In 1895, Wilhelm Roentgen, Professor of Physics in Wurzburg, Bavaria, discovered X-rays. The development changed the face of medicine, becoming vital in field hospitals during the First World War and playing a crucial role in the fight against tuberculosis—one of the deadliest diseases in the world. By the 1930s, it became clear that accurate interpretation of imaging for diagnosis and treatment would require specialists with training and experience. Thus, the role of the radiographer as we know it was created.
Today, radiographers form an essential part of our health service. They’re responsible for carrying out X-rays, MRI and CT scans, ultrasounds and breast screenings, as well as radiotherapy for cancer patients. Nine out of ten patients in the NHS are supported by a radiography professional.
But the profession is in crisis. Too few radiographers are being recruited or retained. As a result, one million patients are currently waiting to be seen by a radiographer—often delaying vital diagnosis and treatment for months. It’s a familiar pattern across our National Health Service. We hear the same story from striking nurses, doctors and ambulance workers. Now, radiographers across England are on strike demanding action on pay and conditions to tackle the recruitment and retention problems besetting the profession and denying patients the treatment they need.
A Service in Crisis
John Kelly, a diagnostic radiographer from St Helens, graduated in 2017. Since then, he’s worked in three different trusts. ‘We perform diagnostic tests of various sorts: X-ray, CT, MRI, ultrasound. Often, this is part of interventional theatre. We’re the people showing the surgeons where to operate.’
When John was newly qualified, he found it incredibly difficult to make ends meet. At one point, early in his career, he worked a twenty-two-day stretch. ‘Colleagues would say, “Can you please do this? We’re absolutely desperate.” When you’re asked that sort of question, you do think about the money, but mostly about the patients.’
But he was exhausted—completely beaten down. ‘You get to the stage where you’re living for your days off. You shouldn’t be in that position when you do such a rewarding job. I’m thirty years old and I live with my parents. That’s not really where I wanted to be now. But that’s just the reality of where we are.’
Naman Julka-Anderson qualified as a therapeutic radiographer six years ago. Dedicated to his profession and his patients, he was recently commended as UK radiographer of the year. He spends three days a week clinically and a further two days working as a national clinical advisor for the Macmillan Cancer Support charity. ‘If you imagine the energy an X-ray would use to look at a broken bone, we use probably one hundred times that energy in a controlled environment to treat cancerous and non-cancerous tumours throughout the body. We’re the only people who can legally deliver radiation to treat cancer.’
When it comes to radiotherapy, there are around sixty centres across the UK. From a geographical perspective, says Naman, they are very spaced out. According to the Department of Health, patients should only travel up to forty-five minutes for radiotherapy treatment, but radiographers like Naman report that it often takes patients, on average, well over an hour. ‘I’ve treated patients who travelled over two hours one way for treatment before. Patients will be travelling four hours a day. It’s unfair.’
Naman says the scarcity of radiotherapy centres comes down to a lack of investment, particularly in specialised equipment. ‘Radiotherapy only receives five percent of the cancer budget, yet over sixty percent of cancer patients will have radiotherapy at some point in their cancer pathway.’
He estimates that there are about sixty or seventy linear accelerator X-ray machines in use across the UK that need to be refreshed. ‘They have a ten-year lifespan. A lot of them are older than that and break down more frequently. If there’s no engineer support, patients will be delayed or have to come on the weekend to receive treatment. Going through cancer diagnosis is tough enough as it is. This just creates additional stress for patients.’
And it’s stressful for radiographers like Naman too. ‘We want to deliver the best care we can to patients, but it’s difficult. There’s not enough investment coming from the government. Attrition rates are the highest they’ve ever been at universities. Quite a few people have a degree in therapeutic radiography but won’t actually get a job because they can work as a car salesman for twice the money.’
Among John’s class of 2017, twenty percent aren’t radiographers anymore. ‘I see people being ground down by the system. It’s really difficult to get our heads above the water sometimes. People feel so beholden to their patients—they care so much, but they’re not able to give the service they want to give.’
Since John qualified six years ago, he’s yet to come across a fully staffed department. ‘We have less equipment than other countries with similar standards in the OECD, especially when it comes to significant projects like new CT and MRI scanners. There’s a significant lack of investment. And it’s not just the equipment—we also need the staff.’ But John warns that simply increasing recruitment without addressing retention won’t solve the staffing crisis. ‘They talk about turning on the taps, but we’ve not even put the plug in. People have to make really difficult decisions about whether they continue in a career they trained for three years to do because they can’t afford it anymore. Which, when you have such a rewarding job on a day-to-day basis, is really sad.’
Naman concurs. ‘Many friends and people I’ve gone to university with are leaving the profession. It’s not feasible. There’s not enough money. Travel costs are higher. The cost of living is higher. Everything’s higher.’ Some departments, he says, have even opened foodbanks for staff. ‘These are fully qualified professionals with degrees having to rely on the generosity of their colleagues.’
In April, over eighty percent of radiographers rejected the government’s five percent pay offer in a Society of Radiographers’ ballot. The union’s leadership recommended a rejection vote, stressing a below-inflation pay award would do little to help members struggling with the cost-of-living crisis and would not solve the retention and recruitment crisis.
In that time, the Society of Radiographers has been seeking meaningful discussions with the government without success. Following a strong vote for strike action, the society was invited to a meeting with Will Quince, the Minister of State for Health, on 4 July, followed by a second meeting two days later. But despite hearing about radiographers working long hours for low pay, chronic understaffing and long waiting lists, the government refused to make any concrete proposals on pay.
Leandre Archer, head of industrial relations at the Society of Radiographers, says strike action is regrettable but was sadly inevitable given the government’s attitude. ‘We’re seeing an exodus of staff. There are fifteen percent vacancy rates. Radiographers are picking up extra work and doing overtime. I’ve visited numerous picket lines yesterday and today, and radiographers are absolutely exhausted.’
Some radiographers, says Leandre, couldn’t even afford to strike. ‘I spoke to a couple, both radiographers, who said they support the strike but can’t afford to join and lose pay because at the end of the month after they’ve paid their bills, they have ten pounds between them.’
‘Yesterday, we had radiographers at Great Ormond Street Hospital who said they come in to get the free breakfast and free lunch because it helps them to feed their families,’ recalls Leandre.
With the government stubbornly refusing to negotiate, a further escalation of industrial action could be likely. ‘We’ll have to review how the forty-eight hours go, but we have a strike mandate until December. We’ll assess that and announce further dates if we have to.’
As with other NHS strikes, public support on the picket lines has been strong, providing a morale boost for radiographers. Leandre witnessed the solidarity first-hand outside Great Ormond Street Hospital yesterday. ‘People were coming over and saying, “You are doing amazing. Good on you. You deserve better.” That was really uplifting and reassuring that we have the support of the public. It’s time for the government to listen.’