The Royal College of Radiologists’ (RCR) latest annual ‘Clinical Radiology: Workforce Census’ report warns that NHS patients are at risk of harm owing to dangerous shortages of clinical radiologists. Radiologists play a vital role in the diagnosis, management and treatment of major conditions, such as cancer, spinal injury and stroke, but RCR warns that the shortage of radiologists is causing increasingly severe delays for patients waiting for diagnosis and treatment, with many hospital clinical directors saying that they do not have enough radiologists to provide safe and effective patient care. The Clinical Radiology: Workforce Census 2024 report’s detailed snapshot of the specialty, as at September 2024, is based on its 100% completion rate from all of the UK’s 159 radiology departments. RCR says this means they can speak decisively and make their case for urgent change ‘based on incredibly strong data’. The Royal College of Radiologists (RCR) urges the UK’s governments to recognise the central importance of radiology to patients and the wider NHS, pointing out that delays in diagnosis mean that the whole system works more slowly. Patients wait longer to learn about their condition and begin their treatment and suffer poorer outcomes. In contrast, fast and accurate diagnosis leads to better patient care and better outcomes which work for the good of the patients and society. RCR calls for UK governments and NHS leaders to engage with the census report and act on its recommendations for a renewed commitment to the recruitment, retention and training of these important specialists. What are radiologists? “Many policymakers do not know what a radiologist is and does. This is unfortunate, because we are central to the NHS’s ability to diagnose and treat patients safely and in good time.” [Dr Robin Proctor Medical Director, Professional Practice, Clinical Radiology.] Clinical radiologists are specialist doctors who use medical imaging (e.g. CT and MRI scans) to diagnose and monitor benign (non-cancerous) and malignant (cancerous) diseases and injuries, and perform minimally invasive procedures. They are experts who lead imaging services, interpret scans and write reports that make diagnostic findings to guide other clinicians’ decision making. The Royal College of Radiologists (RCR) describes radiologists as ‘conducting the orchestra’, linking all the specialties together, communicating with them, interpreting increasingly complex data and putting the findings into the context of a real patient. RCR says that radiologists are ‘the backbone of the NHS, responsible for the majority of diagnoses made and for driving forward innovations in the modern management of patients’. They point out that more than 47 million diagnostic imaging examinations were carried out in 2023/24 and that diagnostic activity forms an important part of more than 85% of all patient pathways. Interventional radiologists (IR) are a radiology subspecialty which conduct a wide range of image-guided procedures, often in emergency settings, for adults and children. IR procedures are minimally invasive, enabling patients to recover more quickly, often without the need for a hospital admission. Commonly used IR procedures include biopsies or treatments for patients with active bleeding, sepsis, aneurysms, fibroids, curative and adjuvant treatments for cancer, or the treatment of acute stroke by mechanical thrombectomy (removal of a blood clot from an artery) to reduce lifelong disability. Many IRs specialise in vascular IR (focussing on treatment within the blood vessels), non-vascular IR (interventions such as biopsies, drain placements), interventional neuroradiology (INR) working with the central nervous system and spine, or paediatric IRs who specialise in treating children. How many radiologists are working in the NHS? Key statistics from the Royal College of Radiologists’ (RCR) 2024 workforce census reveal that, in September 2024: There were 4,699 consultant clinical radiologists in the UK, compared with 4,509 in 2023. 42% of diagnostic clinical radiology consultants are women. The UK has 10.1 radiologists per 100,000 population, but this is not evenly distributed across regions. The radiology workforce grew by 4.7% in 2024 but the demand for CT and MRI imaging grew by 8%, leaving a 29% shortfall which will rise to 39% by 2029 if no action is taken. The UK needs 1,953 more clinical radiology consultants to provide patients with required levels of care. The census found that radiology services rely on recruiting staff trained outside the UK. 38% of clinical radiology (CR) consultants, 88% of specialty and specialist (SAS) radiology doctors and 86% of locum radiology consultants gained their primary medical qualification (PMQ) outside the UK. RCR emphasise that foreign consultants who join the NHS bring invaluable skills and experience, but overseas recruitment is not a sustainable solution to NHS staff shortages given the higher attrition rates for clinicians who trained overseas, the global shortage of radiologists, and ethical concerns about recruiting staff from countries with their own medical workforce shortages. The clinical radiology workforce census revealed a 9% vacancy rate for CR consultant posts, with 67% of NHS trusts having had one or more radiology vacancies (consultant/SAS) unfilled for over a year. Radiology posts are highly sought-after by resident doctors, and the vacancies reflect lack of financing rather than lack of