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44 2011


IMAGING & ONCOLOGY


Currently, accreditation is confined to advanced imaging techniques such as CT and MRI. This, in part, has been driven by reimbursement policies that may require accreditation and to meet the criteria of CMS (Centres for Medicare and Medicaid Services) 7


, state


or federal government, or third-part payers. Medicare is a social insurance programme administered by the United States government, providing health insurance coverage to people who are aged 65 and over, or who meet other special criteria. The ACR outlines how all MRI, CT, PET, breast MRI and nuclear medicine facilities that bill under the Medicare fee schedule, must be accredited by January 2012 to receive Medicare payments for the technical component of these service8 for its value as a marketing tool and is clearly promoted as such.


better health outcomes is clear. It recognises the financial challenges the NHS faces and the role QIPP (Quality, Innovation, Productivity and Prevention) will play in supporting the NHS in identifying efficiencies, whilst driving up quality. An editorial in the British Medical Journal in 2008 outlined how most recent NHS reforms have been designed to improve efficiency and productivity and also to improve the quality of care.13


That trend is ongoing. . Accreditation is also recognised


In Australia and New Zealand, there is a voluntary accreditation scheme jointly administered by The Royal Australian and New Zealand College of Radiologists (RANZCR) and the National Association of Testing Authorities (NATA), which commenced in May 2004, and is open to all diagnostic imaging providers that wish to apply. However, sites that offer MRI services that are eligible for Medicare rebates are required by the Commonwealth government to participate in the RANZCR’s MRI Accreditation Registration Programme.


Mandatory accreditation schemes exist in South Korea and Finland, although these have a different configuration to that being developed in the UK.


In the UK, accreditation is only now starting to become established and is still a long way from being a mandatory requirement, although it is certainly possible that this may happen in the future. However, in parallel with schemes elsewhere in the world, it is appropriately influenced by the guidelines of the professional colleges (Royal College of Radiologists and the Society and College of Radiographers). Unlike elsewhere, the actual scheme is exclusively run by a third party, the United Kingdom Accreditation Service (UKAS), which is ‘the sole national accreditation body recognised by government to assess, against internationally agreed standards, organisations that provide certification, testing, inspection and calibration services’9


. UKAS is a non-profit-distributing private company, limited by guarantee. It is


independent of government but is appointed as the national accreditation body by the Accreditation Regulations 2009 (SI No 3155/2009) and operates under a memorandum of understanding with the government through the Secretary of State for Business, Innovation and Skills. The Imaging Services Accreditation Scheme sits within UKAS. Background to the development of the Imaging Services Accreditation Scheme is outlined by Garvey, et al.10


So to take this further, how do some of these findings translate into the role for an imaging services accreditation scheme in the UK in the current political climate? The principles underpinning the original Radiology Accreditation Programme were drawn from those referred to in the 2007 White Paper ‘Trust, Assurance and Safety: the regulation of health professionals in the 21st Century’11


(NHS) White Paper ‘Equity and Excellence: Liberating the NHS’12


. More recently (2010), the National Health Service set out the Government’s


long-term vision for future healthcare; that of a patient centred NHS in which the drive for


Quality is becoming the leading driver in healthcare reform going forward, representing a move away from performance targets per se. This aligns with the core purpose of accreditation, being the formal recognition that an imaging services provider has demonstrated that it has the organisational competence to deliver against key quality measures across four domains which include ‘Clinical’, ‘Facilities, resource and workforce’, ‘Patient experience’, and ‘Safety’. These four domains comprise the ‘Standard’ which has been designed to • Be patient focussed; • Cover the functions and systems of a whole diagnostic imaging and interventional radiology service;


• Address the dimensions of quality and support quality improvement.


‘Outcomes’ are the indicators by which the quality and effectiveness of a service can be assessed. The NHS Outcomes Framework14


published in December 2010 sets out the


outcomes and corresponding indicators that will be used to hold the new NHS Commissioning Board to account and, as such, represents a clear message about the importance of verified outcomes going forward in health policy. Each of the 31 standard statements across the four domains in the ISAS Standard has an associated outcome measure of the individual service’s design and choosing. This aligns with the direction of travel of health policy in the UK.


It must, therefore, be hoped that participation in the ISAS programme in the UK will, in itself, be some form of evidence that radiology departments may, in future, submit to the various regulatory bodies such as the Care Quality Commission (CQC), who are the independent regulator of care provided by the NHS (and also of local authorities, private companies and voluntary organisations).


ACCREDITATION ON THE GROUND The radiology department at Great Ormond Street Hospital for Children has been associated with the emerging accreditation programme since early 2007, when it became one of five pilot sites for the Radiology Accreditation Programme (RAP) across England, and since 2009 has been formally committed to the resulting ISAS accreditation scheme. Ten imaging services have been in the first wave and one has just received accreditation along with Great Ormond Street. One other NHS Trust, having had assessment visits, is anticipating formal accreditation imminently.


The ISAS website15 gives a vast amount of user-friendly information on what accreditation is about, pre application information and preparatory workshops, a


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