Why do diagnostics matter? Maximising the potential of diagnostics services

The Covid-19 pandemic has increased awareness of the role that diagnostics play in disease detection, prevention and management.

Policy-makers have also singled out diagnostics for greater focus in recent years, particularly given their pivotal role in supporting system recovery from the pandemic, including reducing waiting times for hospital treatment and earlier cancer diagnosis. This spotlight has revealed the scope for innovation through the introduction of new technologies, widening access and changes to patient pathways.

This briefing explores the role that diagnostics play in underpinning much of the activity that takes place in the health and care system, the policy focus to date and where attention is needed to ensure diagnostic capacity and capability are fit for the future.

Key messages

• Diagnostics play a fundamental role in clinical decision-making. Access to timely and effective diagnostic services is critical to providing high-quality care, reducing waiting times for treatment and improving health outcomes.

• Each year, the NHS undertakes more than 1 billion diagnostic tests, accounting for about 6 per cent of the NHS budget.

• Demand is rising across almost all aspects of diagnostics, with 4–7 per cent increases in activity seen for tests such as colonoscopies and magnetic resonance imaging (MRI) scans each year between 2014/15 and 2018/19.

• Growth in the diagnostic workforce has not kept pace with demand and activity, and there are now significant staff shortages across all specialties, but with imaging, radiology, pathology and endoscopy notably under strain.

• Historical underinvestment means that the supply of equipment such as computerised tomography (CT) scanners, MRI units and X-ray machines is inadequate and existing equipment is often outdated and in need of replacement.

• Patients are waiting longer for diagnostic tests. There are now more than 1.5 million people currently waiting, and the standard that patients should wait less than six weeks for a diagnostic test has not been met since February 2017.

• The roll-out of new community diagnostic centres across England is very welcome. However, government restrictions on the building of new facilities and the so-far limited range of tests on offer at these centres risk limiting their potential to increase diagnostic capacity and provide quicker and more convenient access to patients.

• Rapid innovations in diagnostic technology and the scope to improve patient pathways provide significant opportunities to expand the accessibility and delivery of diagnostics. But a concerted policy focus, an increase in the workforce and capital investments are required to support this if the muchneeded increase in diagnostic capacity in the NHS is to be realised.

About this project

The work for this project was sponsored by Roche Diagnostics, a member of The King’s Fund’s corporate partnerships programme. This output was independently developed, researched and written by The King’s Fund. The sponsor has not been involved in its development, research or creation and all views are the author’s own.

Are community diagnostic centres really moving care closer to home?

The vision is for CDCs to be ‘one-stop shops for checks, scans and tests’, designed to achieve early diagnoses for patients and timely treatment and intervention. But are they delivering on this vision by removing barriers to access and moving care closer to home? Charlotte Wickens, Danielle Jefferies and Sneha Sircar examine the evidence over on our blog.