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Bonus Episode: Donna Hughes and Carol Scott - Equipment Managed Services in the UK · Rad Chat

• Jo McNamara Rad Chat Host (00:00) Hello everyone and welcome to Rad Chat, founded by me, Jo McNamara. Naman Julka-Anderson (00:04) And me, Naman Julka-Anderson. Rad Chat is a forward-thinking global knowledge hub where healthcare professionals can advance their expertise in therapeutic radiography and oncology. Unlike traditional academic resources, we blend real-world experience, expert insights, best practice, and patient perspectives. Jo McNamara Rad Chat Host (00:21) We make advanced knowledge engaging and accessible, supporting continuous learning and professional development without compromising patient care or your personal time by providing insights into both technical skills and career development, helping you to progress confidently in your field and shape your professional future. Naman Julka-Anderson (00:38) Just to let you know, our episodes may contain sensitive and difficult topics that you might find distressing or triggering. Please consider checking out another episode. Jo McNamara (00:47) Donna shall we start with you? Would you like to introduce yourself please and tell us a little bit about yourself Donna (00:50) you Jo McNamara (00:51) and where you're currently working, your career pathway to date? Donna (00:55) Sure, my name is Donna Hughes. I work for Oxford University Hospital's NHS Foundation Trust and I am the lead radiographer here at our new radiotherapy satellite centre in Milton Keynes. Carol (01:06) I'm Carol I'm the radiotherapy services manager and lead therapeutic radiographer for Oxford University Hospital Trust and I manage the service across our three sites, so that's at the Cancer Centre at the Churchill Hospital in Oxford, our Swindon satellite which is on the Great Western Hospital grounds and also this new Milton Keynes satellite. Jo McNamara (01:33) Donna, do you want to tell us a little bit about your career pathway? Donna (01:37) Goodness, so I came straight out of school and studied radiotherapy at university over here in England and then I went home for 12 years to Ireland and worked in Dublin and Cork and then decided I needed to come back over here and I spent a few years working as agency and I ended up working agency in Oxford and actually they were doing just really great things in Oxford. They were rolling out SABR there was a great culture there and a great group of people and I felt that that's where I kind of wanted to put down some roots. So I started working there as a team leader and then I ended up doing a maternity cover for the neuro-oncology SRS service there, which I really enjoyed and I think that gave me a real passion for like specific roles. And I spent some time doing that and then I decided to go and get a little bit of experience outside of the NHS and I helped be part of a team that set up an MR-Linac service in the private sector. So I've done that for about two years, dipped my toe into the medical device industry, but it wasn't really for me. I kind of missed the patients too much, so I came back to Carol and asked for a job at the OUH. And soon after that, the job came up here in Milton Keynes and I applied for it. And here I am. So that's been my career so far. Jo McNamara (02:54) Amazing. Lots of different kind of aspects of your career to talk about, so that's Donna (02:58) Yeah. Jo McNamara (02:59) exciting. Carol, what about you? What's your career pathway been like? Carol (03:03) So similarly, I left school to train as a therapeutic radiographer. So I trained in London at the Royal Free and then really enjoyed living in London. I came from the North West originally, so I stayed in London and spent almost 20 years working in different departments in London. So my first job was at the Cromwell. So that was quite a baptism of fire. In the days before quality management systems, and we had 20 plus consultants all doing things differently. So there was a lot to remember, but it was a great way to learn about different approaches to delivering the same sort of treatment. Cause obviously when you train, you're trained in one way of doing things. It was a real eye opener, but it was, it was really good experience, worked at the Royal Marsden for a long time and also at at UCH. So at UCH I went there because they were extending the department and bringing in a new vendor and I've got experience with that new vendor so that was my first sort of real opportunity to be involved in a build and bringing in a new technology to the service. So that was a really good experience. When I left UCH, I was acting service manager. And I went to work for the Department of Health in the radiation division for four years. One of my roles there was as an Irma inspector. And that was across all disciplines using radiation in medicine they transferred us out to Oxford as part of a rationalisation of the number of civil servants, if you like. So I moved to the health protection agency and that sort of, that was a good opportunity for me to, you it was a good time in my life to move out of Oxford. And