I applied for the BIR/Philips Student Travel Bursary to provide financial help towards my planned elective placement in the Orkney Islands. I was astonished and delighted to be awarded the bursary, which was a great help in enabling me to travel to the islands in August and September 2013.
The aim of the elective placement, a new concept for medical physics trainees and a feature of the similarly youthful Modernising Scientific Careers Scientist Training Programme, is to “facilitate wider experience of healthcare…in a cultural or clinical setting that is different from the usual training environment.” With this in mind, I decided to compare radiology services in my urban teaching hospital, the Churchill Hospital in Oxford, with a more remote island setting: the Balfour Hospital in Kirkwall, Orkney.
The small Orkney population has an interesting mixture of very good and very poor health characteristics. The Scottish Government Health Survey for 2008–2011 found that Orcadian adults were the least likely in Scotland to have required hospital outpatient attendance in the past 12 months, and were significantly more likely than average to describe their health as “good” or “very good”. However, Orkney also has the highest prevalence in Scotland of adults who are overweight or have no natural teeth!
NHS Orkney, the smallest health board in Scotland, serves a population of 21,500 people scattered over 17 
islands, with around 9,000 in the capital, Kirkwall. Most of the smaller islands have either a general practitioner or a nurse practitioner. The only hospital in Orkney, the Balfour Hospital, has 48 beds, an accident and emergency department, day surgery unit, maternity, assessment and rehabilitation and Macmillan cancer care wards. Other departments include physiotherapy, occupational therapy, audiology, a laboratory and my area of interest, radiography.
All radiology services in Orkney, with the exception of dental X-rays, are provided here. The department covers both X-ray and ultrasound and has five staff: two radiographers, two reporting sonographers and a secretary on rotation. A further radiographer and sonographer are available to provide support at times of short staffing. The department’s work consists of general planar radiography including intravenous urograms, theatre and ward radiography, and general and obstetric ultrasound. The annual workload is around 6,000 X-rays and 3,000 ultrasound scans, and a consultant radiologist visits monthly from NHS Grampian in Aberdeen to carry out interventional procedures.
Having only worked in large city trusts, my aim was to see how radiology services are adapted to suit the particular challenges and opportunities of a small population and a remote and island-based topography. Some of the differences in terrain were obvious from the outset: on my first day, a combination of sea fog and industrial action by ferry drivers prevented one of the sonography team from getting to work! Other differences became clearer as my placement progressed: for example, the highly efficient and well-thought-through communication system. Being so remote, NHS Orkney relies on good communication links with the outer Orkney islands and mainland Scotland, from regular teleconferences with remote island general practitioners and consultants in Aberdeen to the Scotland-wide picture archiving and communications system (PACS), by which radiologists in Aberdeen can report images from Orkney within a day.
The patient transport system is also very impressive, for both emergency and non-emergency patients. The lack of CT in Orkney (the last health board in Scotland without one, but not for long!) means that patients often need to travel to NHS Grampian hospitals for imaging, sometimes, as in the case of stroke patients, in timescales shorter than would be considered possible for comparable distances by road in mainland Britain. Ferry services, scheduled flights and air ambulances, both fixed wing and helicopter, are all taken into account and included in the way Orcadian radiography is run.
The general impression I got from my time at the Balfour was of a small, friendly hospital with a real sense of community. The fact that most of the staff and some of the patients are known to each other creates a supportive atmosphere and allows easy communication between departments. Staff are generally required to be more flexible and have a broader range of skills than might be the case elsewhere, taking responsibility for department administration and every aspect of clinical services. More generally, Orkney is even more beautiful than I expected it to be, and I would encourage anyone to visit if they get the opportunity!
I would like to thank the Balfour Hospital Radiography team for their kindness and welcome. I would also like to thank everyone in Orkney who took the time to talk to me and let me observe them at work, and everyone who leant me vital supplies such as Ordnance Survey maps and wellies!
Apply for the BIR/Philips Student Bursary 2013 here
