Published: 10/04/2003, Volume II3, No. 5850 Page 22 23

An ongoing capital replacement programme is essential to ensure minimum standards of diagnostic care are maintained (cover feature, 'No Scan Do', pages 2829, 20 March).

However, this issue should not be confused with the separate issue of growing overall capacity.

The failure to consider this is central to the challenge of delivering quality and costeffective diagnostic care in the UK.

European or international equivalent equipment proliferation rates are often used to highlight shortages of capital stock in the UK. I would argue this is because of the funding mechanism and service delivery models of the NHS, rather than a lack of simple investment.

Capital allocation is the easy part; in fact banks will lend money for just about anything against guaranteed cash flow.

Ongoing operational cash flow, good planning, finding human resources and investing in training and education are far greater challenges.

These were highlighted in the Audit Commission's radiology report last August, which shows that median annual utilisation rates are well below optimum.

One could argue that poor utilisation rates are a result of old equipment.

But ongoing operational and human resources are also critical. In addition, using capacity in the independent sector should be seen as a valid alternative, especially as both liquid-based cytology and MRI are both under capacity in this sector.

This is not a case of more scanners or equipment but rather more revenue funding from an existing pool of funds in which diagnostic care is one of many pressing needs.

The use of New Opportunities Fund cash as an alternative to independent sector involvement, as has on occasion been the case, is not consistent with the principle of 'replacement' as opposed to growth in capacity.

The delivery method for diagnostic care has a significant impact on patient throughput.

Replacement and reinvestment will not be cost effective if this is not considered carefully.

For example, the installation of state of the art diagnostic imaging will struggle to achieve maximum throughput in an acute environment. Mixing largely unplanned complex and costly procedural work with outpatient diagnostics is a deficiency that needs tackling.

Walter Kmet Chief executive officer MIA Lodestone Diagnostic healthcare