then I felt I wanted to go back into clinical work. So I then moved to Cheltenham as the radiotherapy service manager and was fortunate enough to arrive there when they were extending the building. So my previous experience really helped. Whilst I was there, we built the satellite in Hereford and opened that in 2014. And then I thought, well, you know, I've replaced everything here once, what next? So the job came up in Oxford, which I applied for because at least one satellite was definitely happening. So yeah, I moved to Oxford about nine years ago and it's been quite busy because we've built two satellites, replaced all our equipment on the main site as well, really grown the department, grown the team and we have a comprehensive service. We're delivering SRS and lots and lots of SABR. We've got some very innovative consultants who are driving forward practice in the UK. that's great, particularly around pancreas saver. A lot of the work to get that commissioned by the NHS was done by one of our consultants. So it's been really great to be involved in all of those projects. So I'm not sure how many. more opportunities I'll get to build from the ground up in the NHS. Jo McNamara (06:41) You Carol (06:44) It's been a real privilege to be able to do that and to do it three times now as well. Jo McNamara (06:49) Carol, I bet in the managers meetings they're like, right, we're going to do a new build. Carol, we need your expertise and help. Carol (06:59) Sometimes people come and ask, definitely. I think the other thing that I've been able to do as well is I've sat on the radiotherapy clinical reference group at NHS England for quite a long time. So that's been really helpful in sort of understanding. I had some idea of how policy decisions were made having spent time at the Department of Health years ago. But it's been really helpful to know how things are changing in the NHS as well, and particularly with the new commissioning landscape, it's been good to be in there and hearing it first hand, and hopefully disseminating that to my manager colleagues as well, so that we're all sort of aware of what's going on, what's changing. Naman Julka-Anderson (07:43) And I suppose moving us nicely on from there, Carol, how does the managed service model work within your centre and how different is it compared to what you've had before? Carol (07:52) Yes, so one of the attractions of going to Oxford was that there was already a managed service contract in place and the one in Oxford covers both radiotherapy and radiology, so it's a big contract. But those services on the Churchill site, radiology in the rest of the Trust, which has three other sites, is not part of that managed equipment service. I think initially... I had no experience of a managed equipment service and I looked at the contract and I thought well this is going to be straightforward, you know we have a replacement program. So it's all timetabled in, we get upgrades for our hardware, our software, which is great. It keeps us at the forefront technologically. What I hadn't appreciated was that some of the nuances in the contract, which then made it really difficult actually to get what we needed in terms of the equipment in the first replacement cycle. And also to bring in our... treatment planning system which for some reason had been excluded in the initial contract. So although we could upgrade machines, we didn't necessarily then have the planning capability to use the functionality on those machines. So there was a long, long negotiation that took about three years. Towards the end of that period actually, Medipas, who have now with another company called Ergea actually took over that contract and we were inching forwards to resolution before they took over they completely understood what our challenges were in terms of, you we needed equipment that would allow us to fulfil all the contracts that we held with NHS England and we were really struggling to get that message across. The work started before we'd actually all signed off finalised plans, which was just incredible really. I don't know that that happens very often at all. But the momentum then just was kept up through the whole thing. We've got one last piece of equipment to replace and that's our brachytherapy machine and we're very close to starting that work now but everything else has been replaced. completely understood what we needed, why we needed not to have a simulator anymore, why we needed two CT scanners, why we needed the direct organ software, why we needed HyperArc for our SRS work, all of those things. They just completely got it. We didn't have to explain. Jo McNamara (10:42) I've certainly heard from managers and radiographers that this isn't something that is a one-off, there quite often is kind of replacement schemes and someone has forgotten about a specific piece of equipment or a specific piece of software and I've absolutely heard of £20,000 worth of kit just sitting in a box because someone hasn't necessarily ordered the right amount of software for the licensing for the computers and they can't use it and then they say well you have to go back through the business