WAO Imaging Letter Report








Document Information:

Document Name:

NIPSB WAO Imaging Letter Report



Issue Date:




Document Owner:

Steve Moore, SRO, NIPSB

Document Authors:


Chris Kalinka, Programme Manager, NHS Wales Health Collaborative.


Document History:

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The purpose of this paper is to respond to a letter from Andrew Goodall, Director General of Health and Social Services/Chief Executive NHS Wales. The letter seeks assurance that the actions identified within the WAO report have been incorporated into NIPSB Statement of Intent Imaging Implementation Plan and are monitored on a regular basis and reported to NIPSB to enable risks to be identified and mitigating actions to be taken accordingly.




The Wales Audit Office published a report on Radiology Services in Wales on 8th November 2018, the report is based on radiology reviews undertaken in 2015-16. It must also be acknowledged that the Covid 19 pandemic has affected and changed imaging services radically, reducing imaging capacity.

The report highlighted that rising demand, difficulties with recruitment and retention of staff, outdated and insufficient scanning equipment, along with IT weaknesses are putting Radiology Services in Wales under pressure.

Despite these pressures, the report found that waiting time targets for radiology examinations were currently being met and radiology services were generally well managed.

NIPSB was founded in 2019 with a remit to oversee implementation of the Imaging Statement of intent and promote progress in imaging services in Wales. The boards overarching imaging implementation plan includes Imaging Statement of Intent and Welsh Audit Office Report Recommendations. The Board has a number of workstreams and groups reporting to the board, including workforce and quality. The board receives regular updates from its groups in board meetings where progress is documented and assured. NIPSB has recently switched partially to a Gold command approach to swiftly react to Covid issues in imaging capacity, a significant risk to future patient care.



The Report on Radiology Services in Wales 2018 highlighted four key recommendations from the Wales Audit Office.

Progress against recommendations:

Recommendation 1 - The national implementation plan addresses each of the actions set out in the Imaging Statement of Intent and the key challenges highlighted in this report.

Good progress has been made in developing a high level Imaging Implementation Plan to deliver the actions identified in the Imaging Statement of Intent.

Governance arrangements for the delivery of the Imaging Plan have been developed via a National Imaging Strategic Programme Board (NIPSB)

The following four sub-groups have been established to lead on the actions identified against the eight priority areas included in the Imaging Statement of Intent and the key challenges highlighted in the Wales Audit Office Report on Radiology Services in Wales:-

Workforce and Education

Quality, Safety & User Experience

Strategic Resource Planning

Informatics, Information & Business Intelligence  

Leads have been identified / recruited for Workforce and Education and Informatics, Information and Business Intelligence. Programme managers are in Place for Workforce and Education and more recently Breast Radiology. A Clinical Lead and Subject Matter Expert have been appointed for Informatics and Business Intelligence. Recruitment has been delayed in some areas by the effect of Covid, but is now progressing.

The Strategic Resource Planning sub group has established projects and clinical/ project leads for the following service areas and work is currently being undertaken to develop sustainable service models for the future:

Multiparametric MRI – to support NICE guidelines; Prostate Cancer: diagnosis and management.

Breast Radiology & MRI surveillance for very High Risk Women – to support the further development of a sustainable symptomatic and screening Breast Radiology Service for Wales and to provide an equitable MRI surveillance offer for women in Wales at very high risk of developing breast cancer  

 Paediatric Radiology – development of the service model for a 24/7 service for the South Wales area.

 PET-CT – development of a Strategic Outline Business case for PET-CT in Wales.

The sub group leads are currently working with a range of stakeholders to clarify and confirm the necessary actions required to deliver the agreed objectives. 

The Strategic Programme Unit (NHS Health Collaborative) is working closely with Health Education & Improvement Wales, Welsh Health Specialist Services Committee and NHS Wales Executive Directors of Planning and associated key stakeholders to support delivery of the plan.


Recommendation 2 - The national implementation plan should include clear implementation dates to deliver action in the short to medium term, with clearly identified accountabilities for delivery.

The formal leads, for each of the sub-groups are leading on the actions identified against the eight priority areas included in the Imaging Statement of Intent and the key challenges highlighted in the Wales Audit Office Report on Radiology Services in Wales.

A draft implementation plan has been produced by the Strategic Programme Unit and shared with Welsh Government and the programme SRO. The plan details delivery, resource allocation, accountable groups, milestones, deliverables, benefits and outcomes for NHS Wales. The plan is reviewed within NHS Collaborative where the above are scrutinised and edited. A coordinated medium term programme plan which covers imaging amongst all programmes is approaching finalisation within the NHS collaborative and contains milestones and deliverables over the next three years. A consultation meeting with NIPSB is on the agenda for the next NIPSB meeting where plans will be presented to the board.



Recommendation 3 – The Welsh Government should properly cost the implementation plan and ensure that the necessary resources are in place to support delivery.

The draft Imaging Implementation Plan identifies resources required to deliver the actions identified in Statement of Intent for Imaging.

A Draft Resource Management Strategy has been developed, that identified the additional resources required to support the programme of work. Further work will be undertaken to identify the costs of implementing each work area, such as Quality / Accreditation and workforce and equipment expansion.

Further work will be necessary to understand the investment that will be required to support the delivery of sustainable imaging service models into the future (e.g. Strategic Programme Business Cases and subsequent Outline Business Cases for expansion of services to address capacity gaps – especially in the areas of workforce and equipment)


Recommendation 4 – The Welsh Government should ensure the necessary arrangements are put in place to monitor delivery of the national implementation plan.

