We used to think of radiation as being a highly dangerous substance and thoughts of historical international disasters would possibly spring to mind. As an invisible and powerful force, it can certainly be harmful when not handled correctly, but there are many benefits to its use in healthcare, and it plays a vital role in diagnosis and treatment. Most people will know of someone who has had an x-ray and some of use will know someone who has gone through radiotherapy. These are common healthcare procedures that most of us will consider safe and effective. Regulation of the use of radiation is about making something that is already very safe into something that’s extremely safe.
Safety is at the heart of what we do
But how do we know these procedures are safe and that we’re protecting patients from the potential harms of radiation? That’s where the IR(M)ER inspectors come in! IR(M)ER stands for Ionising Radiation (Medical Exposure) Regulations, and it’s our job to ensure that ionising radiation for medical exposure is as safe as practicable across both the NHS and private healthcare in Scotland.
In this role we work for Healthcare Improvement Scotland to inspect services throughout Scotland, but we carry out these regulatory duties on behalf of the Scottish Government. IRMER regulations cover the UK, so whether we are in Scotland or other parts of the UK we are all inspecting to the same regulations. We work together to drive consistency where possible. The UK safety standards are based on international standards and countries all over Europe and globally have agreed to implement these into their regulations. A recent international review of how the UK manages radiation safety was undertaken by the International Atomic Energy Agency. As part of that review we had to demonstrate how we were fulfilling our international obligations as a regulator. This was a unique experience and offered a chance to meet regulators from all over the UK. The reviewer that looked at our work was from Sweden. We were delighted with the outcome from the visit and will use the results to continually improve how we deliver our work.
A rare and unique role in healthcare
This type of role requires a lot of specialised training and on the job experience. For me, it’s a fantastic opportunity that’s also enjoyable and rewarding, plus I get to learn from other bodies like Public Health England and to develop relationships with colleagues in other countries. We work alongside radiologists and radiographers around the country to ensure that they have all the safety measures in place. These include rigorous controls to make sure that when ionising radiation is used it is appropriate to do so and as safe as possible.
I’ve been inspecting for over a decade, and have experienced a variety of receptions when I arrive on site. Inspecting in IRMER has been really enjoyable. Every department we’ve visited has been extremely welcoming to us, and have made every inspection a pleasant and rewarding experience.
My role, alongside fellow inspectors, is to ensure that each provider complies with the regulations, and to support and encourage compliance where necessary. We do this through inspections, responding to notifications of incidents and through engagement with national groups.
What we’ve found is that there is a true focus on improvement, and any recommendations are for the safe use of ionising radiation are accepted with a commitment to implement them. We have had the opportunity to see at first hand the different type of equipment and the truly remarkable work that’s undertaken. Everyone we visit has a passion for their work, and safety and improvement is always a priority.
Training is vital
The regulation of IRMER is a very important area of work, and requires us to have sound, specialist working knowledge of diagnostics, nuclear medicine and radiography. These include x-rays, nuclear medicine, CT scanning and mammography.
Before I started undertaking IR(ME)R inspections, I had to complete a robust training programme. The main part of this was a fantastic week delivered by Public Health England (PHE) experts, who carry out this training for regulators across the UK. We learnt about the various aspects of ionising radiation and its use in medicine, as well as the regulation and monitoring of it. It’s really beneficial to learn alongside regulators from all over the UK. We can also call on the support of colleagues from PHE and the CQC whenever it’s required.
It’s been a fascinating but steep learning curve to understand such a highly specialised area of work. However, the learning is never finished. In the same way that we’re always expecting providers to improve, we endeavour to do the same. It’s satisfying to know that the work that we all do together helps to keep patients safe, enabling them to be protected from the harms of radiation, and instead to receive only the benefits.
Alastair McGown is a Senior Inspector with Healthcare Improvement Scotland