planning model to get that approved and it's already taken three years to get the bit of kit it's just the bureaucracy involved in it is I just had no appreciation for how it kind of interfered with service redevelopment and service redesign. Is that something that you kind of are then supportive of having a Ergea to help manage that? Carol (11:40) We approached equipment replacement in, you know, through the standard route in the NHS. And it's subject to, you know, you're just one service within a bigger organisation and priorities change throughout the year. And if you haven't fallen over, then you may not be the priority. Jo McNamara (12:09) In terms of kind of the clinical impact, what have you seen? know, have you been able to see the changes by having that kind of service available to you? Donna (12:20) Yeah, absolutely. I think with the opening of our satellite centre here in Milton Keynes and obviously our satellite in Swindon as well, we're able to provide really accessible, high quality radiotherapy to the patients in the area. And we're really closely linked with the Milton Keynes Cancer Centre next door. So we're actually situated on the Milton Keynes University Hospital site and we're actually positioned on the hospital site right next to their cancer centre and we're linked by a short little link corridor. So, you know, the patients are able to access their local cancer care and then just come across into the Oxford Radiotherapy Service for their treatment as well. And that's a really seamless journey for the patients. And really, they don't even realise that they're moving between the care of two trusts. It's all just very smooth for them. And I think that's of great benefit to them really. Their CNS's teams are on site there in Milton Keynes they can get their concurrent chemo in the cancer centre as well. And I think accessible cancer or accessible radiotherapy means probably different, slightly different things to different patients when you think about it. So, you know, we have patients here who are maybe elderly and the journey to go to Oxford previously before the satellite opened would have been quite onerous on them. They might have had to rely on family to bring them. So now they can access that the radiotherapy treatments usually within 15 or 20 minutes of where they live. You know, we've got families with young children, they need to do school runs and maybe keep working as well because, you know, the cost of living at the minute is there's a huge financial impact of undergoing cancer treatment. Probably for me, the most rewarding part of opening our cancer centre has been the impact on those palliative patients, especially the emergency patients that are maybe on the ward here at Milton Keynes. And previously, they would have had to go to Oxford for their treatment. So there would have been pressure on the ward here in Milton Keynes to organise transport to get them down to Oxford as soon as possible. And they would often spend the day then in Oxford having their CT scan, you know, having their treatment and then hoping that the transport is going to pick them up and get them back to Milton Keynes that evening. And there's huge pressures on the hospital transport system at the minute. So there's often patients waiting around for quite a long time and staff as well. Now, we get a referral for an emergency patient next door in the ward. They literally come down in the lift across our little link corridor and into our pre-treatment suite. They have their CT and they can go back up and spend that precious time with their family and friends up on the ward and then come back down two or three hours later, have their treatment and back up to the ward. It's really seamless. And I think that's something that's me really great joy in this role is just seeing the impact that we have on all the patients groups, but particularly those that's really close to my heart. Naman Julka-Anderson (15:15) I suppose as well for the staff it's nice. I think we always struggle when you know a patient's coming from a couple of hours away, they're going to be stuck in the department all day, there's no space for them and now yeah that's really nice for the workflow. What's retention been like with staff and I suppose attracting new talent to come? Donna (15:32) Well, I suppose maybe when I took on this role and maybe even Carol before I came on board as well is that you don't really know until you open a centre what your recruitment is going to be like. But we've had no problems at all recruiting here to Milton Keynes. I'm really pleased to say Milton Keynes is a really unusual city. It's purpose built. It's one of the fastest growing cities in the UK and it has so much to offer staff in terms of like sports and restaurants. The shopping is on another level, just to mention that. But in terms of the service that we're providing here, it's a new building, it's beautifully designed, it's open and airy. A lot of people want to come and have a look at the department before maybe they apply for a position. And we started out with a really nice blend. We had some staff that transferred from Oxford, so we had