National Imaging Programme Strategy Board is accountable for monitoring the delivery of the Strategic Imaging Implementation Plan and this is supported by clear Terms of Reference.

Stakeholders including imaging and Health board representatives are supporting the delivery of the Strategic Imaging Implementation Plan, which will focus on advising, enabling and delivering key objectives.


Health Board Responses to WAO.

Health Board responses are currently being compiled for sharing in a summary document by NIPSB. Responses reviewed demonstrate a substantial reaction to address WAO imaging challenges and action plans. Some HB Returns of revised and updated responses have been slightly delayed against the background of Covid pressures. WAO recommendations are included in the overarching plan for NIPSB and provide appropriate direction for imaging implementation. NIPSB have compiled a spreadsheet document table of HB responses for Wales-wide ease of assessment. (Appendix 1).


NIPSB Progress and Work against Key WAO themes.

NIPSB Activity

The following are examples of recent work that NIPSB and its reporting groups are undertaking:


Imaging Workforce and Education Group (IWEG) has been established with a chair and representation from professional and educational groups. HEIW links to IWEG are established. IWEG has a remit for Development of an Imaging Workforce Plan and strategic partnership with HEIW. (Progress and direction has been heavily revised against the environment of “new normal” post-Covid imaging service). IWEG restarted in June 2020. Demand / capacity and workforce data collections have been initiated. Workforce planning scoping documents and workforce training  plans are underway with a cohort being submitted for manager training in 20-21.



Covid equipment implementation has been coordinated via Imaging Essential Services Group. A case for additional CT and MRI mobile capacity has been developed and submitted. Siting for mobile equipment has been assessed and data across Wales compiled.

Radiology Informatics System Procurement (RISP) Programme is actively developing a Business Case for delivery of a replacement Radiology Imaging and Management System across NHS Wales, which meets the needs of the Imaging service. Equipment is an area acknowledged to be under development and will address audit of requirements during 21-22.

WG have agreed to fund some additional CT and MRI equipment during 20-21, this is being managed via IESG membership pan-Wales.




The Radiology Informatics System Procurement (RISP) Programme has been established and is actively developing an Outline Business Case for the procurement of an end to end   Diagnostic Radiology System for NHS Wales, to enable service modernisation to meet the needs of the Imaging service.




Common examination codes have been established across imaging departments via Radis in Wales. Common Demand data has been compiled across Wales for MRI and CT gap assessment post-covid. Effects of Covid on demand and activity have been compiled for major modalities affected. Active discussion of demand and capacity requirements for the imaging programme has begun with the Delivery Unit to assess national dashboard feasability.

Management of Services  / Service Redesign

This Workstream has been substantially affected by the Covid Pandemic. Imaging has been identified as a high-risk service post Covid resulting in  a Position paper identifying subsequent problems to NIPSB (compiled by IESG). Imaging Essential Services Group has been established and has been meeting regularly. IESG has its governance link into NIPSB and Essential Services Group. Workforce and Equipment have been identified as significant capacity constraints. Capacity gaps have been reviewed for CT and MRI scanning.

The Prostate Cancer Diagnostics Pathway Subgroup reconvened in September 2020 to continue delivering the programme of work for a successful standards based implementation of updated NICE guidelines.



An accreditation pilot has been established in Betsi Cadwallader University Health Board with funded support. The pilot has demonstrated the need for a resource support to develop a quality structure within Imaging similar to that in pathology. A Quality forum promotes and coordiantes activity across Wales towards accreditation. Work has commenced on a process of peer review to support departments progress through Tier 1 to Tier 3 in readiness to apply for formal accreditation (Tier 4).

There is an agreed work plan for Quality, safety and patient experience. The forum also directs work in relation to radiation safety and regulatory compliance including the development of common procedures across Wales.




NIPSB has reacted quickly to the Covid pandemic and established the Imaging Essential Services Group.

The aim of the group is to work within the World Health Organisation Operational guidance for maintaining essential health services during an outbreak to oversee imaging work related to ensure the identification and delivery of essential services to minimise avoidable morality and significant morbidity from health conditions both during and in the wake of the  COVID response and to ensure equity across Wales.


The group will provide direction and work with Imaging in NHS Wales to oversee:

·         co-ordinate the Imaging response throughout the Covid-19 pandemic

·         the identification of ‘essential services’ that should be maintained (or, where stopped, reinstated)

·         the agreement, production, dissemination and implementation of specific guidance on imaging services for health boards and trusts

·         the assurance and monitoring of the delivery of imaging services

·         communications and engagement with stakeholders and health professionals in relation to the above.


The group may advise on (but not be responsible for) issues relating to cross boundary and regional planning and operational implementation related to the maintenance of essential services.

The group will have links to other clinical planning groups, which may be focused on the direct response to COVID-19. The group will be informed by specialist advice as required.

Covid 19 has significantly reduced imaging capacity in all HBs. Appointments for imaging are now longer due to infection control procedures and consequently, numbers of appointments per session are reduced.

Management capacity has also been affected for HB leads to allocate time to NIPSB programme activity although engagement and goodwill remains strong across Welsh Health Boards.




Substantial progress has been made against the key priority areas, including governance and accountability mechanisms that will provide assurance in relation to the delivery of the Imaging Implementation Plan including WAO recommendations.

A draft imaging implementation plan has been shared and is aligned with the priorities described by the Recommendations in the WAO Report on Radiology Services and the Statement of Intent for Imaging.

A robust governance framework for evaluating progress has been established via NIPSB. This includes decision-making, risk management and providing assurance to Welsh Government and NHS Wales.

The imaging implementation plan is being overseen by National Imaging Programme Strategy Board and its workstream groups and leads.