Proposal for Replacement Magnetic Resonance Imaging (MRI) Scanner Nº 1

1. Outline of proposed development

1.1Access to MRI forms a key part of achieving the 18 week referral to treatment [RTT] pathway. Without an increase in high quality MRIcapacity there is a significant risk that this target will not be met. Immediate replacement of the old MRI is now essential if the Trust is to achieve a 2 week wait to support the December 2008 target. MRI is also likely to play an increasing role in sustaining the delivery of the 4 hour Emergency Care Standard and maintaining throughput in ambulatory care, stroke services and other key care pathways.

2. Rational for the proposed development

2.1The old MRI scanner has considerably exceeded its expected life having been commissioned more than 12 years ago. National guidance on replacement is at 7 years.

2.2The old machine has very limited capability and is slow. This scanner is currently staffed for only 3 days a week and it performs 150 scans per month. We do not have suitable basic work to fill the scanner for longer periods and the existing work may soon cease due to deteriorating quality of scans. Replacement parts are increasingly hard to source for an obsolete machine. Breakdowns are also more frequent further threatening ongoing service provision.

2.3The average waiting times for all MRI investigations are < 4 weeks and the plan is to step down to a maximum wait of 2 weeks by October 08. The “new” 2 year old scanner was funded only for extended days but we are now working weekends at waiting list initiative rates to attempt to meet the demand both for additional capacity and for the complex cases not suitable for visiting vans. This is both a cost pressure and is unsustainable in the long term for the existing staff.

2.4The RUH is also supported by 7 mobile MRI van visits per month on top of the government fast track mobile provision. The cost of each 12 hour mobile day is £2,650 excluding VAT. An additional 7 vans per month will be required to do the existing work of the old scanner should the quality deteriorate further or suffer irreparable breakdown.

2.5Business Intelligence Unit data indicates that we need to carry out an additional 3,264 scans per annum to sustain a two week wait for MRI in 2008/09.

Table 1.

Radiology – Additional activity required to sustain two week wait
Modality / Annual / Monthly / Weekly
MRI / 3264 / 272 / 63

Please see Appendix 1 for further details.

2.6We have the capability to do breast MRI but not the capacity. This work is currently funded by the PCT to be undertaken at the Bath Clinic. The PCT pays approximately twice the current RUH cost per case for this service.

2.7We have the capability to do cardiac MRI but not the capacity. This work is currently funded by the Medical Division [50-60 cases per annum] and is undertaken at the BromptonHospital in London.

2.8We are unable to accept any research funded income generating work due to shortage of capacity.

2.9Any downtime on the new scanner severely limits our ability to provide a service for in-patients and represents a serious risk of single point failure

3. Benefits of change

  • Support all specialities in continuing to achieve and exceed the 18 week RTT targets ensuring maximisation of income into the Trust
  • Support in delivering the 4 hour Emergency Care Standard and the development of ambulatory care pathways through improved daily availability of MRI services
  • Enable MRI to support Surgical Division new elective pathway the one-stop service
  • Reduce the risk from a single point of failure should the new scanner fail or is taken out of action on service days
  • Repatriation of work with associated income
  • Potential ability to attract new work and associated income
  • Mobile van costs savings of 222K per annum, 435K per annum if we are no longer able to use the old MRI
  • Improved quality and reduced risk of misdiagnosis
  • Greater flexibility - a static scanner allows IP’s, ill patients and patients with mobility issues to be imaged which is not possible using mobile units
  • Better patient comfort and acceptability than current mobile units.
  • Better ability to respond to demand variability and to maintain waiting times
  • Modern MRI scanners are faster and can increase efficiency and patient throughput by 20% (extra 4 patients / day.)
  • Current anticipated demand to maintain 2 week wait would require 3 full and 2 extended days per week leaving some allowance for additional demand if required
  1. Consequences of do nothing option
  • Failure to deliver 2 week diagnostic target and significant potential impact upon 18 week RTT pathways.
  • Unnecessary admissions
  • Long emergency waits and adverse impact on delivery of 4 hour Emergency Care Standard
  • Unacceptable delays to cancer treatment and adverse impact on delivery of cancer targets
  • Increased bed blocking within the Trust
  • Risk of single point failure
  • Lost income to the Trust
  • Reconfiguration of specialities within the Trust if limited imaging available.
  • Increasing cost of continued use of relatively poor quality mobile MRI
  • Increased risk of litigation - a delayed cancer diagnosis may mean it becomes inoperable
  1. LEASE V PURCHASE COST IMPLICATIONS - see Appendix 2