demand. In fact, despite the shortage and demand, 19% of radiology departments reported recruitment freezes, which RCR criticised as undermining NHS efforts to reduce delays for patients. RCR noted that even if all the vacant posts on offer were filled, this would provide significantly fewer than the 1,953 radiologists needed to run an adequate radiology service for the UK. More than a quarter (26%) of NHS trusts (and health boards) do not have an adequate IR service. Some don’t have a 24/7, 365 day service. Others lack a sufficient on-call rota or agreed pathways for transferring patients when the IR service is not available. And 17% of NHS trusts have no IR service at all. How does the shortage of radiologists affect patients’ care? RCR warns that the number of CT and MRI examinations grew by 8% in 2024 and the demand for medical imaging, and for the radiologists to interpret the images, continues to rise. A third (33%) of CT and MRI scans were unscheduled and came from emergency settings, with a 13% rise in referrals from emergency departments for CT and MRI scans since 2023. Demand for IR procedures also rose, particularly for procedures involving computerised axial tomography (such as for mechanical thrombectomy to treat stroke). RCR says that there is now a greater reliance on emergency imaging, interpreted by radiologists, than ever before but there has not been appropriate planning for the necessary increase in capacity. In addition, England’s four-hour reporting target for all CT and MRI scans from A&E departments has also exacerbated the pressure on radiology departments, with delays commonly featuring in medical negligence claims. Radiologists are struggling to keep on top of diagnostic waiting lists because demand for their expertise is growing more rapidly than the workforce. RCR warns that unless this situation is turned around, patients will continue to suffer long, uncertain waits for diagnosis, which will ultimately affect their health outcomes. Nearly two thirds (63%) of clinical directors said they do not have sufficient consultant clinical radiologists to deliver safe and effective levels of patient care. 100% of clinical directors were concerned about worsening backlogs and delays. RCR pointed out that these concerns are reflected in NHS England’s diagnostic waiting times. In most cases involving diagnosis and treatment of a serious disease, the patient must have a scan, which must be interpreted. NHSE’s target says no more than 1% of patients should wait for over six weeks to receive a scan, however, in 2024, 16% of patients waited longer. Another target requires that all scans must be reported within 28 days, but 3.4% (more than 434,000) of CT and MRI scans were not reported within four weeks, leaving patients waiting more than a month for their diagnosis. In relation to interventional radiology (IR), 56% of clinical directors told RCR that they do not have sufficient interventional radiologists (IR) to deliver safe and effective patient care. Barriers to safe IR care included IR staff shortages(78%), other staff shortages, such as nurses (85%), lack of access to inpatient and day-case beds for patients awaiting IR procedures (78%), insufficient access to the physical space or equipment needed to do their work (65%). RCR point out that the need for more radiologists will not be fixed by the government’s plan to double the number of CT and MRI scanners in the NHS. Half of all clinical directors said their facility could not accommodate an additional, fully-funded CT or MRI scanner owing to a lack of sufficient radiographers to operate the scanner (83%) or to report on the images it would generate (72%), and a lack of space to house an additional scanner (53%). For the first time, not a single radiology department in the UK could meet its reporting requirements within staff contracted hours. All radiology departments were leaving imaging examinations unreported or relying on unpaid overtime to meet reporting requirements. In 2024, trusts and health boards spent a total of £325 million (equivalent to the cost of 2,910 CR consultant salaries) on alternatives. This included outsourced radiology reporting, which often takes place without the external radiologist having access to patients’ previous imaging and medical records or the ability to talk to the patient’s clinician, risking harm caused by missing information. In 2024, just 6% of radiology clinical directors felt they had sufficient time for clinical leadership. RCR points out that clinical leadership is essential for the training of resident doctors, creating a positive culture and teamwork, setting expected standards of care, taking responsibility for safety and operational performance, answering colleagues’ queries, improving patient pathways and being a source of advice or guidance for junior staff. The Royal College of Radiologists calls for urgent action to increase the radiology workforce, increase retention, remove obstacles to training, and deliver innovations that can enhance radiologists’ capacity to deliver care. Without action, radiologists are unable to carry out their vital role in the timely diagnosis and treatment of patients, leaving them at risk of greater harm. If you or a family member have suffered severe injury as a result of medical negligence or have been contacted by HSSIB/MNSI or NHS Resolution you can talk to a solicitor, free and confidentially, for advice about how to respond or make a claim by contacting us.
