Title: The determinants of the utilisation of the support and assistant workforce in diagnostic imaging: a multi-methods investigation
Funder: Department of Health and Social Care

Abstract: Research question: What models of deployment of the Support and Assistant (S&A) workforce exist within diagnostic imaging departments and what service, hospital, regional and national factors may encourage or inhibit implementation of these models? Background: For many diagnostic imaging services, demand for imaging massively outstrips workforce capacity to deliver the imaging. The Covid-19 pandemic has exacerbated already stretched services, which are now 'in crisis'. Recent high profile national reports have highlighted the urgent need to develop the capacity and capability of the S&A workforce, yet many imaging services have not embraced, or under-utilise, this workforce. While national priorities (such as apprenticeships) to support S&A roles are welcomed, the provision of educational opportunities alone will not drive forwards the vital transformational change that is required to address this workforce crisis. Aims: To investigate the development, deployment, and contribution of the S&A workforce to diagnostic imaging activity across England to determine effective models of practice that will support future workforce transformation and re-design. Objectives: i. Explore where and how the S&A workforce is deployed within imaging services in England; ii. Explore contextual factors including organisational culture which serve to facilitate or inhibit the contribution of the S&A workforce to imaging services; iii. Understand how investment in the imaging workforce has enabled role expansion and advanced practice within the imaging departments; iv. Identify the potential for collaboration across Imaging Networks to disseminate and implement effective S&A workforce strategies across regions; v. Synthesise the findings from i) to iv) to generate an evidence-based framework for effective implementation and expansion of the S&A workforce; vi. Identify additional research questions emerging from the investigations. Methods: This study provides a detailed analysis of the contribution of the S&A workforce to diagnostic imaging, and is delivered by a research team combining imaging expertise alongside healthcare methodologists. The study employs a Mixed Methods Explanatory research design, whereby a qualitative work package explains and enriches the understanding of earlier quantitative data workstreams (WS). There are six consecutive work packages: WS1) Preparatory stage; WS2) Census of imaging workforce; WS3) Survey of imaging networks; WS4) Deep dive review of selected Trusts; WS5) Case studies of selected Trusts; WS6) Mixed Methods Synthesis. A five-stage structured triangulation protocol will collate and triangulate the data from each phase, resulting in the creation of a Determinant Framework for the effective deployment of the imaging S&A workforce. Timelines for Delivery: 27 months. Impact and Dissemination: The study will deliver eight academic outputs throughout the project, culminating in the final Determinant Framework for dissemination to imaging workforce leaders. An infographics-based 'highlights' report will be disseminated to the wider healthcare community, and to patients, service users and the public. The research team will work throughout the project with key stakeholders (e.g. professional bodies; arms-length organisations such as Health Education England; system-level organisations including imaging networks and Integrated Care Systems) to ensure that dissemination is effective and impact maximised.

Lay abstract: The use of medical imaging for diagnosing disease has increased dramatically in recent years. The more complex, costly and time-consuming investigations such as Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) have seen the greatest increase in demand. This increase means patients are having to wait longer for their imaging appointment and for the results. The Covid-19 pandemic has made the situation worse because many non-urgent imaging services (including cancer screening programmes) were suspended for several months. In February 2021, 12 times as many patients in England were waiting over 6 weeks for a CT, MRI or ultrasound scan than in February 2020. Having to wait for an investigation increases people’s anxiety. In some cases it can also have more serious consequences, because the disease may have worsened during that time and the treatments used to combat the disease may be less effective. The pandemic (and people exiting the NHS for other reasons) has led to significant staff shortages, reducing the number of scans that can be carried out. Efforts are being made to train, employ and keep more staff in the imaging services. However, this is not sufficient to deal with the backlog of scans, and the increased workload in future. We need to urgently review how the different types of imaging staff work together, and in some cases provide training to allow some staff to take on other job roles, allowing the service to work more efficiently. This "skills mix" will mean that the abilities and knowledge of all staff members are used to their fullest extent, and the most effective and efficient service can be delivered to patients. We have noticed a big variation in how different hospitals use support workers and assistants in their imaging departments. Some employ very few support workers, while others have used them in many interesting ways. Our project will investigate where and how support workers are used across all imaging services in England. This will highlight those organisations with effective skill mix approaches where support workers are enabling radiographers to take on advanced roles. We will then explore what has helped and what has prevented imaging departments employing these workers. We will share this learning with all the imaging services to support them to adopt a more efficient way of working which will improve services to patients. Our project will use a 'mixed methods' approach which will review existing NHS imaging workforce figures alongside new information collected through a census and a survey of selected hospitals and regional networks. We will explore the findings further through a 'case study' of selected Imaging Departments, involving interviews and focus groups with key staff. The data will be combined to produce a model of practice to guide the future deployment of the support and assistant imaging workforce.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE