South West Imaging Services Ltd

Introduction

The origins of SWIS Ltd lie in the frustrations of working in a system that has lost site of its main purpose - to deliver first quality patient centric healthcare.

The NHS has become an employment agency where the vested interests of individual employee groups take precedence over patient care. There is no joint line of responsibility between nursing, medicine and management so there is never a co-ordinated approach to care delivery. Politicians want the NHS to work - votes depend on it, so are prepared to spend large amounts of money to secure those votes. Unfortunately they are wedded irrevocably to the concept of free access to all healthcare, a concept that has never worked and will never. The money they spend services a bureaucracy put in place to deliver targets defined by political rhetoric that bear little relation to patient needs.

The private sector, on the other hand is wedded to a low volume, high cost model of healthcare delivery where baseline costs of healthcare delivery are not known and have never been known. Prices charged are what, historically they have got away with! The end result is that private healthcare is accessible only to a minority of the population (10 - 15%). Investment in private healthcare only occurs in high revenue models.

The solution is to "render unto Caesar that which is Caesar's". The NHS must be responsible for first quality emergency care, cancer care, ITU based specialist care and long term care. These aspects of healthcare should all be free at the point of access for all and paid for out of taxation. A new clinician led independent sector should be responsible for elective care where a customer centric, value for money, first quality service is delivered through separate, dedicated healthcare facilities, where there is no competition for resources between elective and emergency patients and where a 'focussed factory' approach to heathcare delivery can be developed to maximise efficiency and value for money. Ultimately this is paid for by people (the long suffering Middle classes) with disposable income but is money well spent if diagnosis and treatment is timely, patient centric and good value. It is a system that gets people better before chronic illness sets in, unlike current elective healthcare where delays create illness instead of curing it!

The SWIS approach

SWIS Ltd is an ethical company that is clinically led. Its aim is to delivery a first quality integrated diagnostic and treatment service that is patient (customer) centric. It is not a charity. By defining the costs of healthcare delivery very precisely, the company is able to define a price for its services that allow for sustainable growth in the company at the same time as offering its customers best value for money - elective healthcare that is chargeable to a credit card not paid for by remorgaging the house! Emphasis is on delivering an integrated service, bringing together all the elements required to complete a cycle of care for a patient in a way that keeps the patient at the centre of that cycle.

Swis Past

The company started by tackling inefficiencies in the diagnostic service. By leasing 'down time' on a static MRI scanner, we were able to demonstrate the need for an integrated service. After the pilot study came to an end in Bath, we were able to lease time on the MRI scanner at Frenchay Hospital in Bristol and increase our scanning volumes by bringing a mobile scanner to Bath Racecourse

The service was set up initially for self pay patients who wanted to avoid delay for investigation but who could not afford the premium rates charged by the private sector. However the standards set by SWIS also met the rigorous audit standards set by the private medical insurers leading to the compnay receiving accreditation as an MRI provider by BUPA and then the other medical insurance companies.

SWIS Present

We curently scan at two sites, Frenchay hospital, (Mondays) and BathRacecourse (Thursdays). 90% of patients are scanned within two weeks of referral. All scans are reported by specialist NHS radiologists within 24 hours of the scan being done or immediately if required.

"One stop" scanning and specialist assessment is offered to patients with neurosurgical problems, spinal disease, neurological problems, musculoskeletal problems and sports injuries

Integration of radiology reporting into the clinical service has been facilitated by the adoption of a web based radiology information system and scan viewing system

Both the process of service delivery and the service itself is fully audited with double reporting of scans and discrepancy meetings between radiologists and clinicians.

The company now offers a standalone radiology reporting service and we have just completed the first PCT based reporting contract.

SWIS Future

It may be a trueism to the business world, but as a clinician it is something I have learned from first hand experience. A business has a dynamic of its own. To survive, a business lke SWIS Ltd has to scale. There is therefore a natural pressure to expand the diangnostic service, taking on more sites and involving more clinicians in the SWIS ethos.

In September therefore we expand our scanning service in Bristol with a collaboration with The Nuffield hospitals to scan at the Chesterfield Hospital. We also will be scanning in Surrey in Esher at Sandown Racecourse. We have further plans to expand elsewhere in the country.

Acquiring the infrastructure for remote radiology reporting has two advantages. Firstly it gives a radiology clinician base that can be nationwide, allowing us to fulfil our aim of delivering customer centric diagnostics using local NHS clinicians. Secondly we have the infrastructure to deliver a radiology reporting service separate from the scanning service. As far as we know we are the only reporting  business involved in wave 2 reporting contracts that has the potential to use UK trained radiologists. If current wave 2 reporting contracts are to be delivered as planned then for the next five years a significant volume of GP generated imaging will be reported offshore. We intend to reverse this trend if we can.

Timely diagnosis however important, does not close the loop for patients, so in addition to diagnosis we have to deliver therapy where necessary. Tariff rates for elective surgery have defined the price of elective care for the future. Bt applying the SWIS principles of customer centricity, cost defininition and specialist care delivery in a focussed factory setting we intend to deliver elective care at or near tariff rates. Plans to do this are most advanced in neurosurgery. Development of therapeutic services will be a major direction of development this year.