What are diagnostics, and how are diagnostics services performing?

Demand for diagnostics has been increasing steadily in over the past decade as hospital referrals and attendances have risen, and since the Covid-19 pandemic there has been a significant increase. This means more people are now waiting for diagnostic tests – 1.58 million1  in January 2023, a 9 per cent increase over the past year, and a 150 per cent increase over the past decade.

The national target is that 99 per cent of patients should wait less than six weeks for a diagnostic test. This standard has not been met nationally since February 2017 – in January 2023 only 69 per cent of patients received a test in under six weeks. There is also a faster-diagnosis standard for cancer, which states that 75 per cent of patients who GPs have urgently referred for suspected cancer must be diagnosed or have cancer ruled out within 28 days. This has not yet been met, and is currently 67 per cent.

• 1This number may be higher, as the waiting list figures only have 15 types of test in scope.

In November 2022, nearly 4 million diagnostic tests were undertaken in the NHS. This is slightly lower than November 2019, so does not meet the target set out in NHS England’s 2022 elective recovery plan, that diagnostic activity would increase to a minimum of 120 per cent of pre‑pandemic levels across 2022/23. Pre- and post-Covid-19 activity varies by diagnostic test; of the most frequently performed tests, activity ranges from a 21 per cent fall in fluoroscopies1  between November 2019 and November 2022 to a 21 per cent rise in CT scans.

• 1Fluoroscopy is a diagnostic test that uses X-rays to create a video of inside the body.

The diagnostic workforce draws on a wide range of health professionals, ranging from radiologists to nuclear medicine specialists, and histopathologists to endoscopists. Staff shortages across the NHS are impacting diagnostics, as the workforce has not kept pace with demand and activity and now there are significant vacancies across all specialities. The Independent Review of Diagnostic Services for NHS England estimated that 3,500 extra radiographers alone are needed by 2025.

The Royal College of Radiologists found that NHS trusts are using a variety of work‑arounds to compensate for staff shortages. For example, 41 per cent of trusts are leaving imaging examinations unreported or auto‑reported. Outsourcing is another approach; expenditure on outsourcing and ad-hoc locums in radiology departments rose from £90 million in 2018 to £122 million in 2021.

The UK currently has less diagnostic equipment than comparable countries; it has 8.8 CT scanners per million population, 25th out of 28 OECD countries, and the number of MRI units and PET scanners are also below average. While there is no ideal number of scanners, this lower than average figure is cause for concern, especially given rising demand – NHS England estimates that demand for CT scans will rise by at least 100 per cent in the next five years. As well as expanding the supply of diagnostic equipment, some of the existing supply needs replacing, such as mobile X-Ray machines that are more than 10 years old.

Diagnostics have been recognised as a priority to improve NHS performance as a whole. A 2020 report recommended significant reform and investment in diagnostic services. In 2021 the government announced the creation of new community diagnostic centres (CDCs), and additional funding was announced at the 2021 Spending Review to invest in new technology, improve equipment and expand CDCs further. So far 92 CDCs have been opened, though it is early to gauge their effectiveness. This funding and prioritisation is welcome, as without sustained investment, especially in workforce and equipment, any expansion of diagnostics to meet rising demand will be hampered due to lack of staff and supplies.