a really... great kind of base to work from when we were getting the service go live, but we also had quite a few members of staff join us from other trusts and everybody brings in, you know, new kind of ideas and new thoughts about how we can approach things and together that really made like a really solid group of staff starting out when the service went live, which was really great. Jo McNamara (16:58) Are there any specific targets or benchmarks that you're actually tracking from the new centre in terms of maybe thinking about national cancer strategies? Carol? Carol (17:11) Well, obviously we're looking at our waiting times continuously. The other thing we're looking at is sort of, because we've been open for 14, 15 months now, just looking at uptake as well. So I think there was a published quite a few years ago in the BJR about the impact of satellites and the increased uptake for radiotherapy. I think now we've got a full year's data since we've been offering all of our whole pathway in Milton Keynes. We weren't initially able to open the CT for reasons we can happily explain once we now that we've had a year's worth of the full service we can have a look and analyse what what the difference has been in uptake of ready therapy I know certainly when I looked back at the data after we'd had the Hereford satellite open for a year we actually saw the normal sort of workload growth in terms of numbers referrals to a consultant oncologist but a 16 % increase in the numbers of patients accepting radiotherapy as part of their treatment pathway. I don't expect it to be quite the same here because Hereford's a very rural area, Milton Keynes is not. But you do have that effect of accessibility making it... It's really important to patients and it influences their decision. Particularly, you know, if you're offered robotic surgery for your prostate cancer and told you'll be in hospital for a week, or you're offered four weeks of radiotherapy or seven weeks of radiotherapy, then you know, you may be self-employed, you may have, you're going to have other commitments as well which means that you're potentially, you're factoring all of those things in, and I think that makes a big difference. Especially if you can come for your treatment at eight o'clock in the morning and still go to work, it makes a big difference, definitely. And that's one of the beauties about the way we've set the service up here. There is that opportunity for patients to be treated really early in the morning so that they can still carry on with normal life. Donna (19:38) I suppose one of the standout things that we've noticed is that there is so much or so fewer patients relying on patient transport at the minute now. So we would have had a lot of patients from Milton Keynes requiring hospital transport to get to Oxford for the radiotherapy. But now, like for instance this week, I think we've had one patient on one day come in in hospital transport because everybody lives so locally and you're not asking a family member or friend to drive you an 80 mile round trip to Oxford. It's like, can you drop me two miles down the road and pick me up maybe an hour or two later? you know, it's great for the patients. It's also great for ourselves. You know, we're not here late in the evenings waiting for transport patients to be collected. And also, you know, what is that positive financial impact on the NHS overall is that we're reducing reliance on patient transport systems. Jo McNamara (20:30) And I suppose environmentally as well, because it's something that actually is overlooked quite a lot within the NHS. I think the statistic is something that like five percent of traffic on roads is NHS driven. you know, having a positive impact in that way must be beneficial, especially for anyone who's ever driven around Oxford and also Milton Keynes. How many roundabouts has Milton Keynes got? I used to live near Milton Donna (20:53) 53. Jo McNamara (20:55) Keynes. I love the fact that you know that. Naman Julka-Anderson (20:57) I love that you know that as well. Donna (20:58) I that's what I checked a while back. Naman Julka-Anderson (21:03) You know when they do the job blurbs do you have it in there? Like, we have 53 roundabouts. Donna (21:07) Yeah, you might get dizzy, but it'll be fine. Actually, the roundabouts are great for keeping the traffic moving, I have to say. But I think the service has had a great environmental, positive environmental impact. think Carol and I were looking at the stats a few days ago about how many miles were saved by the satellite centre opening. We reckon well over half a million miles have been saved in patient journeys in the first 15 months. And given that we're a very small satellite centre, I think that's really impressive. And with the cost of living as well at the minute, know, if you were having to fill your car up, you know, however many times to get to Oxford, that's got a huge financial burden on patients as well. Naman Julka-Anderson (21:49) I suppose with the sustainability side, do you think there's an impact on the staff as well? Maybe if there's more satellite centres, for example like you, for people