The need for radical investment and reform of diagnostic services was recognised at the time the NHS Long Term Plan was published in 2019. This report, commissioned by NHS England at that time, alongside a review of adult screening services, was nearing publication before the COVID-19 pandemic struck. However, while the recommendations made pre-pandemic still stand, additional actions will be needed to deliver safe, high quality diagnostic services in an endemic phase of the disease and to support the recovery of diagnostic services.
The COVID-19 pandemic has further amplified the need for radical change in the provision of diagnostic services, but has also provided an opportunity for change. Many beneficial changes in relation to diagnostic pathways, such as increased use of virtual consultations and community services, have already been made. These changes must now be embedded. However, much more now needs to be done in the recovery period to establish new pathways to diagnosis, so that both patients and healthcare professionals can be assured that investigations will be done safely.
To deliver the increase in diagnostic activity required now and over the coming years, and to provide safe, patient-centred pathways for diagnostics, new service models are needed. Availability of COVID-19 virus testing for patients and healthcare professionals is likely to be critical, especially when community prevalence of the virus is high. Without such testing, patients will have to be considered as ‘Covid-19 uncertain’, which will slow throughput in imaging and particularly in endoscopy. The following key actions can be defined:
- Acute and elective diagnostics should be separated wherever possible to increase efficiency.
- Acute diagnostic services (for A&E and inpatient care) should be improved so that patients who require CT scanning or ultrasound from A&E can be imaged without delay. Inpatients needing CT or MRI should be able to be scanned on the day of request.
- Community diagnostic hubs should be established away from acute hospital sites and kept as clear of Covid-19 as possible.
- Diagnostic services should be organised so that as far as possible patients only have to attend once and, where appropriate, they should be tested for Covid-19 before diagnostic tests are undertaken.
- Community phlebotomy services should be improved, so that all patients can have blood samples taken close to their homes, at least six days a week, without needing to come to acute hospitals.
These new services will require major investment in facilities, equipment and workforce, alongside replacement of obsolete equipment. Training of additional highly skilled staff will take time but should start as soon as possible. International recruitment should be prioritised when possible but national workforce solutions will also be critical. Alongside this, skill-mix initiatives involving more apprenticeships and assistant practitioners, and using qualified staff at the top of their licence will be essential, as will learning lessons from staff flexibility and roles undertaken during the COVID-19 pandemic.