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as computerised tomography (CT) scanners, MRI units and X-ray machines is inadequate and existing equipment is often outdated and in need of replacement.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.

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Comments

Most diagnostic tests are blood tests and testing of the samples, once taking, is likely to benefit from increasing centralisation rather than dissemination into commuting sites, largely driven by testing machine technology relying on high throughput. You are confusing testing, which in my opinion is faster now than at any time in my career, with obtaining a blood test request form which requires increasing waits to see a medical practitioner and the subsequent wait to organise phlebotomy which remains as difficult now as it has always been. A similar situation is likely in imaging with high cost and maintenance machinery probably best left centrally, i.e. within the local hospital. I can see secondary healthcare requires freeing up of expensive space in acute hospital sites but would suggest moving much or all of outpatients and physical therapy departments out of the acute site, as occurs on the continent and North America, freeing up space to house the new imaging machines you mention.

We have a partial solution to the delays and backlogs, as myself and my colleagues have trained an algorithm to report chest films and head CTs within seconds. It has taken many years and eventually an NHS Trust has signed up with us to speed up diagnosis. It's a bit like swimming up a waterfall!!
https://behold.ai/who-we-are/

There are some great examples in there of the value of diagnostics, but I have great concern that the 4-7% increase in diagnostic requests is unquestioned. Certainly, in my field of MSK medicine, diagnostic use is often inappropriate, contrary to NICE guidance and often used in light of poor clinical skills. The workload for the NHS both from performing inappropriate diagnostics and the subsequent workload created is a significant waste. Also, public expectation is being fuelled and the " I need a scan" demands are rising exponentially and the results often fuelling anxiety and unrealistic demands. You can guarantee more diagnostics = more work for the NHS

This document is therefore not balanced, and I have significant concerns as a reaction to waiting lists pre and post Covid is simply going to make things worse. "Unlimited diagnostics for all " seems the philosophy and smacks of a political marketing tool rather than rational health policy and expenditure. Why are we making these mistakes and killing the NHS?