coming. Donna (21:58) Yeah, that's one thing we've definitely seen now. think your satellite centers are often situated in probably smaller towns and cities where, you know, the cost of living is maybe slightly more affordable. So housing and housing, house prices and rental prices are definitely lower here in Milton Keynes and maybe Oxford and in London. But also like Milton Keynes is really strategically placed, so it's actually really commutable from London as well. So know, people still living at home can actually commute out to us as well. And the building itself is, you know, as I said earlier, it's really well designed with staff wellbeing in mind. We've lovely staff spaces. It's bright and airy. And I think we've walked in this morning and the sun is kind of shining through into the reception area through the glass. And it's a really nice feeling for the staff. Jo McNamara (22:54) So looking at kind of future planning then, do you expect that the demand for radiotherapy is going to increase and will you then be able to kind of support that increase and without necessarily impacting negatively on waiting times? Carol (23:09) Yes, definitely. So part of the planning for this was to, although we only had agreement from NHS England to put one LINAC in initially, there was agreement right from the start that we could build two bunkers. So we actually not only built two bunkers, we fitted out two bunkers. And then working with Ajiya, we obviously designed a contract for them to supply the equipment we needed to open with one LINAC CT and a lot of accessory equipment as well. That's a really positive thing. You can build into your managed equipment service contract because that often is a real problem to get funding to get immobilisation equipment and QA equipment renewed when it needs to be renewed. So we built all of that in but they also put within the modelling the cost for putting a second machine in. So the Trust had upfront knowledge about of putting in a second machine. We are then able to go and we have been to commissioners already to seek approval to put a second machine in because from the day we opened we've had a waiting list. mean one of the drawbacks of having a one LINAC satellite is you're limited to what you can treat from the point of view of you have no resilience if your machine breaks down so you absolutely can't treat category one patients because you and we've got nowhere to move them to easily. Although our machines are all matched across all three locations, there's still that transport issue potentially and you may have somebody's shell in the wrong place or you know, so we just don't treat category ones at the moment. And then there are a group of other... tumour sites where we don't necessarily have an OUH oncologist visiting Milton Keynes. So we are working to expand the numbers of sites that we treat but we've got such high demand for the breast prostate, some lung SABR and palliative work that actually we haven't got capacity. So we're very, very quickly able to make the case for a second machine and that's a business case that we're putting through the trust at the moment. I think we didn't build the building here Milton Keynes Hospital built it. They have no experience of building a radiotherapy department. We as a clinical team were able to input into the design, which was essential, but equally there were challenges around, who's responsible if something's not right in the building? Having the Ergea Project team engage right from the start, they were able to work with the Estates team at Milton Keynes. So wasn't just us as a clinical service saying, no, can't put that there because we need to put this piece of equipment there. They were able to back that up as well because they know what they're talking about really really helpful. So we're ready to go if you like once we get the business case approved for the second machine. And the fact that they're vendor neutral is really helpful. So there is that flexibility as well. So we don't have to be tied to one particular vendor. Obviously from a safety point of view and a staff training and compatibility point of view, we're sticking with our current vendor. But I think that... their ability to engage with us and continuously engage with us to know what we want, what we need to look ahead in their supply chain to see how quickly they can support us to get a second machine in is really beneficial. You know, I wouldn't be able to even start the process of procurement until we had a business case approved using the old method. Then you'd have to go either through supply chain and tender waiver process, or you would have to go out to the market it and get three quotes etc etc so all of that time is cut out of the process and that's really helpful. Naman Julka-Anderson (27:38) For anyone listening, how much time would that take if you didn't have a managed equipment service? I think just for people who are maybe on the fence about it would be quite interesting. Carol (27:47) think it depends on your trust to be honest. It depends on the size of your organisation and what their other competing priorities are. And if they