up pretty quickly in specialist centres. The rest of the world soon caught up though! As always, financial constraints prevent even the best developments becoming quickly widespread.

Change in the NHS so often seems to run in cycles. Generally progress is made but some themes come round again and again. For example, in the mid-1980s there was a Department of Health move to de-professionalise the non medical use of ultrasound.Their view was that sonographers didn’t really need specialist skills. This was successfully opposed by the Society and sonography became established as a specialised technique practised by professionals.

However we are still battling to get recognition for the professional title Sonographer and the DH once again seem to regard this as an unnecessary move. Just when you think you’ve got away from something it then comes back round again.

Of course, one of the biggest battles we have always had to fight has been over pay and conditions. In recent times this has been to do with the Agenda for Change agreement.

The previous system hadn’t really changed since inception – Whitley dates back to 1948 – so we were trying to squeeze rapidly changing practice into the old framework. A change was definitely needed and the AfC principle of “equal pay for jobs of equal value” isn’t a bad idea. However it has been very poorly implemented in many parts of the UK.

In radiography one of the most significant developments is the way we as a profession are viewed. Radiographers were once seen very much as subservient to radiologists and oncologists and development as a profession was limited.

However, it’s a fact that over the last 60 years radiography in the UK has responded to the opportunities presented and we are now leading the rest of the world in terms of professional development.

A vital component of this development in radiography was the achievement of degree status in the 1990s. Further education and development in radiography means there are now so many more opportunities open for radiographers in all clinical specialities, into management, education and including a growing number in research and of course now to consultant level.

The phenomenon of radiography role development in the UK is largely due to the context of the NHS, and whereas role development was led by pioneering individuals and the SoR rather than the health policy makers, the value in enhanced patient care and efficiency was quickly recognised and generated support.

Radiographers in many other countries are struggling to follow in the path of role development and to achieve a professional status equivalent to that which we enjoy in the UK.

We should celebrate the fact that the NHS has provided the ideal environment for this to occur.

Q How have radiographers contributed to the advances in healthcare provision and knowledge over the last 60 years?

A Radiographers make a significant contribution and it’s fair to say that many services would have crumbled if it hadn’t been for radiographers.

For example, the breast screening programme simply couldn’t have managed without radiographers and particularly without radiography role development.

More recently the same could be said for services to support the 18-week and other access targets.

It’s because radiographers are happy to support multi-disciplinary working and are expert at successfully delivering patient-centred care despite limitations of funding that there have been so many success stories.

One excellent success story has been sonography, which could have easily been lost to general diagnostic imaging, or – an even less satisfactory position – could have seen radiographers doing the image acquisition but not reporting – disastrous for the profession and unsafe for patients.

Diagnostic imaging has become a core part of the majority of all care pathways. This has placed radiographers even more at the heart of healthcare.

There has also been a renaissance in the world of radiotherapy. Image guided and intensity modulated radiation therapy, thomo therapy and gamma knife have all developed rapidly and radiotherapy is re-established as the key technique in cancer treatment.

This is despite many professionals not so long ago writing radiotherapy off in favour of chemotherapy. The convergence of imaging and radiotherapy is crucial in cancer care.

All this goes to show that radiographers make a huge contribution to ensuring that patients get a much better service from the NHS.

Q What are the highs and lows in the history of the NHS?

A Lows have generally been to do with poor leadership, both at national level when political agendas have been allowed to get in the way of patient-centred service provision.

But also there has been poor leadership at the local level when hospitals and local managers have allowed their own inability to manage finances and other priorities to affect staff conditions and care standards.

At times, problems have very clearly been to do with under-resourcing. However, as has been seen in recent years, even when additional finance is supplied to the NHS, too often there has been a lack of good management of resources and attention to developing more efficient, productive processes. The result in many areas has been that front line services remain under pressure and NHS employees feel under-valued.

The fact is that the politicians know that NHS staff will ultimately deliver great services for patients and this has too often resulted in a complacent attitude to how those staff are treated.

Where employees such as radiographers are actually mistreated, such as in the poor implementation of AfC, this amounts to exploitation of the professionalism of staff.

On the positive side, we have seen how the opposite effect, where good leadership, repeatedly brings excellent results.

We have seen right the way through the history of the NHS that those who have a vision for patient-centred care and who engage their whole teams, across professional boundaries to deliver that care not only succeed but also achieve a kind of super-additivity as their teams become settled, contented and motivated to make further improvements.

These are the contexts where redesign and workforce change have been successful initiatives. It is excellent leaders at a local level who made it work.

Q How have radiographers coped with modernisation?

A Better than any other profession! Radiographers are ahead of all other professions in terms of professional and service restructuring. This kicked off with the breast screening programme which showed there was a connection between pushing the profession forward and requiring assistant practitioners.

The four-tier model was a really revolutionary concept when it was introduced, leading the way for other professions and concepts such as the NHS career escalator.

That’s not to say that everyone has found this easy, but we’ve coped better than any other group.

Q What do you think the future holds for NHS radiographers? How will their role develop over the next 60 years?

A There is now a massive reliance on radiotherapy and diagnostic imaging in healthcare so we’re in a strong position.

In the immediate future, we can expect to see the move to provide care closer to patients altering the way that some imaging and therapy services are operated.

Exciting developments seem certain to continue to increase the importance of nuclear medicine as a central speciality in the future of diagnostic imaging.

Combining modalities as is now standard in PET/CT seems also likely to become more and more common and especially important to locate possibly minute centres of disease detected at a molecular level.

Radiographers should be able to become more involved in role-sharing with other allied health professionals and may develop their roles as specialists in particular care pathways or disease processes.

The obvious opportunities in cancer is for radiographers to take patients right through their journey, from diagnosis to rehabilitation and follow-up.

Even if new technology does come along that threatens to take out parts of the radiographer’s role, excellence of service to patients will always be of paramount importance. If we keep patient service at the forefront of radiographic care then we’ll do well.

It’s very difficult to see over the horizon. The future of radiography is obviously interwoven with technological development and innovation and nobody can tell what might emerge next.

We have very strong links with industry and we hope to have better fore-knowledge of what’s going on.

We need to maintain these links so that we can make sure we’re in a position to spot changes and continue to develop radiography at the heart of healthcare.

Q How you think Lord Darzi’s Review will impact the way radiographers work in the future?

A This will depend very much on the impact it makes on the NHS as a whole. We will have to wait and see what sticks. It has the potential to disappear into the sand if it’s not seen to deliver rapidly enough or make changes quickly enough.

One idea to come out of it is the further development of taking services to the patient. There seem to be few SHAs saying that diagnostic tests should be available on the high street, but most will agree that they could and should be more widely available. Patients might not necessarily want that type of service at their local supermarket, but that’s not to say they don’t want a centre they could drop into for certain services.

The ‘Polyclinic’ model is considered by some to be controversial. However, they offer clear opportunities for radiographer-led imaging services and for innovation in sharing roles with other professions.

In radiotherapy, satellite treatment centres are beginning to be mentioned. These seem to present us with the chance to show the unique abilities of therapy radiographers to lead integrated cancer care through the entire care pathway. We should be looking for radiographers to get out onto the front line and be the first point of contact for patients, but also to be involved in further referral, treatment, follow-up and ongoing care.

Q What are your fondest memories of working in the service?

A It’s a terrific and satisfying job to do as it has patient care and contact right at the front of it.

Although not all patients are cheerful and openly grateful, there is real satisfaction knowing that you can make a real difference to those individual people and also to the other healthcare professionals who rely on you to do a good job.

The moments where you realise this become fondest memories.

Q What do you loathe about the NHS?

A Loathe is a strong word. There are things I wish didn’t happen – and it’s mostly all down to politics with a capital ‘p’.
The NHS is used as a political football, but to change that would be to change the entire system.

You learn to live with that but it can cause chaos. In the past it has caused significant problems for patient care, some of which were quite dangerous.

One recent example has been the cutting back of cleaning budgets which led to the spread of infections. Some very short-sighted decisions have been made.

Politics with a small ‘p’ also get in the way. Interprofessional politics are very regrettable and can be a real problem. It’s partly because of this that the government became disillusioned with the professions in general.

Q And what do you love?

A I love everything it is and stands for! I love the fact that it’s there and it is internationally renowned. Many people from outside the UK have told me that they wish they had the same system.

We’re very fortunate that the NHS provides the context for designing new opportunities for professions such as radiography.We should always be looking at ways to develop into new areas, and embracing advancement.

Tell us what you think about the radiography profession and the NHS! Plus, we'd love to hear about what you got up to during celebration week. Email the website editorial team with your stories and pics.

Download the Department of Health's book Sixty Years of the National Health Service: A proud past and a healthy future.

Posted: 04/07/2008