5.1Purchase Cost

Description / Gross Cost / No. of sessions / WTE / Recurrent / Non Recurrent
Radiologist / 6 / 0.6 / £58,849
Radiographer band 6 / 10 / 1 / £41,249
RDA band 2 / 10 / 1 / £17,511
MRI Scanner / £815,995
Maintenance
Capital Charges
Interfacing / £70,665
£196,459 / £2,000
Building / RF cage / £270,000
Injector pump / £28,835
Removal expenses / £8,000
Travel & Training / £1,000
Total Cost / £385,773 / £1,124,830

5.2Lease Cost

Description / Gross Cost / No. of sessions / WTE / Recurrent / Non Recurrent
Radiologist / 6 / 0.6 / £58,849
Radiographer band 6 / 10 / 1 / £41,249
RDA band 2 / 10 / 1 / £17,511
MRI Scanner Lease / £121,707
Maintenance
Capital Charges
Interfacing / £70,665
£46,729 / £2,000
Building / RF cage / £270,000
Injector pump Lease / £2,350
Removal expenses / £8,000
Travel & Training / £1,000
Total Cost / £360,060 / £280,000

Based on the figures overleaf the lease option over 7 years is the most cost-effective option for the Trust

Leasing an MRI scanner is a also a good service option as it ensures that the scanner is replaced at the end of its recommended 7 year life expectancy with minimal disruption or displacement to any other Trust capital commitments at the time.

This development will enhance the MRI service to all service users.

6. Are there other options available?

6.1 Option 1 - Purchase of Additional Mobile Visits

This will not solve our existing capacity problem for complex cases which is likely to increase.

The supply side of capacity is variable depending on van availability and this may have a major impact on waiting times as waiting times shorten. Smoother availability of capacity will smooth variability in waiting times and improve our ability to deal with peaks and troughs in demand.

Quality of scanning on vans is very variable due to higher turnover of staff and may be poor. Companies are variably willing to make recompense for poor scanning and may arrange a subsequent van visit but that will take some weeks and will impact on waiting times, potential outcomes and the patient experience.

Cost per case is approximately 60% more than at the RUH.

6.2 Option 2 – Purchase of spare MRI capacity from the Bath Clinic/Shepton Treatment Centre

Insufficient capacity available and limited to basic imaging requests. Cost per scan is even more expensive than a mobile service.

Shepton Mallett Treatment Centre has capacity but this still does not resolve the issue of complex cases. Data transfer and availability also pose significant issues. Both of these options would still leave us at risk of a single point failure.

  1. Source of funding

Funding Available
Description / Total
Direct access income / £151,000
Breast MRI @ BC / month x8 @£400
Relocation of Cardiac MRI 55x £950 / £38,400
£52,250
Divisional Funding pro-rata from SLAM activity increase 06/07 – 07/08 / £118,410
Total Income / £360,060

8Are there any income generation opportunities?

  • BIP
  • Research project income

9Any further supporting information.

Current data from the Business Intelligence unit demonstrates that having reduced wait times for MRI the number of referrals have started to increase from October 2007 onwards as shown in the attached graph. The expectation is that referrals will continue to increase, this trend has been seen in other local hospitals as waiting times have reduced.

Note: December and February were shorter working months.

10Conclusion

10.1A replacement of the MRI scanner No.7 is required to support appropriate and timely MRI capacity for both elective and emergency services.

10.2An Equality Impact Assessment is currently being undertaken and will be made available on request.

11Recommendation

11.1The Trust Board are asked to approve the proposal to replace MRI Scanner No. 7

Author: Craig Forster, Assistant Divisional Manager Date: April 2008

Content approved by John Travers, Divisional Manager Version: 1

Page 1 of 8

Trust Board

14th May 2008