have to find the capital, if it's not in this year's plan and it hasn't been flagged up to the ICB in England as needing to be in this year's plan or next year's plan, you could find yourself having a business case approved but actually there's no capital for it for 18 months, two years. It's very dependent on, and because we're in a situation at the moment where the new commissioning structure and the new allocation of capital structure is evolving and the teams in the ICBs who are going to be dealing with all of this are still being developed, then there are risks around that delaying decisions as well. So for me it gives us security and at the moment we don't have a contract with Ergea that includes replacements in Milton Keynes. But the way they operate it means we can actually vary the contract very easily to incorporate that into our next. you know, if we're going to go for option two and put the second machine in, which we are going to do, we could also do a variation at the same time to then include a replacement cycle for everything as well. And they have the ability to flex really easily equally if you wanted to add in some technology. So we have had approval from the trust to add some functionality to our existing fleet of LINAC. They have a way of doing it without you having to sort of, we don't have to argue with the vendor about how it's going to be done. They do that on your behalf. So I know I'm sounding like a real advocate for year but actually it was a real game changer in 2020 when Medipass as they were then came on board and took over our contract and we had absolutely no doubt that we wanted to take out a separate managed equipment service contract with them for the Milton Keynes satellite and we're in negotiations now to merge the equipment we have, any other equipment that we have in radiotherapy that sits outside of a managed equipment service to pull that in as well because it gives that certainty. Jo McNamara (30:30) I think promoting something that is working so well, I think is just a no-brainer, isn't it, when it comes to radiotherapy? And obviously we're really biased, but therapeutic radiographers know what they're doing, don't they? So it's great to kind of have that as part of the team. So we could probably talk all day because you're both amazing guests and have loads of knowledge and experience, but we are coming to the end. We always ask our guests for top tips. So Donna, any top tips that you'd like to leave our listeners with? Donna (31:03) I think probably for the therapeutic radiographers out there, I was chatting to a colleague the other day, is that I think as we as a profession really underestimate our impact on patients and families in what we do. You know, we're a small profession and I think it's incredibly important that we recognise that in ourselves and really appreciate what we do for people and our role in the cancer patients journey. I would say find something that you're passionate about in radiotherapy. It might be as part of the Sabre team or even interesting like sarcoma treatments. But if you can find that passion, really powers you through those kind of, there's always dips as you go along. And I think that really supports you as you go through your career. If I was to go back to university tomorrow, I would still study radiotherapy. I love everything about it. Jo McNamara (31:51) Amazing. Carol (31:52) You've stolen my thunder there, to be honest. But what I would say is though, think radiographers, therapeutic radiographers particularly, they also underestimate the skills that they have and it's not just about what they were trained to do initially and they also underestimate the opportunities as a therapeutic radiographer. you know, when I qualified I never thought I would have an opportunity to be, you know, involved in developing national policy or... building facilities and bringing all my experience of working in different places into building something that feels good from a patient point of view. And you know all the things that aren't right in the, you know, in a department that you work in and the things you'd like to tweak and change. But there are opportunities to do all sorts of things as a therapeutic radiographer. It's not a niche one track. Jo McNamara (33:10) Amazing. Well thank you both so much for joining us here on Rad Chat. Naman Julka-Anderson (33:13) You can use this episode as part of our free, continual professional development, accredited content, which offers flexible learning that fits your busy schedule. Just check out the show notes for the reflective questions, links to literature and resources, and a link to complete the form to receive your accredited certificate. Jo McNamara Rad Chat Host (33:29) Stay up to date with the latest radiotherapy and oncology advancements by liking and following us on social media channels and hitting subscribe wherever you get your podcasts. Naman Julka-Anderson (33:39) Join a supportive community designed by professionals who understand the unique challenges of radiotherapy and oncology. Check out our website www.radchat.co.uk. 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